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A public health warning


LOOKING AT THE NUMBERS, Dr. Emily Erbelding realized she had an outbreak on her hands: 26 cases of syphilis among gay men in Baltimore in the first half of this year. The reports were surprising because overall cases of syphilis in Baltimore had declined drastically due to an aggressive campaign by the city Health Department.

In 1997, Baltimore was ranked No. 1 in the country in syphilis cases. Not anymore.

But Dr. Erbelding and her boss, Dr. Peter Beilenson, knew that the cluster of cases among gay men could quickly evolve into an epidemic if left unchecked. This wasn't only about syphilis, a treatable disease but one that can go undetected with serious health consequences. The outbreak suggested gay men were having unprotected sex, exposing them and their partners to greater risk of contracting the virus that causes AIDS.

Dr. Erbelding and her staff went on the offensive this summer, urging gay men in the city to get tested and to wear condoms. They issued an alert, reached out to the community, visited the gay clubs.

The quick action seems to have paid off. As of last week, the city Health Department had recorded no syphilis cases among gay men -- zero -- last month.

Other cities in the country, notably San Francisco and New York, have faced an alarming increase in syphilis infections among gay and bisexual men. The Centers for Disease Control and Prevention in Atlanta say the syphilis cases in New York more than doubled from 2000 to 2001.

Ironically, officials say, the increase in syphilis cases may be due to advancements in the treatment of AIDS. People feel less vulnerable because AIDS drugs available now are more accessible and cheaper. And, as a result, the public's perception is that the disease has gone from fatal to chronic.

But people may not realize that other sexually transmitted diseases can increase the likelihood of contracting HIV. That's why public health professional Emily Erbelding remains vigilant despite the decline in syphilis cases among Baltimore's gay men.

She isn't the only one who should be on guard.

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