Rise in syphilis rate creates fear of AIDS spike: Most cases among gay, bisexual men


San Francisco Chronicle – Friday, November 1, 2002
Christopher Heredia, Chronicle Staff Writer

Reversing a 10-year trend, syphilis rates rose nationally in 2001, raising concerns that the spread of the sexually transmitted disease could lead to a resurgence of HIV infections, federal health officials said Thursday.

While the number of new infections went up only slightly, by 2 percent, or 124 cases — to 6,103 in 2001 from 5,979 in 2000 — experts expressed concern because syphilis sores make one more susceptible to transmitting HIV.

The new data were reported today in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. Among the report’s other findings:

— Syphilis infections were up 15.4 percent among men, a rise that coincides with outbreaks among gay and bisexual communities in several major metropolitan regions including San Francisco, Los Angeles and Seattle.

— Syphilis infections were down by 9.9 percent among African Americans, and by 19.5 percent among women.

— The overall syphilis rate in the country increased to 2.2 per 100,000 people from 2.1 per 100,000 people, the first national uptick since 1990.

Exacerbating the situation, experts said, is the fact that in communities hardest hit by the disease — primarily gay and bisexual men — prevention messages have often fallen on deaf ears.

Experts called for a renewed prevention effort targeting gay and bisexual communities, although they acknowledged that because of funding constraints, it would be largely up to local and state health officials and grassroots efforts.

“The decline among women shows that targeted effort to eliminate syphilis can and will work,” said Dr. Ronald O. Valdiserri, deputy director of the CDC’s HIV, STD and TB prevention programs. “The success of our work depends on our ability to target resource to communities that are affected.

“Our challenge and the challenge for gay and bisexual communities across America is to underscore the connections between syphilis and HIV, and to renew the kind of commitment these communities brought to HIV prevention in the early years of the epidemic,” Valdiserri said.

Valdiserri said the CDC has sent “rapid response” teams to cities — including San Francisco, Los Angeles, New York, Chicago, Seattle and Miami — that have been hardest hit, to do surveillance and prevention.

Valdiserri said it was likely the outbreaks were a symptom of the broader challenges related to changes in the HIV epidemic.

“Many people believe HIV is a less serious disease because of improved treatments or miscalculations about their risk of HIV transmission,” he said.

“We’re going to continue to search for solutions to these new and evolving challenges.”

In the “good news” portion of Thursday’s CDC press conference, health officials noted that half of the syphilis cases occurred in 20 U.S. counties.

One in eight counties did not report a single case of syphilis.

Local health experts said the CDC’s report was helpful but not new news to San Francisco, where health experts have been tracking increase and trying to drum up resources and support for prevention and treatment since 1999.

“I’m hoping that by the national attention this is getting that there will be more resources applied to intervention efforts, particularly toward reducing risk behavior among men who have sex with men,” said Dr. Jeffrey Klausner, the city’s director of STD control and prevention. “Hopefully, it’ll be a wake-up call to our legislators to fund STD control efforts as an important part of HIV prevention.”

As of Sept. 30, in San Francisco, health officials had recorded 383 early syphilis cases this year, up from 113 during the same time period last year.

The vast majority — 95 percent — of the new cases are among gay and bisexual men, and of those 67 percent were HIV positive.

Conversely, there have been only six cases among women.

“The huge story here is the absence of heterosexual transmission and the absence of syphilis in women,” Klausner said. “It’s something we attribute to improvement in health care access for women.

“If we can figure out a way to have gay and bisexual men to get regular check ups, we could use that as a strategy to control STDs.”

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