Washington Blade - December 3, 2004
Ryan Lee

She remembers the disbelief and horror she and many other lesbians and gay men experienced as they witnessed seemingly healthy young gay men waste away before their eyes within a matter of weeks, and then die.

But today, Hawkins, associate executive director of the Whitman-Walker Clinic in Washington, D.C., fears too many young gay men do not remember the days when HIV was an automatic death sentence, and have reverted to having unsafe sex that leaves them susceptible to contracting a host of sexually transmitted diseases.

More fuel was added to Hawkins' burning concern on Monday when the Centers for Disease Control & Prevention released its 2003 STD Surveillance Data showing that gay and bisexual men continue to be responsible for rising syphilis rates in the U.S.

The national syphilis rate was at an all-time low in 2000, but increased for the third straight year in 2003 to 2.5 cases of primary and secondary syphilis per 100,000 people, a 4.2 percent increase from the 2002 rate, according to the CDC.

The CDC estimates that more than 60 percent of the primary and secondary syphilis cases reported in 2003 were found in men who have sex with men, and syphilis cases among all men have skyrocketed 68 percent in the last three years.

"When you have syphilis rates go up 68 percent among [men] across the country, that is an indicator people are not practicing safer sex as they were years ago," Hawkins said. "I think we have to acknowledge that we've had a significant increase in [high-risk sexual behavior] in our community and that's what is being born out in this data."

San Fran, Atlanta top syphilis list

San Francisco topped the list of cities with the highest rate of reported syphilis cases per 100,000 people in 2003, with 43.5. Some 332 cases were reported last year. Atlanta saw a 16.1 percent increase from its 2002 syphilis rate, ranking No. 2 on the 2003 list, with 298 cases reported and a rate of 36.1 per 100,000 people.

Baltimore's syphilis rate grew by 27 percent in 2003, when the city reported 153 cases, which ranked it third on the CDC list. Its rate per 100,000 people is 24.

"The gay and bisexual men's community has been dealing with HIV and AIDS for decades now, and there is some complacency in the community around that," said Jason Riggs, communications director for the Stop AIDS Project in San Francisco.

"People need to make informed decisions, be honest about their behavior with themselves and what is needed now more than ever is a community engagement that goes beyond the public health organizations," he added.

Safe-sex messages must again be sounded from places outside of community-based clinics, including in gay bars and other social venues for gay men, Riggs said.

The uptick in reported syphilis infections in San Francisco have mainly been among HIV-positive men, which causes health experts to worry that a similar HIV outbreak would soon follow, Riggs said. But evidence suggests that some HIV-positive men are "sero-sorting," or only having sex with other HIV-positive men, which may explain why a dramatic HIV outbreak hasn't recently occurred in San Francisco, Riggs said.

Syphilis, which can easily be cured by penicillin in its early stages, is transmitted through often unnoticeable sores during oral, anal and vaginal sex. If untreated, the infection could damage internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints, according to the CDC.

In 1999, the CDC launched its National Plan to Eliminate Syphilis from the United States, but its efforts focused mainly on preventing the spread of the disease among African-American females, who at the time accounted for most syphilis cases, said Ron Valdiserri, deputy director of the CDC's National Center for HIV, STD & TB Prevention.

After experiencing success with reducing syphilis among black females, whose rate decreased 33.3 percent from 2002 to 2003, Valdiserri said the CDC is now working with local health agencies to target gay and bisexual men.

Plans include using the Internet to deliver safe-sex messages, and addressing the "very dangerous synergy between crystal meth use and outbreaks of syphilis," he said.

Gay men also at risk for gonorrhea

The CDC also issued sobering news about gonorrhea among gay and bisexual men earlier this week. Although the national rate of gonorrhea dropped to an all-time low of 116.2 cases per 100,000 people in 2003, CDC expressed concern about increases in drug-resistant strains developing in gay and bisexual men.

Gonorrhea, whose symptoms can include a burning sensation when urinating, or a white, yellow, or green discharge from the penis, is usually cured with antibiotics. But one antibiotic, fluoroquinolones, is becoming increasingly obsolete for gay and bisexual men, Valdiserri said.

"We can't develop one antibiotic and use it forever and ever because for the most part these germs will evolve to the point where it is resistant," Valdiserri said.

In April, the CDC said increased resistance to fluoroquinolones meant it should no longer be used to treat gay and bisexual men, he said.

The problem is that the only remaining antibiotics for gonorrhea are injectable, which can sometimes dissuade individuals from seeking treatment, Valdiserri said.

If left untreated, gonorrhea can cause pelvic inflammatory disease in women and cause epididymitis, a painful condition of the testicles that can lead to infertility in men. It can also spread to the blood and joints of a patient, a condition that can be life-threatening, according to the CDC.

Gonorrhea, syphilis and certain other STDs also make it easier for an individual to contract HIV, according to health experts.

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