COLUMBUS RANKS HIGH FOR CASES OF SYPHILIS

Rural Health Care, Drugs Are Actors

Going door-to-door in search of those carrying a sexually transmitted
disease may seem a little extreme, but in Columbus County, health officials
think it may be the only way to stop syphilis in its tracks.

According to the Centers for Disease Control, North Carolina ranks fifth in
the nation in syphilis cases, and state Division of Public Health
statistics show that Columbus County is among five area counties that rank
in the top quarter out of all counties statewide.

Left untreated, syphilis can eventually leave its victims with devastating
effects, including heart and neurological damage. In a pregnant victim, the
disease can lead to birth defects or stillbirth. And since syphilis is
spread through contact with a lesion that develops in the early stage of
the illness, its victims are also at higher risk for contracting AIDS.

If diagnosed early, syphilis is easily cured with just a few doses of
penicillin, which is why health officials find it painfully ironic that
pockets of it still exist in areas like Southeastern North Carolina.

"When we end up fifth compared to other states, that is pretty significant
because every one of them has twice the population of North Carolina," said
Del Williams, head of epidemiology and special studies for the HIV/STD
Prevention and Care Branch in the Division of Public Health.

Mr. Williams said the lack of available health care for rural residents and
the affected counties' position on what has become a drug supply corridor
are factors in the outbreaks of syphilis.

Health officials have noted that the disease is higher among the users of
crack cocaine who commonly trade drugs for sex.

In late 1997, North Carolina was among other high-risk states receiving
funds from the CDC to establish the Syphilis Elimination Project, which
employs an aggressive campaign of education and testing to fight the disease.

As part of the project, state health officials began coordinating Rapid
Intervention Outreach Teams (RIOT) to target areas experiencing syphilis
outbreaks.

"Raleigh sent down a group of people and they went out into the byways and
highways," said Columbus County Health Director Marian Duncan. During a
two-day RIOT event last November, Ms. Duncan said, the county Health
Department kept the lab open after hours to accommodate those brought in
for blood tests needed to diagnose the illness.

One of the coordinators was Rhonda Ashby, said of the nearly 600 residents
contacted, 313 agreed to be tested. Of those, 12 new cases of syphilis were
identified. What's even better, she said, was that 212 of those people
agreed to also be tested for HIV.

After identifying syphilis sufferers, health officials then must identify
and notify any sexual contacts of those infected so they can be tested and
- - if necessary - treated as well.

Mr. Williams said that is the only way to really stop the disease, and if
current numbers are any indication, the RIOT efforts paid off.

"Last year in Columbus County there were 54 cases for the entire year, and
so far this year through June they have reported 19," he said. "If you make
an assumption - which is always a dangerous thing to do - that you'll have
the same number in the second half, they should have 38. It's not the end
of it, but in looking at it on a weekly basis, the number of new cases are
continuing to drop."

But he said in Robeson County, which has the nation's highest syphilis rate
at 50 per 100,000 residents, progress is much slower.

"The size of the epidemic is still very large there," he said.