KING COUNTY, WASHINGTON - Today, the Centers for Disease Control and Prevention (CDC) released a new report citing continued declines in syphilis among African Americans and women of all races, but an alarming resurgence of syphilis among gay and bisexual men (November 1 issue of Morbidity and Mortality Weekly Report). In King County, syphilis was eliminated in the mid-1990s, but reappeared in 1997, and since 1998 this sexually transmitted disease has continued at epidemic rates locally among men who have sex with men.

In King County, there are now between 50 and 60 cases of syphilis each year among gay and bisexual men. "That's 120 to 150 cases per 100,000 gay men each year. The rate in heterosexual county residents is less than one per 100,000," said Dr. Hunter Handsfield, Director of Public Health - Seattle & King County's STD Control Program.

Forty-one cases of syphilis in gay men were reported in the first nine months of 2002, and at least 50 cases once again are predicted by the end of the year. According to Public Health officials, over 60 percent of the gay and bisexual men with syphilis also are infected with HIV, the virus that causes AIDS.

Gonorrhea, another STD, also is accelerating in men who have sex with men. In 2001, 166 gonorrhea cases were reported, but in 2002 this number was reached before August. Public Health predicts at least 300 cases by the end of 2002. Chlamydia rates in gay men also are rising.

"The real problem is HIV. Gonorrhea and syphilis are serious in their own right, but AIDS kills. And other STDs make a person even more likely to catch or transmit HIV," said Handsfield.

Public Health records and local research show that many HIV-infected gay men often do not use condoms and do not tell their partners they have HIV. Rising rates of syphilis and other STDs in gay men are attributed in large part to changing behavior in response to improved treatment and survival of persons with HIV and AIDS.

"People are letting down their guard," said Dr. Bob Wood, Director of the Public Health's HIV/AIDS Program. "It's not just complacency. It's that people who feel healthy are more likely to have sex than sick ones. And gay men probably just aren't as afraid of AIDS as they were." Public Health also cited substance use and burn-out on following safer sex guidelines.

Public Health has greatly intensified its HIV and STD prevention efforts for gay and bisexual men in the past five years. These efforts include expanded testing, encouragement of health care providers to counsel and test their patients at risk, and collaboration with community-based organizations to educate gay and bisexual men and publicize the problem of STDs and increased HIV risk.

"We can educate, we can cajole, we can test people at risk, we can try to find and treat persons' sex partners," he continued. "But behavioral change must come from gay men themselves."

Public Health emphasizes that gay men should always use condoms for anal sex and that those with HIV infection have an absolute obligation to inform their partners of their infections, even when they intend to use condoms. "From any perspective-public health, common sense, or ethical-it is never appropriate to put someone at risk of harm without that person's knowledge and consent," said Handsfield.

For more information on Public Health's STD and HIV/AIDS prevention efforts, please visit: www.metrokc.gov/health/apu

To view the November 1 issue of the CDC's Morbidity and Mortality Weekly Report, visit: www.cdc.gov/mmwr/PDF/wk/mm5143.pdf