Syphilis Rates Rising Among U.S. Men

Study cites lax safe-sex behavior by gay and bisexual males

TUESDAY, Nov. 8, 2005 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention was ready to declare syphilis all but eradicated in this country in 1999. Since then, rates of the disease have soared.

In a report released Tuesday, the CDC attributed the bulk of this latest spread of syphilis to men who have sex with men.

At the same time, cases of gonorrhea have reached a new low. And while the number of chlamydia cases has risen, federal health officials said this reflects better screening and diagnosis, not an increase in incidence of the disease.

These and other findings appear in a new CDC report, Trends in Reportable Sexually Transmitted Diseases in the United States, 2004 National Surveillance Data for Chlamydia, Gonorrhea, and Syphilis.

"STDs (sexually transmitted diseases) pose a significant and ongoing threat to millions of Americans," said Dr. Ronald O. Valdiserri, acting director of the CDC's National Center for HIV, STD and TB Prevention, told a news conference Tuesday. "Especially for young women, men who have sex with men, and people of color," he added.

The CDC estimates that some 19 million cases of sexually transmitted disease infections occur each year in the United States. Chlamydia is the most common of the three diseases covered in the report. "Almost half of them are among young people ages 15 to 24," Valdiserri said. "In addition, all three STDs increase the risk of HIV transmission."

In 2000, the infection rate for syphilis reached its lowest point since record keeping began in 1941, Valdiserri said. "But each year since 2000, the syphilis rate has increased steadily. The rate increased 8 percent from 2003 to 2004, largely due to increases among men," he said.

Reported cases rose from 7,177 in 2003 to 7,980 in 2004, according to the report. "There are clear signs that syphilis increases have occurred largely among men who have sex with men," said Dr. John M. Douglas, the director of the Division of STD Prevention at the CDC's National Center for HIV, STD and TB Prevention.

The CDC estimates that about 64 percent of all adult syphilis cases in 2004 were among gay and bisexual men, up from 5 percent in 1999. "The overall increases in syphilis are largely attributable to increases among men," Douglas said. "The rate among men increased 11.9 percent from 2003 to 2004 and 81 percent from 2000 to 2004."

From 1999 to 2004, the rate of syphilis infections among blacks decreased 37 percent, and the rates among women dropped 55 percent. But from 2003 to 2004, the syphilis infection rate increased 16.9 percent among blacks, Douglas said. "Once again, likely reflecting increases among men who have sex with men," he noted.

There are a number of reasons for the increases in syphilis, said Linda M. Niccolai, an assistant professor of epidemiology and public health at Yale University, who sees the rise in syphilis among men as a serious situation.

"It's what we call HIV treatment optimism," Niccolai said. "People think the treatment for HIV is so good that they relapse their safe sex behaviors," she said. "There is probably condom fatigue. We are in the third decade of the AIDS epidemic and people are getting tired of the condom messages."

In addition, the rising use of methamphetamine and Viagra has also increased risky behavior, Niccolai said.

"The Internet is one of the things that has fueled the spread of this epidemic," Niccolai said. "The Internet has made it very easy to make contact with anonymous sex partners, a lot of partners in a short period of time."

But Niccolai also believes the Internet can be used to help fight the syphilis epidemic. "There are a lot of Web sites where men go to meet other men for sex," she said. But the Yale expert added that those sites have also been used successfully in San Francisco to warn about syphilis and identify men with the disease.

There is no one single measure that will reduce the syphilis rate, Niccolai said. "We need public campaigns to increase testing," she said. "One of the things that's going to be important is early diagnosis. Physicians need to be aware of these increases and diligent about screening patients who have risk factors."

As for the other two STDs -- chlamydia and gonorrhea -- covered by the report, Douglas noted that in 2004 there were 330,132 cases of gonorrhea reported in the United States. "Like other STDs, gonorrhea is substantially under-diagnosed and reported," he said. "The CDC estimates that more than 700,000 new infections occur each year."

According to the report, cases of gonorrhea that are resistant to antibiotics, called fluoroquinolones antibiotics, increased from 4.1 percent in 2003 to 6.8 percent in 2004, Douglas said. Resistance among men who have sex with men is eight times higher than among heterosexuals, he added.

Given this data, the CDC has recommended that fluoroquinolones no longer be used as a treatment for gonorrhea among gay and bisexual men. In addition, antibiotics are not recommended to treat the disease in anyone in California or Hawaii, where resistance has been widespread for years, Douglas said.

Of the three STDs reported on, chlamydia was the most common, with 929,462 cases reported in 2004. "Reported chlamydia cases are just the tip of the iceberg," Valdiserri said. "We estimate that there are about 2.8 million chlamydia infections in the United States every year."

Since chlamydia is often undiagnosed, the CDC recommends that all sexually active women under 26 be screened for the disease, Douglas said.

More information

The CDC can tell you more about syphilis.

SOURCES: Nov. 8, 2005, news conference with Ronald O. Valdiserri, M.D., M.P.H., acting director, National Center for HIV, STD and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta; John M. Douglas, M.D., director Division of STD Prevention, National Center for HIV, STD and TB Prevention, CDC, Atlanta; Linda M. Niccolai, Ph.D., assistant professor of epidemiology and public health, Yale University, New Haven, Conn.
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