John Locher / AP
Monday, April 22, 2019 | 2 a.m.
Certain sexually transmitted diseases go through periods of latency. The infection is temporarily dormant and perhaps less visible, but it could flare up at any time — and it could certainly still spread to someone else.
A parallel, cyclical process seems to be taking place in Clark County when it comes to the incidence of these diseases, particularly syphilis. Southern Nevada consistently ranks high for STD rates per capita compared to national averages. And, once in a while, a particularly troubling “flare-up” will strike, prompting public health officials to escalate educational campaigns about the problem.
Such a flare-up is occurring right now, as Clark County ranked first in the nation for syphilis rates per capita in 2017. The number of reported cases of syphilis here is steadily increasing, with nine cases having been reported in 2016, 20 cases reported in 2017 and 24 reported in 2018. Nationally, 30,644 cases were reported in 2017, according to the Centers for Disease Control and Prevention.
Syphilis is an age-old sexually transmitted infection that can be cured today with antibiotics if identified early on. Fewer than .001 percent of the U.S. population has primary or secondary syphilis. But in Clark County, the rate of the disease is over 2.5 times the national average.
For those who do suffer from syphilis, which is contracted through direct contact with syphilitic sores typically located on the genitals, symptoms range from the unpleasant — rashes, fever, sores and more — to irreversible brain damage in the final stage of the disease.
“It’s a disease that impacts human nature, and left untreated, it can cause a lot of problems for your health and for babies,” said Marlo Tonge, a communicable diseases manager at the Southern Nevada Health District.
The infection can also lead to other complications in the long-term, including meningitis, dementia, blindness and hepatitis, said Dr. Alireza Farabi of University Medical Center. “Don’t think about syphilis as just an STD,” he said. “This is a systemic disease involved from head to toes.”
Although rates of syphilis have increased in recent years in some other major cities, a combination of factors has led to the particularly high rate in Clark County, health department officials say.
Millions of international tourists flock to Las Vegas each year, spreading disease of all kinds. The region also has a high incidence of illegal, unregulated prostitution and a large homeless and indigent population, who are at a much higher risk of contracting STDs.
There also aren’t enough accessible health care resources in the state to serve these at-risk populations, said Dr. Joe Iser, chief health officer at the Southern Nevada Health District. This is particularly problematic when it comes to preventing the spread of congenital syphilis, or syphilis passed from a pregnant mother to a child; Clark County has the second highest rate of congenital syphilis in the nation.
“What we find is that many women who are pregnant may not seek care as quickly as they should,” Iser said. “Most of those may be women who are uninsured, or they don’t have insurance because they may not be documented in the country.”
Other at-risk populations include individuals in their 20s and members of the LGBT community, particularly transgender people and men who have sex with men, said Vince Collins, director of operations at the Gay and Lesbian Community Center of Southern Nevada.
Collins said all at-risk populations — young people, LGBT, low-income, the homeless and more — need access to free testing centers as well as educational resources about the incidence of STDs and how to prevent them.
When the Center previously offered free STDs and HIV testing, the benefits were clear: Upwards of 70 people were tested on any given day, Collins said. He hopes that more regular testing at the Center, in partnership with the health department, will start up again soon.
“If there’s no immediate free testing available to them, it’s kind of off their radar,” Collins said.
Even when testing and health resources are available, it’s also important that health professionals are aware of the particular needs of at-risk populations, something doctors are beginning to understand, said Executive Director John Waldron. More and more, medical schools will invite representatives from the Center to come talk to students about how to discuss STDs, particularly in a way that is sensitive to members of the LGBT community.
“They’re recognizing that doctors aren’t as prepared to have those conversations as they need to be,” Waldron said.
Similarly, health professionals must be equipped to talk to sex workers about STDs without passing judgement, said Christina Parreira, a sex worker and public relations coordinator with Trac-B Exchange, a Vegas-based initiative that aims to reduce infectious disease and harm from syringe use and disposal.
In Las Vegas, where prostitution is illegal, those who engage in prostitution have fewer resources than their legal counterparts in rural Nevada’s highly regulated brothels. Many lack health insurance and don’t feel comfortable sharing their status as a sex worker with doctors and nurses, Parreira said.
“We need more non-judgmental care, people who are well-versed in sex work [and] that have cultural competency,” she said.
Nonetheless, Tonge emphasized that all members of the Las Vegas community are welcome at the health department, where they can get tested for free — whether they are undocumented, homeless, engaging in prostitution or anything else.
“Really, all we’re trying to do is identify disease and make sure people are being treated,” she said.
In addition to testing, preventive measures are equally, if not more, important, Tonge said. Talk to your sexual partners, and when in doubt about a partner’s sexual history, always use a condom.
Still, Collins noted that the incidence of syphilis doesn’t seem to be receding in Clark County, and he questions whether the issue needs to be tackled more holistically: not just by medical professionals and small organizations, but also by elected officials, educators and more.
After all, he said, does Las Vegas want to be known as the syphilis capital of the country?
“As a community, we need to decide that this is a really important thing for everybody to get behind so we can come off that list,” Collins said.