On Tuesday, the Atlanta-based Centers for Disease Control & Prevention released its National STD Surveillance Report for 2007. It shows 11,466 reported cases of primary and secondary syphilis, a 15.2 percent increase over 2006. Of those cases, a staggering 65 percent were among men who have sex with men.
Syphilis is often missed because its key early symptoms are a painless sore on the mouth, penis or anus that can go away without medication. While painless, those sores can dramatically increase someone’s chances of contracting HIV.
“Gay and bisexual men have been hearing the same prevention methods over and over again, and so it might not be effective anymore. Also with HIV medications there is a feeling of wellness and that might cause people to engage in more risky behavior."
Read the whole article on Southern Voice.
I'd just like to note the evidence in the 'epidemiological synergy' between syphilis infection and HIV transmission is looking a little shaky. With all due respect to Judith Wasserheit - and there's a lot due, in my view - it's all based on data from Rakai in the very early nineties, when nobody was on treatment and sexual behaviour increasing HIV risk probably increased syphilis infection likelihood as well. In Australia, we have three states on the Eastern coastline with radically different HIV strategies and funding levels, and rapidly increasing syphilis incidence in each state; the state which funds prevention well has not seen any increased incidence despite the syphilis epidemic there.
ReplyDeleteYou're no doubt aware of this article that found something similar in San Francisco. Because HIV-positive gay men tend to have unprotected sex with each other there could be an increase in syphilis incidence among gay men without an apparent impact on HIV incidence. It's plausible (and I'd postulate that it's likely) that it would have an upward influence on HIV incidence as there'd still be some increase in syphilis among negative guys, and even if the synergy effect is modest it would facilitate HIV transmission between seropositives and seronegatives where either of them has syphilis. It's hard to assess the impact of syphilis because that we wouldn't know what the HIV incidence would have been without the increase in syphilis--it might have been appreciably lower.
ReplyDeleteTruong HM, Kellogg T, et al. Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting? Sex Transm Infect. 2006 Dec;82(6):461-6. Erratum in: Sex Transm Infect. 2007 Feb;83(1):76. Truong, H-H M [corrected to Truong, H M].
Another reason we have great concerns about syphilis in the US is that it likely plays a greater role in heterosexual transmission of HIV, particularly affecting populations of color in this country.