The area's troubling number of drug abusers, many trading sex for crack, is fueling the region's syphilis rate to epidemic proportions, flooding public health clinics and filtering into hospital nurseries.
Since 1985, syphilis cases among adults in the District have nearly quadrupled to a rate that rivals the poorest Third World nations. The number has jumped nearly 600 percent in Prince George's County and about 300 percent in Northern Virginia and Montgomery County, according to health statistics.
The number of infected babies born at local hospitals also is on the rise.
Health care workers blame prostitution associated with drug abuse, much of it centered in the District. They also say efforts to stem the outbreak in this region are severely hampered by state borders that prevent them from getting timely treatment to infected partners in other jurisdictions.
They also warn of a surge in local AIDS cases, particularly in the heterosexual community, because people with sexually transmitted diseases are at greater risk of contracting the HIV virus and because people are not practicing safe sex.
"Certainly, we are alarmed," said John Heath, chief of the D.C. Bureau of Sexually Transmitted Diseases. "Here's something perfectly within our means to control and we aren't."
The number of syphilis cases in the District could reach 2,600 this year, Heath said. By June, 1,334 cases had been reported, 500 fewer than in all of last year.
At the city's two venereal disease clinics, patients begin lining up for treatment at 7 a.m., and by 8:15, they are turning people away from the clinic at D.C. General Hospital.
Rosalie Turner, chief medical officer at the D.C. General clinic, said the majority of patients are infected with syphilis, which, in its early stages, responds well to antibiotics. And by interviewing clients, she said, it is clear that drug abuse often plays a major role.
"We know a lot of sex occurs in crack houses," she said. "We know people are exchanging sex for drugs" with many different partners and without protection.
Pregnant women who are addicted to crack are also likely to spend more time searching for drugs than getting prenatal care. Heath said city hospitals, accustomed to seeing one to three infected newborns a year, have reported five already this year, counting neither stillborns nor infants without symptoms born to infected women.
Babies can be infected with syphilis before or during birth. It can lead to death if left untreated and can cause brain infections that lead to developmental, hearing and vision problems, bone lesions and paralysis. In prenatal checkups, syphilis tests are routine, and both mother and fetus can be treated.
"We are seeing syphilis in many more pregnant women and then, in their babies, said Antoine Fomufod, a pediatrician at Howard University Hospital. "We know these are mothers who are not getting prenatal care."
Nationwide, 859 cases of congenital syphilis were reported last year, more than three times the number in 1985, said Joe Blount, a statistician at the federal Centers for Disease Control.
Health officials said syphilis problems in the suburbs reflect what is going on in the District.
"A large deal of our patients live on the borderline . . . . They may come here for treatment, but their partners may be in D.C.," said Elin Gursky, director of epidemiology and disease control in Prince George's County, where 918 cases of adult syphilis and 18 infected infants were reported in the first eight months of this year.
Even in Prince William County, Jared Florance, director of public health, said the numbers mirror the District. "Since 1985 we've gone from five incidents a year to over 40. Last year, we had our first case of syphilis in a high school. So far this year, we've had six."
Last year there were 193 syphilis cases in all of Northern Virginia, up from 82 cases in 1987.
"What hurts us all is that our workers can't go into another jurisdiction to find those sexual partners," Gursky said. Medical workers say public health policy is to notify neighboring jurisdictions about people who may have been infected, but the procedure takes so long that the people frequently can't be located or have unknowingly infected others. "The time lost in paperwork and in transferring cases is tough and hurts us all," Gursky said.
In the first eight months of this year in Montgomery County, syphilis was up 50 percent over last year's total of 77 cases. And Art Brown, senior public health adviser at the Sexually Transmitted Disease and HIV Prevention Program there, said, "Forty percent of people we find infected here name contacts that live outside -- in D.C. or P.G. County. What it points out to us is that this is a whole metropolitan area problem, not just a problem in the District. We're going to have to work together to eradicate it."
Health officials say new cases appear to be equally divided among men and women. Most are between ages 15 and 24, long the dominant age group, said Turner, who has worked at D.C. General for nearly 20 years. Nationwide, cases are up among blacks and down for whites. And since 1985, when AIDS education programs began, syphilis increased among heterosexuals and decreased among homosexuals.
"Prior to 1983, gay and bisexual males made up over 50 percent of the statistics; in 1988 to 1989, they made up less than 10 percent," said Charles B. Clagett, supervisor of Northern Virginia's sexually transmitted disease unit. At the District's Whitman-Walker Clinic, the average number of cases since 1985 has dropped from 140 to 60.
Medical professionals say heterosexuals appear to be ignoring warnings about safe sex. And the more ominous health threat then becomes how easy it is for people with genital lesions caused by syphilis to contract AIDS.
"Clearly, crack cocaine has influenced the increased rate of syphilis among heterosexuals, but it is also sad that people don't understand how important AIDS education is to all of us," said Georges C. Benjamin, the D.C. commissioner on public health.
"If you're protecting yourself against acquiring AIDS, you should be protected against syphilis and gonorrhea, but some people must not see themselves as being at risk," Clagett said.
But Heath in the District also blames medical professionals: "Our time, resources and energies have been given to AIDS while the other sexually transmitted diseases have been ignored," he said. "We can't ignore one in deference of the other."
Prince George's County...70 ....49 ....243....453....845..1,052
First six months
First eight months
Includes primary and secondary syphilis cases only. Figures for later stages were unavailable.