Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date.
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Washington Blade - November 11, 2005
Dyana Bagby
"Increasing cases of primary and secondary syphilis among men who have sex with men are believed to be largely responsible for the overall increases in the national syphilis rate observed since 2000," according to the CDC's Sexually Transmitted Disease Surveillance 2004 report, released Nov. 8.
Men who have sex with men comprised nearly two-thirds, or 64 percent, of primary and secondary syphilis cases in 2004, up from 5 percent in 1999, according to the federal health agency. The findings come after syphilis infections in the U.S. reached an all-time low in 2000.
Syphilis remains a public health problem in metropolitan areas with large populations of men who have sex with men, according to the report.
"When it comes to reducing syphilis among men who have sex with men, there is no simple solution," Dr. Ronald O. Valdiserri, acting director of CDC's National Center for HIV, STD & TB Prevention, said during a telephone press briefing with reporters Tuesday.
For the third consecutive year, San Francisco had the highest syphilis rate of any U.S. city in 2004 - 45.9 cases per 100,000 people. The second highest rate of syphilis last year was Atlanta, which saw 34.6 cases per 100,000 people.
Rounding out the top 10 were Baltimore with 33.2 cases per 100,000; New Orleans with 16.4 cases per 100,000; St Louis with 14.1 cases per 100,000; Detroit with 13.5 cases per 100,000; Washington, D.C., with 12.2 cases per 100,000; Dallas with 11.6 cases per 100,000; Jersey City with 10.8 cases per 100,000; and Chicago with 9.7 cases per 100,000.
Meth may fuel increase
From 2003 to 2004, the rate of primary and secondary syphilis - the early stages of the disease that indicate recent infection - increased 8 percent, from 2.5 to 2.7 cases per 100,000 population, said Dr. John M. Douglas, director of the Division of STD Prevention at the CDC's National Center for HIV, STD & TB Prevention.
The number of cases increased from 7,177 in 2003 to 7,980 in 2004, Douglas said Tuesday.
Regular syphilis screening, especially among HIV-positive gay men, remains an important tool in combating the rising rates, Valdiserri said. The CDC has partnered with health departments and community groups to aid efforts, he said.
Other awareness campaigns include posting educational materials on gay Web sites. In Boston, for example, a successful campaign involving the CDC and the Massachusetts health department includes posting informative ads on Manhunt.com about syphilis, Douglas said. Boston ranks 13th in the U.S. for syphilis infections, with 9.1 cases per 100,000 people.
Since the 1990s, an increase in high-risk sexual behavior among gay and bisexual men, as well as an epidemic of crystal meth use, are "intersecting and exacerbating transmission of syphilis," Valdiserri said.
In addition, studies are finding that gay men who engage in oral sex to reduce their chances of HIV infection are surprised to find they can contract syphilis through oral sex, Valdiserri said.
HIV transmission more likely
Other findings in the report that directly impact gay men include:
* Nearly 25 percent of gonorrhea cases among gay and bisexual men in 2004 were resistant to fluoroquinolones, a first-line treatment for the disease, up from 15 percent in 2003.
In April 2004, CDC recommended that fluoroquinolones no longer be used as treatment for gonorrhea among men who have sex with men. The prevalence of fluoroquinolone resistance among heterosexuals remains low at 1.3 percent.
* STDs also increase the risk of HIV transmission by up to five times, and syphilis may even speed HIV disease progression, according to the report. In addition, because STDs and the risk behaviors associated with them increase the likelihood of acquiring and transmitting HIV, the rise in STDs could indicate potential increases in new HIV infections among gay men.
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