KING COUNTY, WA - Public Health - Seattle & King County has announced guidelines that recommend routine testing of sexually active gay and bisexual men for common sexually transmitted diseases (STDs). The guidelines are an outgrowth of last December's summit meeting of Public Health officials with community leaders and other consultants in response to the ongoing epidemic of STDs among men who have sex with men (MSM).

"The resurgence of syphilis and other STDs among MSM is a public health crisis," said Dr. Alonzo Plough, Director of Public Health. "These guidelines are an important step in addressing the problem."

The recommendations were prepared by Public Health in collaboration with King County's medical community and MSM representatives. They call for yearly testing of sexually active MSM for syphilis, gonorrhea, and chlamydia, as well as a test for infection with human immunodeficiency virus (the AIDS virus) in men who previously had negative tests or had not been tested previously.

"Most STD infections cause no noticeable symptoms," said Dr. Hunter Handsfield, director of Public Health's STD Control Program. "Testing men at risk to detect asymptomatic infection is a crucial step in controlling this epidemic and preventing the spread of HIV."

Reported syphilis among King County men who have sex with men increased from virtually no cases in the mid-1990s to 58 cases in 2000 and 20 cases so far this year. Public Health estimates the annual rate of new syphilis infections to be about 160 cases per 100,000 MSM. In comparison, the rate is less than one case each year per 100,000 women and heterosexual men. Rates of gonorrhea and chlamydia in MSM also rose substantially from 1997 to 2000. About 70 percent of MSM with syphilis and 20 percent of those with gonorrhea or chlamydia also are infected with HIV.

"Our main concern is HIV," said Dr. Bob Wood, director of Public Health's HIV/AIDS Program. He pointed out that the behaviors that transmit STDs also indicate a risk of renewed spread of HIV. In addition, the risk of HIV transmission is greatly increased if either sex partner also has a STD. "STD control is a crucial component of AIDS prevention," according to Wood.

Public Health's guidelines were mailed last week to 1200 King County primary care physicians and selected specialists. "We are asking all doctors and clinics who provide care to sexually active gay or bisexual men to obtain a blood test for syphilis and to recommend HIV counseling and testing at least once a year," Handsfield said. The recommendations also call for routine testing for gonorrhea and chlamydia of the rectum, depending on the patient's sexual practices.

More frequent testing-every three to six months-is advised for men who are at highest risk, such as those with more than one sex partner or anonymous partner, men who use methamphetamine or inhaled nitrites ("poppers"), and those whose sex partners have these risks. "In addition to health care providers, we want MSM themselves to know the recommendations and ask their doctors for the tests," said Handsfield. Testing for the virus that causes genital herpes also should be considered, according to the recommendations.

Increasing risky sexual behavior and rising STD rates in MSM are widespread, according to Handsfield. He said that similar trends have been reported in many other cities in the U.S. and worldwide, including Canada, Australia, and Europe. "But so far, Public Health - Seattle & King County and the California Health Department are the only U.S. public health agencies that have prepared STD screening guidelines for MSM at risk," he said. The California recommendations were released earlier this month. Research in Seattle, San Francisco, and elsewhere shows that many gay and bisexual men are having more frequent unsafe sex than a few years ago. "Most gay and bisexual men know that HIV remains extremely serious, even with improved treatment," said Wood. "But reduced death rates and outwardly improved health probably have led some men to let down their guard."

The STD testing guidelines and other information are available on Public Health's STD Program web pages at www.metrokc.gov/health/apu/std/index.htm