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A total of 15 new syphilis cases were reported in St. Louis in January, the highest number of cases ever reported in any month over the past seven years, the St. Louis Post-Dispatch reports. Eleven of the new cases were reported in gay or bisexual men; nine of those 11 men also are HIV-positive. "The fact that so many are HIV-positive is really alarming because it means they are having unprotected sex," Nyla DeArmitt, a public health adviser for the Centers for Disease Control and Prevention and a consultant to the Missouri Department of Health and Senior Services, told the Post-Dispatch. The incidence of syphilis in the state in 2004 was 41% higher than levels reported in 2002. Most of the new cases of syphilis reported in the city since 2000 have been among gay and bisexual men reporting unprotected sex with their partners.