Syphilis rise in gay, bisexual men causes worry

Syphilis has risen sharply among gay and bisexual men in the United States this decade, driving up the country's rate for the disease and placing these men at higher risk for AIDS, federal health officials say.
Since dropping to the lowest level on record in 2000, the U.S. rate of syphilis, a sexually transmitted bacterial disease, has risen steadily, Centers for Disease Control and Prevention officials said on Friday.
The rate rose five years in a row through 2005, the most recent year for which the CDC had figures.
Gay and bisexual men accounted for 7 percent of syphilis cases in 2000 but more than 60 percent in 2005, CDC experts estimated.
"The most devastating consequence of this increase in syphilis cases would be an increase in the rates of HIV infection," said Dr. Khalil Ghanem of Johns Hopkins University School of Medicine in Baltimore.
"Syphilis and HIV have a close, deadly symbiotic relationship."
CDC epidemiologist Dr. James Heffelfinger said syphilis, like many other sexually transmitted diseases, raises the likelihood of infection by or transmission of the human immunodeficiency virus, which causes AIDS.
Syphilis raises these risks by an estimated two to five times, he said.
Condom use can greatly reduce the risk of getting syphilis, which is readily curable with antibiotics in its early stages but capable of causing severe medical problems and even death if left untreated.
"We are seeing that syphilis is on the rise among a very specific subset of gay men: those who are having a great deal of sex with multiple sex partners," said Joel Ginsberg, executive director of the Gay and Lesbian Medical Association in San Francisco.
Many are HIV-infected or test positive for HIV for the first time when they learn they have syphilis, he said.
'WHY BOTHER?'
"Among these men, there seems to be decreased condom use, perhaps related to an attitude of 'I already have HIV, so why bother?' or because HIV is seen as a chronic disease that can be managed well with medications," Ginsberg said.
Tremendous progress was made against syphilis in the 1990s. In 1999, the CDC announced an initiative to fully eliminate it from the United States.
After reaching 50,000 cases and a rate of 20.3 cases per 100,000 people in 1990 -- the highest since 1949 -- public health efforts helped drive down the rate to 2.1 per 100,000 people in 2000.
But the rate rose to 3 per 100,000 in 2005, with 8,724 cases, the CDC said.
"We're concerned that we're seeing this upturn among men who have sex with men because it could foreshadow bigger increases," CDC epidemiologist Dr. Hillard Weinstock said.
Ghanem of Johns Hopkins faulted the gay and bisexual community, public health leaders and the medical establishment for failing to get across a message of prevention, citing "safe-sex fatigue" after the advent of powerful AIDS drugs in the 1990s.
"Once these wonder drugs came along, patients no longer saw HIV as a death sentence, and clinicians unfortunately became more lackadaisical about conveying prevention messages," Ghanem said.
Use of a smokable form of the illegal drug methamphetamine known as "crystal meth" also is associated with unsafe sexual practices linked to syphilis, Ghanem said.
The syphilis rate among men is nearly six times higher than for women. The vast majority of male cases is among gays and bisexuals.