Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
San Francisco Chronicle, Friday, October 2, 1998
Sabin Russell, Chronicle Staff Writer
The findings are contained in a report released to city health commissioners this week that suggests the city may be undergoing a reversal of a long-standing decline in sexually transmitted diseases.
Included in the findings are indicators that chlamydia -- a venereal disease with few symptoms that nevertheless can sterilize the young women it infects -- is widespread in San Francisco teenagers and may be increasing.
"We are in an era when there should be a decrease in sexually transmitted diseases," said Dr. Jeffrey Klausner, who directs the city's venereal disease programs. "We're more concerned about the trends here than the absolute amount of cases."
The number of cases of rectal gonorrhea among men in San Francisco more than doubled since 1994, returning to rates last seen 10 years ago, the report says.
There were 80 such cases reported during the first half of 1998, compared with a low of 28 during the first six months of 1994. Although the actual number of cases is low in a city of 790,000, epidemiologists consider the disease a reliable way to predict trends in the transmission of HIV, the virus that causes AIDS.
"This is a sensitive indicator of high-risk sexual behavior," said Klausner, who suggested that new AIDS drugs that have dramatically lowered the death rate may be causing gay men to become complacent. "Particularly among younger men, people are becoming less concerned, less safe."
Rene Durazzo, program director for the San Francisco AIDS Foundation, said the rising gonorrhea rate is just the latest evidence that the gay community is losing the safe-sex discipline that reversed HIV infection rates in the late 1980s. "Our research shows that men have put HIV risk on the back burner," he said.
Research at the University of California at San Francisco has shown that at least half of all gay men younger than 29 engage in anal sex without a condom. But, in part because there are fewer men living with HIV infections, the rate of viral transmission has not yet increased.
The San Francisco venereal disease report also found a sharp jump in syphilis cases in 1997 -- to 73 cases from 44 in 1996. Because syphilis rates have declined again so far this year, researchers believe that the increase is more of a random event than an indication that the old scourge is returning.
Health officials are more concerned about the results of testing for chlamydia, which showed a 24 percent increase in 1997 from the previous year. Although most of the increase can be attributed to a new urine test that is encouraging more women to be tested, the results show that the disease has made inroads into a large segment of the population.
Tests show a chlamydia rate of 318 per 100,000, compared with 240 per 100,000 in 1996.
A bacterial infection that produces few or any noticeable symptoms, chlamydia can be cured with a single dose of antibiotics. But it is the stealthy nature of the bug that makes it such a tragic disease. Rates among teenagers are seven times those of adults because tissues in a teenage girl's cervix are particularly susceptible to the bacteria. An untreated infection can cause pelvic inflammatory disease, infertility or ectopic pregnancies later in life.
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