Issue:  Vol. 48 / No. 11 / 15 March 2018

SF syphilis rates flatline


Ads featuring Phil the Syphilis Sore, seen here on a promotional walk in the Castro, have been credited with helping gay men be aware to regularly get tested for the STD. Courtesy: Rick Gerharter
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Syphilis rates in San Francisco, after spiking last year, have flatlined and are on pace to be similar to levels in 2004, the last time cases of the sexually transmitted disease plateaued in the city. Until 2008, syphilis cases had been on a downward trend in San Francisco, falling 20 percent between 2005 and 2007.

The turning of the tide comes after city health officials re-launched the successful Healthy Penis campaign this year. Syphilis remains predominantly found among men who have sex with men, and the comical prevention campaign starring cartoon penises and syphilis sores is credited with increasing gay men's awareness of the need to get tested for STDs every three months if they are sexually active.

According to the latest data from the health department, the city has seen 473 cases of syphilis as of the end of September. That compares to the 475 cases the city recorded during the first nine months of 2008.

Health officials predict that if current trends hold then the total number of syphilis cases in 2009 will total 548, slightly less than the 552 cases recorded in 2004. Last year the city recorded a 55 percent increase in total syphilis cases, going from 472 cases in 2007 to 658 cases in 2008.

A similar stabilization trend has been seen in primary and secondary syphilis cases, which are the most contagious forms of the STD. So far this year there have been 235 cases, a slight dip from the 242 cases reported during the same time frame in 2008.

The news, while certainly welcomed by health officials, is being met with caution, as syphilis cases could easily spike back up again if a sense of complacency sets in among gay men and health care providers.

"I think that any time the rates are not increasing, we are happy with that. But I don't think it is cause for unguarded optimism," said Dr. Susan Philip, acting director of the health department's STD prevention and control section. "[The year] 2008 was an extraordinarily high year. We have come down from that but we are no where near where we want to be with syphilis rates, which is elimination."

Philip credited the turnaround in syphilis rates not only to the revival of the Healthy Penis campaign but also to the community's and health officials' renewed efforts to combat the spike in cases.

"The campaign has been helpful but there have been many factors. Both the community and the continued partnership with providers in the community needs part of the credit as well for at least stabilizing the rates," said Philip, who is filling in on an interim basis while the STD section's director, Dr. Jeffrey Klausner, is on a yearlong sabbatical in South Africa. "The community has done its job, and we have done our job. But we have to continue to be vigilant about it."

The Healthy Penis campaign certainly has played a large role. After mothballing the campaign in 2006, the STD section tried several other marketing strategies to curtail syphilis infections. None had the same impact as the one featuring the phallus, this year given the name Byron H Penis; his friends Pedro, who is Latino, and Clark, who is African American; and their arch nemesis, Phil the Syphilis Sore.

Since its return earlier this year, there have been six different print ads featuring the Healthy Penis. The campaign has also included radio ads and interview shows, outreach events, new posters and outreach materials, and bus ads.

There are also Facebook and MySpace pages, but as of this week the Healthy Penis had only 79 members on Facebook and few postings on its profile. As for the campaign's new Web site at, it has been averaging 200 visitors per day.

Les Pappas, whose firm Better World Advertising created the campaign, demurred when asked if Byron and his pals should be credited for the recent decline in syphilis rates.

"Well, I'm never comfortable assigning all the credit (or all the blame) to any single factor. However, we all believed that bringing the HP campaign back could make a difference since it was so effective the first time," wrote Pappas, who is currently working in Jakarta, Indonesia developing an HIV prevention campaign targeted to gay men in the archipelago, in an e-mail response to questions. "We know that public awareness and social marketing campaigns can be very successful, and if we want to promote healthy behavior we need to invest in consistent, high quality efforts."

Philip said the health department plans to continue using the Healthy Penis campaign, but going forward it will be focusing more on the Phil character.

"We want people to be aware of the symptoms," she said.

Other changes

The drop in syphilis rates comes as the public health lab, which analyzes STD tests, saw a 9 percent drop in syphilis tests this year. Philip said it is unclear if the decrease could account for the plateauing of syphilis rates or if gay men are seeking services at venues other than city clinics.

"As a result, we will continue to closely monitor for changes in both testing and case rates and will continue the STD section's efforts to decrease new infections," wrote Philip in an e-mail.

The STD section has revamped its Web site recently so that it is no longer an online testing program but promotes two walk-in community screening sites where people can access STD screening services before or after work.

"The hours are geared toward being convenient to people who couldn't come in to City Clinic or Magnet," the gay men's health center in the Castro, said Philip.

 In the Castro, STD section staffers have set up inside the Cicatrix Tattoo Parlor at 3991 17th Street at Market Street. Along with HIV testing at the neighborhood site, gay and bisexual men can receive rectal and throat swabs for gonorrhea and chlamydia, as well as blood tests for syphilis.

The drop-in clinic in the heart of the city's gay neighborhood will be open Monday mornings from 7 to 9 a.m. and Thursday evenings from 7 to 10 p.m.

The second location is inside Walden House's Bayview site, 1550 Evans Street at Third Street. The clinic will be open from 3 to 5 p.m. Tuesdays and Thursdays.

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