Number of Syphilis Cases Rising Among MSM in U.S., Could Increase Risk of HIV Transmission, CDC Officials Say
The number of syphilis cases is increasing among men who have sex with men in the U.S., which could boost the population's risk of contracting HIV, CDC officials said on Friday, Reuters Health reports. According to the officials, the number of syphilis cases in the U.S. reached an all-time low in 2000. However, the number of cases has risen annually from 2000 to 2005, the most recent year for which the agency has figures. CDC analysts estimate that in 2000, MSM accounted for 7% of syphilis cases in the country but accounted for more than 60% in 2005. According to CDC, syphilis incidence in the overall population was 2.1 cases per 100,000 people in 2000, compared with three cases per 100,000 people in 2005, or 8,724 cases.
Khalil Ghanem of Johns Hopkins University's School of Medicine said, "The most devastating consequence of this increase in syphilis cases [among MSM] would be an increase in the rates of HIV infection." He added, "Syphilis and HIV have a close, deadly symbiotic relationship." According to James Heffelfinger, a CDC epidemiologist, syphilis can increase the risk of HIV transmission by twofold to fivefold. "We are seeing that syphilis is on the rise among a very specific subset of [MSM]: those who are having a great deal of sex with multiple sex partners," Joel Ginsberg, executive director of the Gay and Lesbian Medical Association in San Francisco, said, adding, "Among these men, there seems to be decreased condom use, perhaps related to an attitude of 'I already have HIV, so why bother?' or because HIV is seen as a chronic disease that can be managed well with medications." According to Ginsberg, many MSM in this subset are HIV-positive or learn their HIV-positive status for the first time when they find out they have syphilis.
According to Reuters Health, Ghanem "faulted" the homosexual and bisexual communities, public health leaders and the medical establishment for failing to get across a message of prevention, citing "safe-sex fatigue" after the advent of antiretroviral drugs. "Once these wonder drugs came along, [HIV-positive people] no longer saw HIV as a death sentence, and clinicians, unfortunately, became more lackadaisical about conveying prevention messages," Ghanem said. He added that use of crystal methamphetamine is associated with unsafe sexual practices linked to syphilis (Dunham, Reuters Health, 5/4).
The Washington Post on Tuesday examined the number of syphilis cases in Maryland; Washington, D.C.; and Virginia. The article is available online.