Rise in syphilis cases in gay and bisexual men highlights importance of testing, condom use

KING COUNTY, WASHINGTON - New syphilis cases in gay, bisexual and other men who have sex with men almost doubled between 2003 and 2004, from 76 to 140 cases, in King County. Nearly eliminated among gay and bisexual men by the mid-1990s, syphilis has increased in this population since 1997.

With today's announcement, Public Health officials are reemphasizing the importance of consistent condom use and regular testing for sexually transmitted diseases (STD) as means for gay and bisexual men to protect their health, the health of their partners, and the wellbeing of the community.

“The increase in syphilis is greatly disturbing,” said Dr. Matthew Golden, STD Program Director for Public Health – Seattle & King County. “Through testing, screening, partner notification and other innovative efforts, we’ve redoubled our efforts in recent years to address the re-emergence of syphilis in this population. We will continue our commitment, and continually evaluate new ways to turn the tide against this significant health threat.”

Syphilis is a bacterial disease that can be transmitted via anal, vaginal or oral sex.

Syphilis can cause serious health problems; several persons recently treated for syphilis in King County have experienced irreversible loss of vision and hearing.

Among those men diagnosed with syphilis in 2004, most had early infections (i.e., diagnosed within a year of acquisition), and sought medical care after developing symptoms. Over half of all 2004 syphilis cases among men who have sex with men occurred in men who were HIV infected.

“Syphilis increases the likelihood of transmitting or acquiring HIV, and having HIV can make treating syphilis more difficult,” said Dr. Bob Wood, Public Health’s HIV/AIDS Program Director.

According to a 2003 phone survey by Public Health, fewer than 20% of men who have sex with men in Seattle report having unprotected anal sex with partners of unknown or opposite HIV status, and most report discussing HIV with their sex partners. “Most gay and bisexual men who are sexually active are taking steps to protect themselves and their partners by engaging in safer sexual practices. This recent rise in syphilis cases, however, points out that many men are not taking sufficient precautions to avoid significant health risks,” said Golden.

A recent report from Chicago indicated that 20% of all syphilis cases in men who have sex with men were acquired through oral sex. “Most people recognize that oral sex probably poses a low risk for HIV transmission. This is not true for syphilis, however. That’s one of the reasons why frequent STD testing is so important,” added Golden.

Syphilis can be detected through a simple blood test and cured with antibiotics; treatment is easier when the disease is caught early. Symptoms may include the appearance of a sore on the penis, in the mouth or rectum that is usually painless, and sometimes a rash. In some instances, no symptoms are apparent, even though serious damage may be happening.

Although infection of two other sexually transmitted diseases, gonorrhea and chlamydia, remain common and have also risen in recent years among local men who have sex with men, rates of these conditions did not increase in 2004. Likewise, no increase in rates of HIV has been clearly documented locally, despite a resurgence in STD rates in men who have sex with men.

Public Health efforts

Public Health – Seattle & King County has made a significant ongoing commitment in response to the spread of syphilis locally. Recent efforts have included:

Increased syphilis testing by Public Health – In 2004, Public Health performed over 10,000 tests for syphilis, a 37% increase since 1998. Public Health funds easy access to syphilis screening targeting gay men at the Gay City Wellness Center, the STD Clinic at Harborview Medical Center, and other targeted venues.

Partner notification - Public Health continues to help people infected with syphilis assure that their sex partners are made aware of risky exposures, screened and treated. The number of partners identified through partner notification per syphilis case increased 350% between 1999 and 2004.

Innovation - Public Health continues to pursue innovative screening and treatment strategies, such as incentives for peer referral where persons at high risk for syphilis refer their peers for syphilis screening.

Ongoing surveillance – Public Health continues to closely monitor syphilis, gonorrhea, and chlamydia among men who have sex with men, and keeps the public, affected populations, and medical providers informed of any significant changes in disease trends.

Recommendations

Public Health recommends that all men who have any oral or anal sex with other men outside of a long-term, mutually monogamous relationship get tested for syphilis as well as other STDs at least annually.

All people, including men who have sex with men, are advised to limit their numbers of sex partners and to use condoms consistently and correctly when having sex unless in a long-term, mutually monogamous relationship with a partner of the same HIV status.

For more information about syphilis, its symptoms and treatment, visit www.metrokc.gov/health/apu/std/syphilis_qf.htm

For information about STD or HIV testing or to make an appointment, call Public Health’s HIV/STD Hotline at 206-205-7837 or 800-678-1595 (open from 9 a.m. to 4 p.m., Monday – Friday). Information is also available at: www.metrokc.gov/health/apu/resources/testing.htm

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