Bay Area Reporter - February 5, 2009
Matthew S. Bajko, m.bajko@ebar.com

The reversal of fortune in the city's effort to eliminate cases of the STD has prompted health officials to revive their Healthy Penis campaign, which will return next week. The successful social marketing effort had been retired in 2006, after a five-year run.

According to preliminary data for 2008, the city recorded a 66 percent increase in primary and secondary cases of syphilis, a rise of 339 cases last year compared to the 204 cases reported in 2007. Total early syphilis cases rose 55 percent, going from 472 cases in 2007 to 658 cases last year.

In 2005, the city recorded a total of 551 cases of syphilis. The nearly 30 percent drop in cases that year ended a seven-year surge in syphilis cases in San Francisco.

Health officials described the upswing in cases last year as "dramatic" in the city's monthly STD report issued January 27, which detailed data for all of 2008 as well as the month of December. The rise was not unexpected, as the Bay Area Reporter had reported in October that data for the first six months of 2008 pointed to an upward climb in syphilis cases.

"I think it is a real concern. Syphilis can make people sick, can make people more likely to acquire and transmit HIV infections, and can have lots of serious health outcomes," said Dr. Ken Katz, epidemic intelligence service officer with the Centers for Disease Control and Prevention assigned to San Francisco.

Katz, who is no relation to Health Director Dr. Mitch Katz, is leading up the city's response to stem the rising tide in STDs. He noted that syphilis is curable and the best prevention strategy for gay men who are sexually active is to get tested and screened for the STD every three to six months.

State STD officials will be meeting with their local counterparts this month to review the data and try to determine what is causing the upward trend in cases. Dr. Gail Bolan, chief of the STD control branch for the California Department of Public Health, said the rise in San Francisco has been all the more surprising considering its neighboring counties have not reported similar increases in syphilis.

"It is odd we have seen in San Francisco a significant increase but not seen it in the surrounding counties," said Bolan.

On a statewide basis, Bolan said the figures for 2008 "might not be as significant an increase" as was seen in 2007. The state expects to have a clearer picture of last year by the end of March.

In San Francisco, cases of chlamydia also rose last year, but only "slightly" over 2007, said the STD report. The STD increased 4.3 percent, from 3,937 to 4,106 cases. Cases of rectal chlamydia also increased by 12.5 percent last year, from 591 to 665 cases.

"Well obviously we are quite concerned and somewhat limited in what we can do because we have had a couple years now of severe cuts in federal funding and had to make reductions locally," said Dr. Jeffrey Klausner, director of the health department's STD control branch. "So we are doing what we can to promote testing, to educate medical providers and people who take care of people with HIV infections about the need to test patients who are sexually active gay men every time they get a blood test."

The one bright spot last year was a drop in cases of rectal gonorrhea, which declined 5.3 percent, falling from 490 cases in 2007 to 464 in 2008. Overall cases of gonorrhea held steady at 2,005 cases in 2008 compared to 2,009 cases in 2007.

It was the second year in a row the city reported declines in rectal gonorrhea. Klausner said compared to chlamydia and syphilis, both of which often can be asymptomatic, gonorrhea is more likely to show symptoms early on in people, and therefore, they get tested sooner.

"Sexually active gay men need to be aware of these STDs and get tested for them," he said. "They also need to know what they are getting tested for, that is critical. If they are having oral sex, they should be having throat tests. If they are having anal sex, they should be getting anal tests."

Even with the increase in syphilis cases, the number among HIV-positive men has remained the same at approximately two-thirds. Last year, 66 percent of cases were found among HIV- positive men.

Health officials believe the reason lies in many positive men opting to serosort, or only have sex with other positive men, and therefore not using condoms, making it easier to transmit syphilis, which is spread by skin-to-skin contact.

Even those gay men who do use condoms should regularly test for syphilis, said Katz.

"Because someone used a condom for anal sex won't mean no transmission," said Katz. "If there is any skin-to-skin contact from rubbing, oral sex, even a hand on that area, a condom won't protect you."

Funding cuts fuel rise in cases

Klausner pegged the latest spikes in STD cases to the drop in funding to combat venereal diseases.

"We know what to do, but if we don't have the dollars to do it, we can't do it and STDs go up," he told the B.A.R. in a phone interview.

More federal money could be headed toward San Francisco and other locations where STDs have also spiked if Congress includes funding for STD and HIV prevention in the stimulus package being worked on at the behest of President Obama. The bill passed by the House included $335 million for STD control measures, but the Senate removed the earmark from its version of the bill to appease Republicans.

Klausner defended the House's action, saying it would allow health officials to hire more staffers as well as bring about positive health outcomes.

"It is a way to invest in health and prevention and stimulate the economy, as well as reduce rates of STDs. It really is a win-win in federal investment," said Klausner of the extra funding. "With an infusion of new federal resources we can hire people to do social marketing."

Klausner had been funding a "Dogs Are Talking" STD prevention campaign featuring local canines, but it ended in the fall. Upon evaluating the campaign's results, Klausner said it was decided to bring back the Healthy Penis. The campaign featured cartoon penis and syphilis sore characters and proved to be wildly successful in getting sexually active gay and bi men to get tested for STDs.

"We know Healthy Penis works. It has been evaluated by researchers around the country," said Klausner.

The CDC's Katz referred to the campaign as "heavy ammunition" that is a proven tool.

"It is a key way to combat syphilis in San Francisco," he said.

Several gay men contacted by the B.A.R. said in addition to the campaign, they would like to see additional measures taken by health officials to combat the rise in STDs.

Mr. Gay San Francisco 2009 John Paul Soto, who works in HIV prevention, said he welcomes a return of the comical campaign. But he also sees using social networks, particularly with men of color, to spread a get tested message as beneficial.

"It was funny and quirky. It was funny enough and sparked enough conversations that people actually talked about it and hopefully led to people testing," said Soto. "What I have been seeing and pushing for statewide is more of a community networking approach to getting people to test."

Steve Gibson, the director of Magnet, said the gay men's sexual health center in the Castro has not only seen an "incline" in men testing positive for syphilis but also men coming in who have insurance but are uncomfortable seeing their primary care doctors to get tested.

"We have had guys go to their primary doc who had a rash and they sent them to a dermatologist. They then came here and we found it's secondary syphilis," said Gibson.

In response, Magnet has made a push to help gay men locate gay-friendly doctors who not only have the cultural competency to see gay male patients but know what tests they should be administering.

On its Web site at http://www.magnetsf.org, the center has posted two sections under the "Happy Homo" page online on how gay men can talk to their doctors and how to locate doctors to go to in town.

"It can't be that we just have everyone go to Magnet. We can't cram 60,000 gay men in here," said Gibson, referring to the estimated number of gay men living in the city. "If people have a doctor they don't like, ask your friends if they have a doctor they like."

The health department also launched the http://www.stdtest.org Web site where people can download a slip for free testing at certain clinics.

The state also launched a Web site at http://www.stdcheckup.org with information on various STDs and service providers throughout the state.

"If sexually active gay men get tested every three months, detections can be found early and we can control this epidemic," said Klausner.

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