The New York Times - Thursday, March 11, 2004
Lawrence K. Altman

PHILADELPHIA - The expanding recreational use of crystal methamphetamine and Viagra is apparently fueling increases in syphilis, H.I.V. and other sexually transmitted diseases among gay and bisexual men in the United States, according to new studies reported here on Wednesday.

At a meeting on preventing sexually transmitted diseases, Dr. Samuel J. Mitchell of the San Francisco Health Department said a study had found that 17.4 percent of 1,263 gay men who had gone to the city's sexually transmitted disease clinic had used crystal in the four weeks before their visit. Crystal users were more than twice as likely as nonusers to be infected with H.I.V., the virus that causes AIDS, 4.9 times as likely to receive a diagnosis of syphilis and 1.7 times as likely to test positive for gonorrhea.

Dr. William Wong of the San Francisco Health Department said that another study found that gay men who used both crystal and Viagra together were 6.1 times as likely to receive a diagnosis of syphilis as those who did not use either drug.

In a study of 388 gay men, Dr. Gordon Mansergh reported that his team from the Centers for Disease Control and Prevention and the San Francisco Health Department found that 16 percent had used crystal methamphetamine the last time they had anal sex. Crystal users in the study were twice as likely as nonusers to have engaged in unprotected receptive anal intercourse. In the men's last anal sex encounter, 6 percent had used Viagra. The Viagra users were 6.5 times more likely to report having had unprotected insertive anal sex during that encounter. Viagra was not linked to receptive anal risk behavior.

For three consecutive years through 2003, syphilis rates among women have fallen by 50 percent but have increased by 65 percent among men. Among women in 2003, there were 1,229 syphilis cases reported, down from 2,445 in 2000. Among men in 2003, there were 5,844 cases, up from 3,532 in 2000. Gay men accounted for more than 60 percent of all syphilis cases in 2003, compared with 5 percent in 1999.

"We are very, very concerned" about the trend, Dr. Ronald O. Valdiserri, an official of the Centers for Disease Control and Prevention, said at a news conference at the meeting.

Health officials from Seattle also reported a sharp increase among gay men in cases of gonorrhea that is resistant to a commonly prescribed antibiotic, ciprofloxacin.

As an alternative, many doctors are now prescribing another antibiotic, cefpodoxime, that has not been as well studied for its effect against gonorrhea, said Dr. Hunter H. Handsfield of the Seattle-King County Health Department and University of Washington.

From October 2003 through December 2003, ciprofloxacin-resistant gonorrhea accounted for 22 of 133 cases, or 16.5 percent, compared with 6 of 159 cases, or 3.8 percent, from July through September 2003. The overwhelming majority of drug-resistant gonorrhea was among gay men. Such drug-resistant gonorrhea has also being reported in Boston and New York.

Los Angeles County health officials reported new evidence from two studies that the Internet and commercial sex clubs helped increase syphilis rates among gay men. One study found that 22 percent of those who received a diagnosis of syphilis had met sexual partners on the Internet about the time they were most likely infected. A second study found that 28 percent of gay men with syphilis met sex partners at commercial sex clubs.

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