New York State, alarmed by a sharp increase in the number of people with syphilis, has begun a three-month blitz to test as many residents as possible in areas with high rates of the disease, including Erie County.
Locally, syphilis cases increased 57 percent last year after a period of decline.
The number of cases, most of them clustered in Buffalo's inner city, increased to 126 in 1989, compared with 80 in 1988, 76 in 1987 and 65 in 1986. There already are 49 cases reported this year through May.
Nevertheless, Buffalo's problem is comparatively small compared to the epidemic in other parts of the state, particularly New York City, its surrounding counties and the Rochester area.
The state reported 12,166 cases of early syphilis last year -- 10,205 in New York City and 1,961 elsewhere, according to the Health Department. Only a few years ago, in 1986, there were 4,607 cases in the state, with 4,117 of them in New York City.
Syphilis is a bacterial infection transmitted mainly by sexual contact. It's also spread from mother to fetus. Early syphilis includes cases still infectious and less than a year old, public health officials said. The disease, which can be fatal if left unchecked, is treated with antibiotics.
The comeback of syphilis is attributed to drug users and their sexual contacts.
Nationwide in the last few years, syphilis decreased among homosexual and bisexual males and increased among women and heterosexual males, according to the federal Centers for Disease Control. The largest increases have emerged among heterosexual syphilis patients who have used illegal drugs, engaged in prostitution or had sexual contact with a prostitute.
"The speculation is that syphilis has been imported into the area, and the common thread among the people who have it is drugs," said Richard Huber, regional state Health Department supervisor for the control of sexually transmitted diseases.
To identify more people with the disease and offer treatment, the state began a three-month voluntary and confidential testing program this week in New York City and seven counties -- Erie, Rockland, Nassau, Monroe, Westchester, Suffolk and Orange -- the source of 96 percent of the state's early syphilis cases in 1989.
In Monroe County, where cases of early syphilis increased from 33 in 1986 to 348 in 1989, federal officials are studying the program for use elsewhere in the country if it's successful, Huber said.
Health officials plan to expand testing beyond public clinics to locations not used previously, including emergency rooms, outpatient services, alcohol and drug treatment centers, youth detention centers, local and county lock-ups, confidential AIDS virus testing sites, homeless shelters, family planning clinics and psychiatric institutions. The test will be offered to anyone ages 15 to 45.
"Beforehand, these places may have tested if there was a reason to do it, such as a patient with symptoms," said Thomas E. Fickett, director of the county's Sexually Transmitted Diseases Clinic. "Now, for at least the summer, these places will offer the test as a routine standard of medical care."
Ralph S. Citron, acting Erie County health commissioner, in a letter to physicians and hospital staff, recommended the screening test be performed on all high-risk patients, including intravenous drug users, patients who test positive to the AIDS virus, prostitutes, and patients with a history of multiple sexual partners.
"We should see an increase in reported syphilis in the short term, but it's hoped the program will break the epidemic in the long term," said Linda Hall, county medical care administrator.
The state last year began testing all babies for the disease after a sharp increase in congenital cases. Erie County, which had no reports of congenital syphilis in past years, recorded four cases in 1989.