TB or Not TB: These are the Questions

A few quick questions: Have you had a cough that won’t go away? Unexplained weight loss? Night sweats or low-grade fevers?

If you answered yes to any of those questions, you should visit your doctor and request a test for Tuberculosis (TB). According to a Castro-distributed fact sheet, the health department has concerns that a "cluster of highly infectious TB cases "may be "working its way through the SF gay community."

Dr. Masae Kawamura, director of the tuberculosis control section of the health department, urges calm and measured responses to this potential problem. "We don't want to cause panic in the community. TB takes quite a bit of exposure to catch it."

What’s The Problem?
Recently, San Francisco health officials have found several active cases of tuberculosis among Castro gay bar patrons. Their findings prompted city officials to ask 140 potentially exposed business employees in the gay neighborhood to get screened for the disease. Kawamura said, depending on their exposure risk, some friends and family members of some Castro employees are also being screened.

The health department found two TB cases linked to a retail establishment in the South of Market neighborhood; the infected individuals were an employee and a patron. Five of the 32 employees at the site were later tested and found infected with TB, "despite a low-risk, indoor gymnasium-like setting with good ventilation." Another case of TB was found in a person who lived near the SOMA business but had no direct link to it. A fourth case emerged last summer in a person with no connection to the SOMA business that works at "a popular nightclub" in the Castro. And in late November, a fifth individual was hospitalized with a cough, night sweats and a 40-pound weight loss.

In early December, California’s genotyping laboratory had matched all five cases to the same strain of TB. Four of the five individuals were openly gay men in their 20s, three of whom were HIV infected. All but one were U.S. born citizens and not normally considered at risk for TB.

A health department document distributed in the Castro neighborhood reported, "After repeat interviews, contacts of the fifth and third case admitted to going to bars in the Castro and named the bar/club employing the fourth index patient. All three of these individuals frequented many of the bars in the Castro during their infectious periods. This outbreak in young gay men who are highly social is a cause for concern for the community."

Health officials stressed this week they have found no evidence that patrons of Castro bars are at risk. “We are targeting staff of the bars because they would have the most exposure than patrons," said Kawamura. And they also noted that, if discovered early, TB is a preventable and curable disease.

The health department’s Dr. Kawamura says, “What we are trying to achieve is 100 percent participation from the bars in getting all staff who have face-to-face relations with the public screened. Without all data, we can't come to accurate conclusions."

Once tests are complete later this month, Kawamura will have a better picture of whether the TB outbreak in the Castro is widespread or isolated to a few cases.

"If we find high rate of infections that shouldn't be there, then we would have to take it from there and determine what sites we feel transmissions have occurred and if there is any pattern," she said. "After that we would begin targeting HIV-positive individuals who frequent bars in the Castro if transmission is found."

What’re the Risks?
HIV is the biggest risk factor. It makes it easier to contract TB and also to perpetuate the infection and transmit it to others. Tb, if untreated, can be deadly for HIV-positive individuals.

"Our big concern here, and certainly we do not want to stigmatize the community, but the Castro is most vulnerable because of high rates of HIV among workers and patrons who go there," said Kawamura. "For the public there is no need for alarm, not yet anyway."

In 2008, San Francisco had 118 reported cases of TB, marking the lowest number of active TB cases since city health officials started tracking the disease. In 2007, there were 143 TB cases.

Most TB cases are found in foreign-born individuals coming to the U.S. from countries with severe TB outbreaks. Kawamura said the city has rarely found a cluster of TB cases among gay or bisexual men. Also, among people living with HIV, the number of cases has steadily dropped over the years. Only 11 people with HIV (of whom, half were homeless) contracted TB last year, again marking an all-time low and representing 7.7 percent of the total TB cases.

Therefore, the cluster of current TB cases in the Castro should therefore be a red flag for gay and bi men, Kawamura said. "Another big concern for the gay community, with the rise in syphilis and unprotected sex, is we are going to see a rise in HIV among young men. What we are seeing now is HIV and TB, and we shouldn't be seeing it in the Castro population," she said.

Where Can I Get Answers?
Magnet, the gay men's community health center in the Castro, hosts the health department’s special screening site for the first two weeks of January. This easier access allows a greater number of people to be screened and tested for TB. More than 50 people have reportedly already been tested. This week the health department also notified service providers with gay and HIV patients in the city to be on the lookout for signs of TB infections.

Screened individuals will be given an advanced blood test for TB; those who are HIV-positive (and particularly at risk for TB) will also be given a chest X-ray when screened. These screenings can help identify persons at risk for developing TB and provide them with follow up treatment necessary to control the disease.

Officials described the screenings as "business as usual" for the TB control section, noting that in 2008 they conducted similar TB testing in schools, on college campuses, a hospital, restaurants, and retail stores. The questioning is also part of the protocol the health department uses to pinpoint patterns of transmission.

What’re the Facts?
TB is an airborne disease spread when an infected person coughs, sneezes, or spits. Kawamura says, "You don't get it from sex or sharing food or beer bottles. It is spread by someone who has it in his or her lungs who either sneezes or coughs. Bars are notorious sites of transmission. There is a higher risk of breathing in contaminated air. Due to the poor ventilation in many bars, employees are more susceptible to TB exposure."

Tuberculosis symptoms include:
• chronic cough
• unexplained weight loss
• night sweats
• low-grade fevers

"If they have any of these symptoms, especially if they are HIV-positive, or a chronic cough that is not improving after three weeks, they should see their doctor," said Kawamura. "TB can affect anyone. It is an equal opportunity disease. You don't have to be HIV to get infected."

The San Francisco health department has set up a TB fact sheet online at www.sfdph.org.

If there’s even a chance you’ve been infected, go get screened, no question.

Photo: Getty Images