Syphilis Infections in United States Rose in 2001 Following 11 Years of Decline; Large Increases Noted Among Men Who Have Sex With Men
The number of new syphilis infections in the United States rose last year for the first time in 11 years, with large increases occurring among men who have sex with men, according to new CDC statistics released yesterday, the Los Angeles Times reports. According to the statistics, which appear in today's issue of the CDC's Morbidity and Mortality Weekly Report, there were 6,103 new primary and secondary syphilis cases in 2001, a 2.1% rise from 2000. Health officials noted, however, that syphilis is declining among some populations disproportionately affected by the disease (Ornstein, Los Angeles Times, 11/1). Although the rate of syphilis among blacks was 15.7 times the rate among non-Hispanic whites in 2001, syphilis cases among blacks declined by 9.8% overall between 2000 and 2001, with cases among black women dropping 18.1% and cases among black men decreasing by 3.5%. However, the syphilis rate rose in all other ethnic groups. The syphilis rate among non-Hispanic whites increased 40%, compared to a 31% rise among Hispanics, a 66.7% increase among Asian-Pacific Islanders and a 75% increase among Native Americans/Alaska Natives. Syphilis rates overall were much higher among men than women; in 2001, men were twice as likely to be infected with the disease as women. Although syphilis infections decreased among women in nearly every ethnic group, increases among men were reported among all ethnic groups. The South had the highest rate of syphilis -- 56.2% of syphilis infections in the country in 2001 occurred in the region -- but the region's syphilis rate declined by 8.1% between 2000 and 2001 (MMWR, 11/1).
Rate Higher Among MSM
In an editorial note, the researchers note that syphilis is declining among blacks and in the South, a population and a region that traditionally has been disproportionately affected by the disease. Because national syphilis statistics do not include information regarding behavioral risk factors, the study does not include figures regarding how many of the cases occurred among men who have sex with men. But the researchers note that the rising number of cases among men reported in the study is consistent with reports from several cities noting an increase of the disease among men who have sex with men. "[T]he continuing decline in syphilis rates among women in conjunction with the increasing male-to-female ratio suggests that the syphilis rate probably is increasing among men who have sex with men and decreasing among heterosexual men," the authors state (Editorial Note, MMWR, 11/1). Health officials said that the rising incidence of syphilis is troubling for several reasons. The increase is a "setback" for the CDC's goal of eliminating syphilis in 90% of U.S. counties by 2005, but it also signals that many gay and bisexual men are no longer practicing safe sex, which could lead to an increase in HIV and other sexually transmitted diseases (Gay Stolberg, New York Times, 11/1). "Awareness (of syphilis) is tremendous. But we don't have any evidence yet that there's been a change in sexual behavior in terms of unsafe sex practices," Dr. Jeffrey Klausner, director of sexually transmitted disease control at the San Francisco Department of Public Health, said (Los Angeles Times, 11/1). Public health officials said that the "resurgence" of risky sexual behavior among men who have sex with men could be linked to "complacen[cy]" in a time when antiretroviral drugs have allowed HIV-positive people to live longer. Daniel Cohen, associate medical research director at Boston's Fenway Community Health Center, added that many gay and bisexual men are "weary" of safe-sex "lectures" and messages that have "bombarded" them for the past 20 years (Smith, Boston Globe, 11/1).
Others have linked the trends to shifting political priorities. CDC officials say they have not received an increase in funding from Congress for STD prevention in recent years, and some AIDS advocates say that the Bush administration has "stymied some efforts to talk openly about sex and condom use among gay men," the Los Angeles Times reports. Dr. Jonathan Zenilman, an STD expert and infectious disease professor at the Johns Hopkins University School of Medicine, said, "I think the CDC is constrained about what they can do because of the political issues in dealing with gay men. The way to deal with this is to be ... open and frank about what the risks are and what you need to do to protect yourself" (Los Angeles Times, 11/1). Dr. Ronald Valdiserri, deputy director of the CDC's Center for HIV, STD and TB Prevention, said that curbing syphilis rates will also have to make more explicit the connections between syphilis, unsafe sex and HIV infection. "Our challenge is to underscore the connection between HIV and syphilis and renew the commitment [gay rights] groups brought in the early years of the HIV epidemic," he said (Yee, AP/Las Vegas Sun, 11/1).