Overall, the U.S. syphilis rate rose by 9 percent between 2001 and 2002, the second consecutive increase from an all-time low in 2000, according to figures released Thursday by the Centers for Disease Control and Prevention in Atlanta.
The bulk of the increase occurred among men, rising by about 27 percent overall, including a staggering increase of more than 85 percent among white men and a nearly 36 percent increase among Latino men. Information on sexual orientation is often not collected by health departments but the CDC estimates 40 percent of the increase was in gay and bisexual men.
The total number of syphilis cases increased from 6,100 to more than 6,800, but CDC officials think this probably is only the tip of the iceberg because many cases go undiagnosed.
"The overall number is probably significantly higher," Dr. John Douglas, director of the CDCs division of sexually transmitted diseases, said during a teleconference about the new figures, which appear in the Nov. 21 issue of CDC's Morbidity and Mortality Weekly Report.
The rise in syphilis infections indicates a growing number of gay and bisexual men are having unprotected sex, which worries health officials because the men could be spreading other diseases, including HIV/AIDS.
The problem is not just limited to the United States. "Several other countries, including the United Kingdom, the Netherlands, Australia and several countries in western Europe have also reported increases of syphilis and other diseases among gay and bisexual men and in many of these there are high levels of HIV co-infection," said Dr. Ronald O. Valdiserri, deputy director of CDC's HIV, sexually transmitted diseases and tuberculosis prevention center.
Valdiserri said there is no clear evidence HIV cases are increasing yet in the United States, "but we are extremely concerned about that possibility."
He noted a study released in July at the National HIV Prevention Conference in Atlanta found rates of diagnosis with HIV infection were up by 17 percent among men who have sex with men. This does not necessarily represent new cases, however, so it is difficult to determine if the HIV infection rate actually is increasing, "but we're very concerned about that increase because it wasn't observed in other risk groups," Valdiserri said.
Heightening concern further is the fact that syphilis increases the risk of HIV transmission by two to five times, because the genital sores caused by syphilis serve as portals of entry for the AIDS virus, Douglas said. In addition, a recent study found HIV viral load increases when a person has syphilis, suggesting he or she may be more contagious.
Sue Blank, assistant commissioner at the Bureau of Sexually Transmitted Disease Control at the New York City Department of Health and Mental Hygiene, said she is worried about syphilis increases -- with 434 cases in 2002, New York had the most of any U.S. city -- because they could translate into an increase in HIV/AIDS infections.
"Certainly, the concern for us is the syphilis outbreaks are going to be heralding increases in HIV," Blank said.
The CDC is now mobilizing efforts to battle the syphilis problem and officials are confident that prevention strategies can help keep the disease in check. Although syphilis increased in gay and bisexual men, education and intensified testing efforts appear to have resulted in a decline in cases among African-American men and a 19-percent drop among women overall -- including nearly a 22-percent decrease in African-American females.
However, prevention strategies will need to be tailored to the gay community to keep the disease in check in that population, Valdiserri said.
Although the factors driving the increase among gay and bisexual men are "multi-factorial" -- not due to one single cause -- some of the reasons include a relaxed attitude about sexually transmitted diseases. This is due to the introduction of medications that can keep AIDS in check, Valdiserri said. Other reasons include substance abuse and "emerging venues that facilitate unprotected sex including the Internet," he added.
Blank noted when her department interviewed a number of gay and bisexual men in 2002 about their sexual habits, it found recruiting sexual partners over the Internet was a common practice, including among those infected with syphilis.
Blank's group also found, however, men infected with syphilis were much more likely to report HIV infection than those not infected with syphilis. In addition, syphilis-infected men were more likely to report unprotected anal intercourse, attending private sex parties, use of illicit drugs and 11 or more partners in the past six months.
One of the strategies CDC intends to employ is to encourage organizations that serve gay and bisexual men to get the word out about the importance of detecting and treating syphilis.
Paul Feldman of the National Association of People with AIDS in Washington, said his organization would be willing to work with the CDC. But he noted a larger problem is a lack of funding for HIV and sexually transmitted disease prevention efforts.
For the fiscal year 2004 budget, the Bush administration requested a reduction of $9 million in the funds for CDC's HIV prevention and surveillance efforts, Feldman said. "Decreasing it in a time when an epidemic rages is insulting and frightening," he said.
The administration also requested decreasing the CDC's budget for prevention of sexually transmitted diseases, which already barely registers at a scant $168 million for the entire country for 2003.
The syphilis rise and potential increases in AIDS cases will cause untold increases in lost wages, healthcare costs and human suffering, Feldman said. All of this easily could "be ameliorated with additional money," he said.
Steve Mitchell is UPI's Medical Correspondent. E-mail firstname.lastname@example.org
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