Nashville's syphilis epidemic appears to be declining for the first time since 1994, thanks to an aggressive campaign that includes screening 70 percent of all jail inmates. In 1998 and 1999, Nashville had the second-highest rate of infectious syphilis among large US cities. In 2000, its rate dropped 21 percent, from 45.4 cases per 100,000 to 35.9 cases per 100,000. Cases of infectious syphilis fell from 250 in 1999 to 200 in 2000. This year, 41 cases were reported from January to June, a drop of almost 60 percent from the 96 cases reported in the same period in 2000.

A spike in syphilis cases can signal the rise of other social problems, especially drug use and prostitution. "If you have this problem, you have a lot of other problems," said Chris Freeman, STD program director for the Metro Health Department. Nashville's syphilis rates jumped with the arrival of crack cocaine in 1990, then, in response to federal and state efforts, fell steadily until the mid-1990s. But rates began climbing again in 1996 -- possibly because of a cut-back in public health services.

1994 saw the launch of TennCare, the state's managed care program, which promised primary health care to almost 25 percent of the state's citizens. To save money, Nashville's health department closed five of its nine public clinics within two years. With the closure of the clinics, some infected people had difficulty accessing care, according to a report by Dr. Jesse Huang, health department chief epidemiologist, and his staff. "This decrease in public health services to the community has had a significant negative impact on the public's health in Nashville," the report said.

The report found that of 803 persons with syphilis in 1998 and 1999, 72 percent had a criminal history. In 1998, a community-wide effort called STD FREE was launched. In 1999, the Health Department received federal funds for screening, and began screening metro jail inmates. During the next 14 months, one-third of all new syphilis cases in the county were detected in jail. Thanks in part to a significant increase in funding and the development of an epidemiology and screening infrastructure, local health officials expect syphilis to continue declining in Nashville.

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