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Objectives: Los Angeles County LAC ; experienced a resurgence of syphilis among men who have sex with men MSM ; in 2001, after initial control efforts, including a two-month media campaign, seemed to have controlled a 2000 outbreak. LAC DHS consequently funded a $396, 000 social marketing campaign for 2002-03, to increase awareness among MSM regarding syphilis and motivate testing. To maximize effectiveness and buyin of the affected population, the campaign was developed and managed by a coalition of six ethnically diverse community organizations serving MSM and funded for an entire year. Collaboration with the San Francisco Department of Public Health was also undertaken, to address possible transmission between localities. Methods: The community coalition reviewed concepts, prototype materials, and focus group responses. The selected concept, Stop the Sores, featured a cartoon format and a recurrent character, "Phil, " the syphilis sore. A perceived concept advantage was the use of humor to counteract feelings among MSM of being overwhelmed with negative sexual health messages; attention to this issue was greatly enhanced through community involvement in the campaign. Use of a recurrent character enabled use of serial narratives involving Phil, to sustain interest in the campaign over a long period. A website created for the campaign stopthesores ; , together with the STD Program hotline, provided testing linkages and flomax.
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This disease is caused by Vibrio cholerae bacteria, which are commonly transmitted by contaminated food and water. Cholera sometimes causes life-threatening diarrhea, but large numbers of bacteria must be consumed and the severe form of the disease is rarely seen in healthy tourists who follow prudent dietary habits. Cholera occurs both sporadically and in worldwide epidemics. Sub-Saharan Africa has the highest reported cholera incidence and mortality rates in the world. By the end of 1999 61 countries reported cases, but the disease is much more widespread than officially recognized. Cholera is basically a disease of poverty, and most illness occurs among people in lesser-developed countries who are exposed to heavily contaminated water or food. Most travelers on a tourist itinerary don't need to worry about this disease. In fact, cholera is officially reported in only 1 in 500, 000 returning travelers. The healthy people who do get the disease often work in high-risk environments, such as refugee camps. Unlike some microbes, cholera bacteria are readily killed by stomach acid. However, if you do ingest a large dose of bacteria from heavily contaminated water--or if you are taking antacids or antiulcer drugs--bacteria can get past the stomach and enter your small intestine. Cholera enterotoxin then acts on the intestinal wall to cause an outpouring of water and salt into the gut. The clinical picture of cholera varies widely. Seventy-five percent of infections are mild or without any symptoms. Only 2%5% of infections cause severe symptoms. Cholera in its most severe form is characterized by massive watery diarrhea, vomiting, and muscle cramps. Vomiting is common and may be severe. The frequent, watery stools soon lose all fecal appearance "rice water stools" ; and practically all odor. Loss of fluids and electrolytes can cause shock and death in hours if fluids are not replaced. Milder cases of cholera can mimic travelers' diarrhea caused by toxigenic E. coli, salmonella, intestinal viruses, and parasites. The absence of blood or pus in the stools, and the lack of fever, are distinguishing features of cholera.
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