The number of syphilis cases has tripled in Erie County over the last five years.
And health officials attribute most of that increase to smartphone applications that make it easier for men to hook up with other men.
The county Health Department recorded fewer than 40 diagnosed syphilis cases in 2011. But last year, the number of new cases climbed to 157. And officials expect the growth to continue.
Health Department investigators trace the surge in recent years to men who have sex with other men and typically find their partners through their phones. A proliferation of GPS-enabled smartphone apps make it possible for men to find like-minded and available male sex partners almost anywhere.
“If people can hook up that fast, that’s all the much faster a disease can be transmitted,” said Evergreen Health Services CEO Raymond Ganoe, whose Buffalo clinic identified about 40 new syphilis cases last year.
The surge in syphilis cases correlates to the rising popularity of smartphone social media apps that enable a lifestyle of instant gratification for users who seek it. While some gay men use these apps to nurture friendships, dates and long-term relationships, others use them as hook-up apps to find sex partners who are nearby, interested and available.
Phone apps have transformed the way gay men socialize and interact, said Christopher Treacy, a local gay journalist who has written about his love/hate relationship with these apps. While the men he’s encountered through the app he uses tend to be responsible and upfront regarding their health status, he said some of these social media sites present a danger for men who are more compulsive and careless.
“I try to have some kind of screening process,” he said. “I’m not like, ‘Come on over. The door’s unlocked.’ But there are some people who are.”
Compared with sexually transmitted diseases like gonorrhea and chlamydia, which infect thousands of people each year in Erie County, and HIV, which requires lifelong treatment, syphilis cases have been measured in the dozens, making it a mere footnote in public health news.
But that’s changing. The number of syphilis cases has risen in both New York State and the country. Locally, concentrations of new cases have been seen in Buffalo, Cheektowaga, Kenmore, Tonawanda and Grand Island, according to Health Department data.
Of those with syphilis in Erie County, 86 percent are men. The largest percentage – roughly 40 percent – are African-American, and nearly a third are white.
Syphilis isn’t just a disease, said Erie County Health Commissioner Gale Burstein. It’s an indicator of even worse things. Men who contract syphilis tend to circulate in high-risk sexual networks, meaning they are more likely to be exposed to – and to transmit – other sexually transmitted diseases like HIV, she said.
Impact of social media
Though syphilis is treatable, it can lead to very serious health consequences if ignored.
Before the popularity of smartphone apps, syphilis was largely considered a disease of the past in developed countries.
The disease is credited with afflicting many great world leaders and artists, from Napoleon Bonaparte to Vincent Van Gogh. It can be contracted through all forms of sex, including oral and anal.
The centuries-old, sexually transmitted disease follows an unpleasant progression.
The initial symptom is a round, painless sore that may or may not be evident on the outside of the body, wherever the bacteria first entered the system. The sore eventually heals. But without treatment, it progresses to skin rashes and many other symptoms, ranging from fever to hair loss. If these secondary symptoms are ignored, they go dormant. But the disease can return a decade or two later with far more serious and life-threatening health consequences.
“It’s really bad,” said Monica Boutin, a disease intervention specialist with the county Health Department. “Syphilis is known as a the ‘great imitator’ because there are so many symptoms that come and go.”
The advent of penicillin in 1928 precipitated the disease’s decline. For many years, new syphilis cases in Erie County were counted only in the dozens.
Gay-oriented social media apps – used by millions worldwide – has changed that.
Grindr was the first app in 2009 to make use of a smartphone’s location technology to help men find other like-minded men nearby. The app’s features and user interface have since been copied and built upon by numerous other apps, including dating apps used by both men and women.
“If you want to have a sex life, and you’re a guy, and you don’t frequent the bars on a regular basis, the apps are where it’s at,” said Treacy, who writes locally for LOOP Magazine and The Public. “Why go out when you can order in?”
How the apps work
GPS-enabled apps cater to just about every gay man’s sexual and relationship interests. Grindr is the first and most popular gay male social media app worldwide. But many other similar apps populate the social media marketplace.
There’s Scruff, which tilts toward guys with body hair; Jack’d, which leans toward men who tend to be more “buff” and athletic; and Growlr, which caters to huskier, heftier builds. Some apps are tamer and emphasize friendships and dating. Others, like Adam4Adam, set no limits on explicit images or pornographic ads.
At a busy Buffalo coffee shop, Treacy opened up his Growlr app, which immediately populated his iPhone screen with a square grid of friendly faces from around the world who had recently come online. Each image was linked to a profile that detailed the man’s age, height and weight, as well as the kind of relationship he’s interested in and a shorthand of his particular sexual leanings. In some cases, the profile also lists the person’s relationship and health status.
With a tap of his finger, he rearranged all the Growlr profiles on his phone, so the men showed up in order of proximity, from feet to miles.
It’s an easy interface, he said, but he’s uninstalled and reinstalled the app many times.
“The psychology is complicated,” he said. “Things are never what they seem.”
Tracking the disease
Boutin, one of three county disease prevention specialists tasked with tracking down the sources of reported, communicable diseases and preventing their spread, cited Grindr, Adam4Adam and Jack’d as among the apps that connected local men to sex partners who likely gave them syphilis.
The ability for apps to deliver immediate, positive attention and instant gratification can be dangerous for people with a low self image who compulsively seek validation through an unsafe sexual lifestyle, said Treacy, who attributes his disease-free status to a combination of luck and caution.
The county offers a free, anonymous service in which it will contact all the people a patient might have exposed to a sexually transmitted disease to help prevent a disease’s spread. But getting identifying information from app users can be hard, health officials say.
“They don’t even know their name,” said Ganoe, the Evergreen Health Services CEO. “They just know their screen name, Hotdude26.”
Local health officials are careful not to call the spread of syphilis a gay community health issue. They call it an STD that is being spread by men having sex with men. Men who are spreading this disease – to both men and women – may not consider themselves gay.
Treacy refers to these men as “bi-curious on the down low.” They may consider themselves straight, or they may be closeted gay or bisexual men who are married or have girlfriends. Yet they keep a profile on these hookup apps.
In minority communities where homosexual behavior is more culturally taboo, some health and community advocates say this is more of a problem than people realize.
Buffalo resident Stevo Johnson is an African-American sex abuse survivor who doesn’t use the apps but has many friends and acquaintances who do. He said a number of black men he knows have been traumatized by past sexual abuse or incarceration. They treat their desire to have sex with men the same way an addict treats drugs – as a compulsion that lacks forethought or planning.
That’s how STDs like syphilis and HIV get spread, he said. He compared a man who feels repeatedly driven to having unplanned, unsafe, homosexual sex or even prostituting themselves as “gay for pay” to a heroin addict scoring his latest fix.
“They need the heroin,” Johnson said, “but they don’t care who had the needle before them.”
Facing the future
Commissioner Burstein said STDs deserve more attention, particularly when diseases like syphilis indicate high-risk sexual networks that are likely also exposing victims to lifelong diseases like HIV and AIDS.
“Because these diseases and the behavior that leads to them are stigmatized in our culture, people like to think this is not a problem in my community or with my children,” Burstein said. “People are in denial that this is a big public health problem and health issue.”
On the upside, some are looking to these popular social media apps to help spread the word about STD prevention and treatment.
Evergreen Health Services, which prides itself on offering health treatment without judgment, employs one staffer who is dedicated full-time to social media marketing and outreach. Aside from social media apps like Facebook and Twitter, the staffer, Corey Mohr, also pushes Evergreen’s message on phone apps like Grindr and Scruff. Scruff even offers nonprofits like Evergreen free ad space worth thousands of dollars.
Those ads are used to make more men aware of preventative treatment options like PrEP – pre-exposure prophylaxis – a once-a-day pill therapy that can drastically reduce a person’s chances of contracting HIV. The therapy does not protect against other STDs like syphilis, which is treatable with antibiotics. In the past three months, Mohr said, the ad has generated online interest from roughly 4,000 viewers.
A message of abstinence is not keeping people from having sex, he said. That’s the reality. While these apps make it easier for men to find sex partners, it also gives health providers a platform for prevention.
“When it’s so easy to hook up, people hook up more,” Mohr said. “That’s the future; that’s the norm now. We’re not going backwards.”