New York City officials reported cases of syphilis more than doubled last year, primarily due to an outbreak among men who have sex with other men. Several other cities in the United States are seeing similar patterns, including Los Angeles, San Francisco, Seattle, Chicago and Miami, said Ronald Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention in Atlanta.
Around the world, Canada, Great Britain and Germany also are reporting outbreaks of sexually transmitted diseases among men who have sex with men, he told United Press International.
Thomas Frieden, NYC's commissioner of health and mental hygiene, said cases of syphilis in that city are "continuing to increase this year ... predominantly in men who have sex with men." This increase is worrisome because it portends an increase for risk of HIV infection, he said.
Frieden noted there is no evidence of an increase in HIV incidence yet but people often do not realize they are infected for quite some time. "Only time will tell what we're going to see," he said.
This underscores the need to increase HIV-prevention efforts, NYC health officials write in the September 27 issue of Morbidity and Mortality Weekly Report, a medical journal put out by the Centers for Disease Control and Prevention.
Valdiserri agreed, saying there is "great concern globally across the prevention community." An individual who has syphilis or another sexually transmitted disease is more likely to become infected with or transmit HIV, he said.
Although health officials are taking steps to limit the spread of these diseases, the gay and bisexual communities must increase their awareness and involvement to get these men to stop their risky sexual practices, Valdiserri said. "We've got to get the gay community as concerned and as riled up about this as they were in the earliest days of the AIDS epidemic," he said.
NYC officials are working with doctors and community-based organizations to get the message out that syphilis is back and condoms should always be used, Frieden said. The officials also are working with patients to identify who their partners are and where transmission is occurring "so we can treat and contain the outbreak," he said.
"Syphilis outbreaks are harder to control in gay and bisexual men," said Kevin Fenton, head of the HIV and sexually transmitted infections division at the United Kingdom's health department, which has also reported outbreaks of syphilis among gay men. This is because they often have high numbers of casual sex partners, making it difficult to locate and notify all those who may have been infected, he told UPI.
Fenton said no increases in HIV have yet been detected in England but "the health department has noted increases in all other sexually transmitted infections in gay men," including genital warts, herpes, gonorrhea and chlamydia. "Unsafe practices are in part driving these increases," he said.
Of the 282 cases of syphilis reported in New York City during 2001, 263 or 93 percent occurred in males. Sexual orientation was known for only 188 of the men and of these nearly 80 percent were classified as gay or bisexual. HIV status was known for 86 of the gay or bisexual men and nearly half were positive for the virus.
Officials interviewed 103 of the gay and bisexual men and found 75 percent of them had more than one sex partner during the time when syphilis could have been transmitted. Most of the men reported meeting sex partners at nightclubs, public cruising sites and Internet chat rooms. Five percent of the gay and bisexual men engaged in prostitution.
(Reported by Steve Mitchell, UPI Medical Correspondent, in Washington)