Ohio Sees a Sharp Increase in Syphilis Cases

The number of new syphilis cases in Ohio has risen 59 percent since 2000, when state health officials began planning to turn prevention programs over to local health departments. At that time, CDC warned the state that a policy shift toward "home rule" could undermine a syphilis campaign that was on the verge of eliminating the disease. CDC was also concerned that a rise in syphilis rates could trigger a spike in HIV infections. New HIV cases have risen since Ohio decentralized its program, albeit less sharply than syphilis cases.

The policy shift is not being blamed for the increase in syphilis cases: U.S. syphilis rates have been rising since 2001 after falling in the 1990s. However, it did bring less experienced field workers into disease prevention at a time when two worrisome trends were emerging: methamphetamine use and the Internet's role in connecting gay men together for casual sex. The restructuring also de-emphasized the prominent role that CDC officers assigned to the state played in investigating outbreaks, said Juliet Dorris-Williams, a former state official who oversaw the state's HIV and STD prevention program.

Deborah Arms, chief of prevention for the state health department, said she believes the rise in syphilis is unrelated to shifting responsibility to local authorities. The state's aim was to move services closer to clients, allowing the health department to oversee grants and provide training and technical assistance.

City health departments report that assuming prevention duties has brought investigators closer to cases. In Columbus, which has seen syphilis cases double from 104 in 2000 to 208 in 2004, local health officials say things are running smoothly. "Honestly, it's manageable," said Joni Finley, who runs the prevention program. Finley attributes some of the increase to enhanced screening.

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