Miami Herald - July 5, 2005
Jacob Goldstein, jgoldstein@herald.com

Nationwide, rates of drug-resistant gonorrhea have risen rapidly in gay men.

And a rare form of chlamydia has spread among gay men in Europe, moved to Canada and New England, and may have made its way to South Florida.

Syphilis, gonorrhea and chlamydia are all curable, but they can be painful and, if not treated promptly, can cause long-term damage. And having a sexually transmitted disease makes it much easier to contract or transmit HIV.

The rise of these diseases follows the return of high-risk sex in some parts of the gay community -- and an increase in new HIV cases among gay men.

Powerful drugs have transformed HIV from a death sentence into a chronic disease. Crystal methamphetamine, which increases libido and decreases inhibition, has become popular among gay men. Internet chat rooms provide a fast, easy way to meet partners for casual sex.

"On the Internet, you get three for one -- you hook up, you get your [crystal meth] and you get your STD," said Manuel Rodriguez, director of the PALS Project, a Fort Lauderdale organization for HIV-positive men.

RARE CHLAMYDIA

A cluster of cases of lymphogranuloma venereum (LGV), a rare type of chlamydia, emerged two years ago among gay men in the Netherlands. Since then, doctors have identified more than 300 cases in the Netherlands, Germany and Great Britain. Last month, public health officials in Canada announced they had discovered 22 cases there since January 2004.

Most if not all of the cases have been in gay or bisexual men, and some of the men who contracted the disease reported having multiple sex partners in Europe and the United States. Local doctors predict the disease will arrive here soon -- if it hasn't already.

At least two Miami-Dade doctors suspect they saw cases of the rare disease this year.

"It is something that we all heard about in medical school, but most of us have never really seen," said Dr. Michael Wohlfieler, who treats a large population of gay men in his Miami Beach practice. "I had one patient who I'm pretty certain had LGV, and I treated him as if he had LGV and he got better."

The disease can be cured with a three-week course of antibiotics, but left untreated it can lead to scarring of the lower digestive tract and long-term abdominal pain, said Dr. Catherine McLean, who directs the newly created LGV program at the Centers for Disease Control and Prevention.

LGV commonly causes swelling around the genitals and painful bleeding from the rectum. The inflammation caused by the disease makes it two to five times easier to transmit and acquire HIV, McLean said.

Common lab tests cannot detect the disease; the CDC last year began conducting genetic testing on samples sent in by doctors around the country.

But because some doctors are probably successfully treating suspected cases without sending samples to CDC for testing, it's impossible to determine how fast LGV is spreading, according to Dr. Karla Schmitt, chief of the Bureau of STD Prevention and Control at the Florida Department of Health.

"We'll never know," she said.

SYPHILIS INCREASE

Doctors do know that the rate of syphilis among gay and bisexual men has exploded in South Florida.

In 1998, eight cases were reported in Broward County and 38 in Miami-Dade. Last year, doctors found 253 cases in Broward and 227 cases in Miami-Dade -- a tenfold increase.

The epidemic -- which echoed outbreaks in gay communities around the country -- may have been fueled in part by the stigma of syphilis, said Lori Jordahl, an STD program consultant for the Miami-Dade and Broward health departments.

"People are more willing to talk about being HIV infected than to talk about having syphilis. Even though syphilis is curable, it's considered a dirty illness," she said. 'You have people coming out and saying they're HIV-positive. . . . You don't have figureheads saying `I've had syphilis.' It's a disease of secrecy."

The epidemic may have plateaued; the numbers remained flat between 2003 and 2004. But it's too soon to say what will happen this year, Schmitt said.

Syphilis is spread through anal, vaginal or oral sex. The earliest symptom is a painless sore called a chancre that lasts for about a month. If the disease is not treated, rashes and other symptoms -- including patchy hair loss, fever and weight loss -- may begin to emerge, then vanish.

Untreated, syphilis remains in the body for years and can damage any number of organs, including the brain, heart and eyes.

RESISTANT TO CIPRO

The typical treatment for gonorrhea is the powerful antibiotic Cipro. In 2001, fewer than 2 percent of gonorrhea cases in gay men were resistant to the drug. By 2003, the most recent year for which data are available, 15 percent of cases were resistant.

The rise prompted the CDC to call last year for a new treatment for gay men with gonorrhea -- injectable antibiotics previously used only as a last resort.

Now public health officials are watching for signs of emerging resistance to the injectables, said Jennifer Wright, who heads the CDC's gonorrhea surveillance project.

"The bug will continue to adapt and change over time," she said. "We may start running out of treatment options."

Because gonorrhea is tracked less intensively than syphilis, it is impossible to say how common antibiotic resistance is in South Florida. Samples from one Miami-Dade clinic found resistance present, but at a lower rate than the national average.

Symptoms include a burning sensation when urinating; white, yellow, or green discharge from the penis; and rectal discharge. Gonorrhea makes it easier to transmit and contract HIV.

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