Syphilis Makes Comeback in Europe

Syphilis is back: The sexually transmitted disease long associated with 19th-century bohemian life is making an alarming resurgence in Europe.

''Syphilis used to be a very rare disease,'' said Marita van de Laar, MD, an expert in sexually transmitted diseases at the European Centre for Disease Prevention and Control. ''I'm not sure we can say that anymore.''

Most cases of syphilis are in men, and experts point to more risky sex among gay men as the chief cause for the resurgence. But more cases are being seen among heterosexuals, both men and women, too.

Syphilis was the sexual scourge of the 19th century and is believed to have killed artists like poet Charles Baudelaire, composer Robert Schumann, and painter Paul Gauguin. But the widespread use of penicillin in the 1950s all but wiped it out in the Western world.

In the last decade, however, syphilis has unexpectedly returned, driven by risky sexual behavior and outbreaks in major cities across Europe, including London, Amsterdam, Paris, and Berlin.

– In the United Kingdom syphilis cases have leaped more than 10-fold for men and women in the past decade to 3,702 in 2006, according to the Health Protection Agency. Among men in England, the syphilis rate jumped from one per 100,000 in 1997 to nine per 100,000 last year.

– In Germany the rate among men was fewer than two per 100,000 in 1991; by 2003, it was six per 100,000.

– In France there were 428 cases in 2003 -- almost 16 times the number just three years earlier.

– In the Netherlands cases doubled from 2000 to 2004. In Amsterdam up to 31 men per 100,000 were infected, while the rate was much lower in other regions.

Similar trends have been seen in the United States.

In 2000 syphilis infection rates were so low that the Centers for Disease Control and Prevention embarked on a plan to eliminate the disease. But about 9,800 cases were reported in 2006.

Van de Laar said syphilis's reappearance was so surprising that many doctors initially had trouble diagnosing the disease.

Though syphilis these days mainly affects urban gay men, experts worry that the disease could also rebound in the general population if stronger efforts to fight it are not taken soon.

In 2005, U.K. authorities reported that syphilis was spreading across the entire country and that more heterosexual men and women were being infected.

''These increases may lead to increases in diagnoses of congenital syphilis over the coming years,'' said Kate Swan, a spokeswoman for the Health Protection Agency.

Pregnant women with syphilis can pass congenital syphilis on to their babies. Nearly half of all babies infected with syphilis while they are in the womb die shortly before or after birth.

Syphilis is a bacterial disease causing symptoms that include ulcers, sores, and rashes. In extreme cases it can result in dementia or fatally damage the heart, respiratory, and central nervous systems. Syphilis is treatable with antibiotics if caught early.

Once there are more than just a few isolated cases, containing the disease is difficult.

Advances made in treating AIDS may have inadvertently boosted syphilis's spread.

''The evidence points to an increase in unsafe sexual behavior since antiretrovirals for AIDS came along in 1996,'' said Van de Laar.

After decades of being instructed to use condoms and to limit the number of sexual partners, some people are probably suffering from ''safe sex fatigue,'' Van de Laar said. In turn, that has contributed to the spike in syphilis cases.

The Internet has also allowed people to find sexual partners more easily than before, and some experts link the rise of dating websites to the jump in syphilis cases.

For some men, the Internet connections can be especially dangerous.

''Networks of HIV-positive men to find other positive men have sprung up on the Internet,'' said Jonathan Elford, an AIDS epidemiologist at London's City University.

While men with HIV having unprotected sex with each other are not at risk of passing on HIV, other diseases like syphilis can still be spread. Among gay men who have syphilis in Britain, nearly half have HIV, Elford said.

Amid this resurgence, some officials are now attacking the epidemic online.

Every day, health workers at the Terrence Higgins Trust, Europe's largest AIDS charity, log into chat rooms on a popular British gay dating website. Their job is to spread safe-sex messages and answer any related questions from men online.

''We know that men are arranging hookups for sex online,'' said Mark Thompson, the charity's deputy head of health promotion. ''So we decided to tap into cyberspace to try reaching them before unsafe sex might happen.''

The trust's health workers disclose their identities and work-related intentions as soon as they begin their shifts.

Health officials like Van de Laar and Elford applaud such Internet-based initiatives.

''It's definitely worth trying,'' Van de Laar said. ''If we don't do enough to stop syphilis in the gay community now, we could potentially be dealing with a much bigger risk in the future.'' (Maria Cheng, AP)