Gay men make up 65 percent of syphilis cases

Infection can increase risk of contracting HIV

By MATT SCHAFER
JAN. 16, 2009

Once thought nearly vanquished in the Untied States, syphilis is on the rise, particularly in populations of gay men, who may be wary of the prevention message.

On Tuesday, the Atlanta-based Centers for Disease Control & Prevention released its National STD Surveillance Report for 2007. It shows 11,466 reported cases of primary and secondary syphilis, a 15.2 percent increase over 2006. Of those cases, a staggering 65 percent were among men who have sex with men.

Compiled through reports from hospitals and doctors in 44 states and the District of Columbia, the report is accurate and frightening, said Dr. Hillard Weinstock, leader of the CDC’s surveillance and specials studies team.

“When you look historically at the number of cases we’re seeing, we still see low numbers of syphilis, especially compared to the ’80s or ’90s,” Weinstock said. “We’re still afraid of those numbers growing larger.”

Since peaking in the 1980s, the disease was nearly eradicated through routine screening of pregnant women and advances in antibiotics. Now, doctors are particularly concerned about the increase in syphilis because it can play a role in spreading HIV infection.

Syphilis is often missed because its key early symptoms are a painless sore on the mouth, penis or anus that can go away without medication. While painless, those sores can dramatically increase someone’s chances of contracting HIV.

“Number one, you have broken the barrier, and you have all these infection cells right there to pick up HIV and spread it. … If you have syphilis you are much more at risk for HIV or any STD,” said Dr. Douglas Gurley, an Atlanta physician who treats patients with HIV.

Gurley said syphilis is a growing threat in Atlanta, reporting he’d seen several cases at the beginning of this week in his office.

NO CLEAR CAUSE WHY

Weinstock said the CDC research hasn’t uncovered any link to explain the disparity between syphilis rates in gay men and their straight counterparts, but he believes fatigue towards prevention messages may play a role.

“Gay and bisexual men have been hearing the same prevention methods over and over again, and so it might not be effective anymore. Also with HIV medications there is a feeling of wellness and that might cause people to engage in more risky behavior,” he said.

Syphilis and HIV have a set of shared risk factors, and gay men with HIV are more likely to develop STDs, and men with STDs are more likely to develop HIV.

Dr. Sean Cahill is the managing director of public policy for Gay Men’s Health Crisis in New York City. He said the disparity is not only broad between gay and straight men, but disproportionably affects men of color.

“I’m sure that’s a factor,” Cahill said of prevention fatigue. “I’m sure it’s a complex issue with a complex set of factors.”

In addition to his agency’s prevention efforts, the GMHC is lobbying Congress to increase STD prevention funding, and alter the course of its prevention strategies.

“What we’re trying to do is get the CDC and other federal agencies to rethink how they do prevention,” Cahill said. “Our advice is to spend a lot more money on community level interventions, because we’re never going to reach enough people by doing individual and group level interventions, we’re just not. We need to shift social norms among gay men.”

Cahill also believes that if the family and school environment of gay teenagers is changed it will have long-term benefits for the gay community.

“We also need to look, not just to the CDC to solve this problem, but that the Department of Education has a large role in this too,” he said, noting that if gay teenagers are accepted in school and home they are less likely to have unsafe sexual practices.

Syphilis is preventable with regular condom use, and health officials recommend that men get tested at least once a year.

“If you’re in a stable relationship, once a year; if you’re single, every six months — that’s my official recommendation,” Gurley said.

This article first appeared in Southern Voice, and copied in whole from their website.

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