San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Friday, September 26, 1997 - Page A2
David Perlman, Chronicle Science Editor

The news came as a sobering counterpoint to recent optimism that powerful new drugs have begun eliminating disease symptoms and lowering the death rate among AIDS patients.

In addition, authorities reported just last week the first drop in the number of new HIV infections since the AIDS epidemic began.

But gonorrhea is staging a comeback around the nation, and that includes San Francisco, according to a report released yesterday by the federal Centers for Disease Control and Prevention.

The lesson is clear, say AIDS specialists: Risky sexual behavior is increasing again among some groups of men, and the increase in sexually transmitted diseases -- known as STDs -- is serving as a "sentinel" to warn that new infections by the AIDS virus are sure to increase, too.

INCREASE IN SAN FRANCISCO

The disease control agency, which has been surveying gonorrhea and its link to AIDS in 26 American cities, found that in San Francisco, the number of gonorrhea cases among men having sex with men increased by 24 percent from 1994 to 1995, and by 34 percent more last year. The evidence is particularly striking among patients reporting to the city clinic from the Castro District, according to the report.

Even greater increases in sexually transmitted disease rates have hit Seattle and Portland, and increases have also been detected in San Diego, Long Beach, Honolulu, Denver and Orange County, the new study shows. Details of the federal survey are being officially announced today in the CDC's Morbidity and Mortality Weekly Report.

The same report showed that in the clinics where numbers of gonorrhea infections are high, at least one quarter of the men with the disease also tested positive for HIV infection.

PLATEAU AFTER SHARP RISE

In San Francisco, Robert Kohn, the city's epidemiologist for sexually transmitted diseases, said that although gonorrhea rates appear to have reached a plateau so far this year, the increase in the previous two years is striking.

He attributed the trend to several causes. Improvements in the condition of many men with AIDS taking combination drug therapies may have convinced some men that the worst of the AIDS epidemic is over, Kohn said.

And in other cases, he added, younger men may simply be failing to heed warnings about the need to avoid risky sexual behavior. It is unclear whether men newly diagnosed with gonorrhea were already infected with the AIDS virus or whether their gonorrhea made them fall prey to HIV infection more easily, Kohn said. "Whatever the reasons, the lessons of safe sex need to be brought home again and again," Kohn said. "This is not the time to quit."

ENCOURAGING STATISTICS

Health workers battling the AIDS epidemic have become optimistic lately as nationwide reports have shown that the number of deaths associated with AIDS dropped 23 percent in 1996 and that the number of newly diagnosed cases of AIDS in teenagers and adults declined by 6 percent.

But infection with gonorrhea and other sexually transmitted diseases can increase the risk of new HIV infections "at least two- to five-fold," according to Dr. Helene Gayle, director of the CDC's center for prevention of STDs, AIDS and tuberculosis.

The microbe that causes gonorrhea increases the concentration of HIV in semen, she explained, and thereby increases the likelihood of transmitting the AIDS virus during any type of intercourse. The risk is particularly strong during oral-anal contact, Gayle said. "It's very disturbing to see cities where a resurgence of STDs is occurring and where so many people seem to be going back to high- risk sexual behaviors," Gayle said in an interview. "AIDS prevention obviously can't be a one-shot business, and this is a real scary trend." What's particularly alarming, she said, is that the recent decrease in new AIDS cases and AIDS deaths has been most striking among gay and bisexual men, among whom the lessons of safe sex have been most effective. But now the newly found association between new gonorrhea infections and new HIV infections is a "harbinger of things to come," Gayle said. "We need better screening for all the STDs," she said, "and we need to redouble our efforts at controlling the spread of sexually transmitted disease. We've got to remember that STDs pose a major threat to everyone -- both by themselves and because of their connection to AIDS."
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