Syphilis rates up on gay male sex
By Cheryl Wetzstein
March 13, 2008
Syphilis rates rose again in 2007, largely reflecting outbreaks among men who have sex with men, the nation's public health agency said yesterday.
The news dampens hopes of eliminating the ancient sexually transmitted disease (STD), which in 2000 looked close to eradication in the United States.
"STDs remain a major threat to the health of gay and bisexual men, in part because having an STD other than HIV can increase the risk of transmitting or acquiring HIV," said Dr. Kevin Fenton, director of the Centers on Disease Control and Prevention's (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.
"The resurgence of syphilis among MSM [men who have sex with men] represents a formidable challenge to our STD prevention efforts, but one that is surmountable," Dr. Fenton said at the agency's STD prevention conference in Chicago.
Screening and treatment should be a central part of medical care for gay and bisexual men, as well as finding innovative ways to help them avoid STD infections, including HIV, in the first place, he said.
Based on preliminary data, the 2007 syphilis rate was 3.7 cases per 100,000 population, or 11,181 cases. It was the seventh increase in a row and pushed rates 76 percent higher than in 2000, when the rate was 2.1 cases per 100,000.
The 2007 syphilis rate among the female population also increased, deepening concerns about a potential resurgence of the disease among women. But, as in recent years, the overall increase in the 2007 syphilis rate was largely attributed to men, especially men who have sex with men, the CDC said.
"While syphilis rates have increased recently for both men and women, the increases have been considerably larger for men," the CDC said. "This differs from the pattern seen in the late 1990s, when rates among males and rates among females were roughly equivalent."
What is syphilis?
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.
What are the signs and symptoms in adults?
Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection.
Primary Stage
The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
Late and Latent Stages
The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10 – 20 years after infection was first acquired. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.
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