Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
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Washington Blade - May 11, 2006
Zack Hudson
The new plan will begin "an innovative and comprehensive strategy to stem the tide of rising infections among men who have sex with men," said Dr. Kevin Fenton, director of the National Center for HIV, STD & TB Prevention at the Centers for Disease Control & Prevention.
Fenton, who is gay, discussed the new program during the 2006 National STD Prevention Conference, a three-day symposium of epidemiologists and medical researchers held May 8-10 in Jacksonville, Fla.
The CDC's current syphilis prevention program is credited with helping to significantly reduce the number of documented cases among women, African Americans and infants since it began in 1999.
From 1999 to 2004, diagnoses of syphilis in its primary and secondary stages decreased 37 percent among blacks, according to data. Infections in newborns were down 39 percent, and infections among women were down 60 percent.
But from 1999 to 2004, the overall rate of documented syphilis cases in men who have sex with men (MSM) had increased by 68 percent. A separate study indicated that MSM made up 64 percent of all cases of the disease in the United States in 2004, up from only 5 percent in 1999.
The National Plan to Eliminate Syphilis, unveiled May 8 at the STD conference, establishes goals that conference researchers say will challenge health care workers to adopt new protocol for treating sexually active gay men.
First, the plan calls for greater investment and enhancement of public health services to combat the growing threat of syphilis outbreaks. Because outbreaks begin in contained environments like cities, the plan asks local health providers to establish a Syphilis Outbreak Response Plan to "address rapid local increases in syphilis as occurred among men who have sex with men in some U.S. cities over the past several years," according to a written outline.
Diagnosis, treatment and prevention of syphilis among gay men, currently a tricky task, also is pushed to the forefront. One problem the conference pinpointed is that most health care providers only perform limited surveillance of the factors concerning individual syphilis infections, including information about patients' sexual histories and recent homosexual activity.
"But by the end of 2006, all public health departments across the country will be gathering that information," Fenton said May 8.
Drew De Los Reyes, assistant director of the David Geffen Center for HIV Prevention & Health Education at the Gay Men's Health Crisis in New York City, called the plan a good step forward.
"It actually feels like they're responding to this much more quickly than they've responded to other things," he said.
De Los Reyes stressed that working with community organizations that interact with gay men regularly will help the medical community in more efficient and successful treatment of gay men.
Lesser known diseases on the rise
Gay men who contract syphilis typically have worse health outcomes than people in other groups because the condition is diagnosed in later stages, researchers said.
Syphilis symptoms, most commonly genital lesions, are harder to pinpoint in gay men because they manifest in the mouth and anus, and can mimic more common ailments, doctors said.
"Delayed diagnosis among men who have sex with men may result in continued risk behavior during the period in which syphilis can be most easily transmitted," said Dr. John M. Douglas, Jr., director of the NCHSTP STD Prevention Division at the CDC.
Other research presented at the conference highlighted the growing threat of lesser-known sexually transmitted diseases, which are appearing more frequently among sexually active people of all sexual orientations within the U.S.
Lymphogranuloma venereum, long found outside the U.S., has emerged as a new STD threat. Caused by a particular strain of Chlamydia bacteria, LGV cases in the U.S.-still relatively few-are most often found in men who have participated in receptive anal intercourse.
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