Rising Syphilis Rate Linked to Gay Men

Syphilis rates in blacks, women and babies declined significantly between 1999 and 2004 but continued to rise overall, driven by a dramatic jump in infections among gay and bisexual men, the Centers for Disease Control and Prevention said Monday.

About 64% of all the new syphilis cases in 2004 were in men who had engaged in homosexual activity, according to the CDC. That group made up 5% of the syphilis cases in 1999.

Overall, the syphilis rates nationwide rose from 2.4 cases per 100,000 in 1999 to 2.7 per 100,000 in 2004.

“Increases in gay and bisexual men are overshadowing the decreases,” Dr. Kevin Fenton, director of the CDC’s National Center for HIV, Sexually Transmitted Disease and Tuberculosis Prevention, said at a national conference on sexually transmitted diseases in Jacksonville, Fla.

Officials said they were pleased that rates among African Americans, the racial group with the highest rates of syphilis, dropped from 14.3 to nine cases per 100,000 from 1999 to 2004. The CDC also reported that rates among women fell from two to 0.8 cases per 100,000 and rates among newborns fell from 14.5 to 8.8 per 100,000 live births.

CDC officials attributed the declines among African Americans and women to better education targeting those groups. The drop in syphilis rates for women resulted in fewer babies with the disease, CDC officials said.

The increase in infections among gay and bisexual men is partly a product of the effectiveness of HIV drugs, said Dr. John Douglas, director of the CDC’s Division of STD Prevention.

He said the fear of risky sexual behaviors, which grew in the era of HIV and AIDS, had faded somewhat. Effective drug cocktails, he said, has led many gay men to think of HIV and AIDS as a chronic but manageable disease. The result is that some do not take the proper precautions, such as using a condom.

To try to stem new infections, the CDC plans to work more closely with local health departments and community groups in the gay community.

In addition, the CDC is developing a rapid test -- perhaps requiring only saliva or a pinprick of blood -- that can be used in nontraditional settings such as bars or clubs.

“We’ve been able to demonstrate that if we focus our efforts and mobilize public health practices, we’ve made substantial gains in reducing syphilis,” Fenton said. “Now is the time to apply some of those successes to the [gay and bisexual male] population.”

More than 50% of the new syphilis cases were reported in 20 counties, primarily urban areas on the East and West coasts, Fenton said. At the top of the list was Los Angeles County.

Dr. Jonathan Fielding, the county’s public health director, said one anomaly in Los Angeles was that infection rates among African Americans had not gone down.

He isn’t sure why. “Whatever it is, we have to do more,” he said. “Things are moving in the wrong direction.”