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Sexual Healing

For decades, Baltimore has struggled to contain swift-moving outbreaks of sexually transmitted infections, and scored some successes. Will creativity and new strategies be enough for the future?

By Jim Duffy

A decade ago, Baltimore endured a syphilis epidemic of astonishing proportions. The city's infection rate peaked at slightly more than 100 cases per 100,000 population, soaring to 18 times the national average and reaching a level usually found only in developing countries.

When those numbers landed on the front page of The New York Times, Baltimore became the punch line in a long string of bad jokes by TV talk show hosts. But more than civic pride was at stake: Over a two-year stretch, 115 babies in Baltimore were delivered with congenital syphilis contracted from infected mothers. Some of those infants emerged stillborn. Others began life facing serious health complications and cognitive impairments.

"To me, that's one of the worst public health statistics you can have, and Baltimore had it—real cases of dead babies because someone never got a shot of penicillin," says Emily Erbelding, MD, MPH '95, associate professor in the School of Medicine's Division of Infectious Diseases, with joint appointments in Epidemiology and Population, Family and Reproductive Health (PFRH).

The city quickly launched a major public health offensive against an infection that, if untreated, can cause an array of serious and sometimes fatal health complications. Armed with an infusion of resources from federal and state sources, the city Health Department added clinical staff, bolstered surveillance efforts and launched new outreach programs.

Along the way, the department expanded its longstanding partnership with the Bloomberg School. The city and the School now share several employees—including Erbelding, who is the department's chief of clinical services for sexually transmitted infections—in joint-appointment arrangements. Other faculty work closely with the Health Department to find grants and launch test initiatives that are evaluated rigorously.

The work is paying dividends: Today, Baltimore's syphilis rate is a quarter of what it was a decade ago, and gonorrhea rates are down 45 percent, from 1,000 cases per 100,000 population in 1995 to 550 in 2005.

But progress is one thing, success another. Compared with other cities, Baltimore still has disproportionately high rates of sexually transmitted infections (STIs).

"The numbers have improved since the late 1990s, but it's not like we're in a position to declare victory," says Erbelding. "You always have the feeling in this field that when you let your guard down, there's a chance infections are going to explode again."

Most STIs thrive on the edges of society. The behavioral patterns that fuel infection rates, such as prostitution and drug abuse, are inextricably linked with social issues, such as poverty, homelessness and incarceration.

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