The nation's syphilis rate has climbed for the second year in a row, mostly because of an increase in cases among gay and bisexual men, according to a government report released Thursday. Between 2001 and 2002, the syphilis rate rose 9.1% from 2.2 cases per 100,000 people to 2.4 cases, the Centers for Disease Control and Prevention said. The rate had dropped every year between 1990 and 2000 before reversing course. The actual increase in cases was small--759 more people, for a total of 6,682 new cases--but the rise among gay and bisexual men has caused concern that the public health safeguards and safer-sex practices adopted over the last two decades during the AIDS epidemic continue to crumble.
"The vast majority of the United States is not seeing any syphilis at all," said John Douglas, director of the CDC's division of sexually transmitted diseases. "We're seeing syphilis rise primarily in groups of gay and bisexual men." Syphilis cases in the West soared 64.3% (1.4 cases per 100,000 to 2.3) between 2001 and 2002 and climbed 54.5% in the Northeast (1.1 cases per 100,000 to 1.7 per 100,000), a rise caused in part by outbreaks among gay and bisexual men in these regions' major cities. But the CDC also reported that prevention efforts appeared to be working in the South, which for the first time since 1984 no longer accounts for half of the country's syphilis cases. Also, women and African-Americans saw a decline for the 12th consecutive year.
Based on the study data, AIDS Project Los Angeles called on the CDC to expand syphilis prevention efforts targeted at gay and bisexual men across the nation. According to Craig E. Thompson, APLA executive director, the CDC's prevention plan focuses on African-Americans and women but contains no specific outreach efforts to slow the spread of the STD among gay men. "Ongoing culturally competent efforts have reduced syphilis among the populations traditionally impacted," Thompson said in a press statement. "Syphilis among gay men was not a significant part of CDC's 1999 syphilis elimination plan. The new data show that sustained efforts specifically tailored to gay and bisexual men are urgently needed."
Syphilis infection can make it easier to transmit or be infected with HIV because the open sores associated with the STD enable HIV to more easily enter and exit the body. Recent studies in three cities of men who have sex with men have documented increased risk-taking, increased syphilis outbreaks, and a high rate of HIV coinfection. "Much greater emphasis must be placed on health policy planning that integrates STD and HIV services at the local and state level," Thompson said.