Viagra, Methamphetamine, Internet Use Linked to Increase in Number of Syphilis, HIV Cases Among MSM, Studies Say

Recreational use of the impotence drug Viagra and crystal methamphetamine appear to be "fueling" increases in the number of syphilis, HIV and other sexually transmitted disease cases among men who have sex with men, according to studies presented on Wednesday at the 2004 National STD Prevention Conference in Philadelphia, the Atlanta Journal-Constitution reports (Wahlberg, Atlanta Journal-Constitution, 3/11). Early reports indicate that the number of new cases of syphilis, which CDC had hoped to eliminate by 2005, increased in 2003 for the third year in a row. CDC researchers said that an estimated 60% of the cases occurred among MSM, compared with 5% in 1999 (Kaiser Daily HIV/AIDS Report, 3/9). According to a study presented by Dr. Samuel Mitchell of the San Francisco Department of Public Health, 17.4% of 1,263 MSM who sought treatment at the city's STD clinic reported using crystal meth within the four weeks preceding their visit. Crystal meth users were more than two times as likely as nonusers to be HIV-positive, 4.9 times as likely to test positive for syphilis and 1.7 times as likely to test positive for gonorrhea. Another study presented by Dr. William Fong of SFDPH showed that MSM who used both crystal meth and Viagra together were 6.1 times as likely as nonusers to test positive for syphilis. In addition, researchers from CDC and SFDPH found that 16% of 388 MSM in a study reported using crystal meth and 6% reported using Viagra the last time they had anal sex. Crystal meth users were twice as likely as nonusers to have engaged in receptive anal intercourse without a condom and Viagra users were 6.5 times more likely to report having had insertive anal sex without a condom. However, Viagra use was not tied to increases in receptive anal sex without a condom, according to the study, the New York Times reports.

Internet, Commercial Sex Clubs
Los Angeles County health officials on Wednesday reported data from two studies that show a connection between the Internet and commercial sex clubs and an increased number of syphilis cases among MSM. One study found that 22% of MSM who tested positive for syphilis had met partners over the Internet during the time they were most likely infected, according to the Times (Altman, New York Times, 3/11). MSM who met partners over the Internet were four times as likely to have anonymous sex and twice as likely to use injection drugs as men who did not meet their partners over the Internet. In addition, 67% of MSM who reported meeting partners online were HIV-positive, the study found (Hurdle, Reuters, 3/11). The second study found that 28% of MSM who tested positive for syphilis reported having met sex partners at commercial sex clubs (New York Times, 3/11). In addition, another study found that MSM from San Diego who tested positive for syphilis were much less likely than straight men to be able to provide contact information for their sexual partners, making it more difficult for health officials to notify the partners to get tested (Atlanta Journal-Constitution, 3/11). "The Internet is an important venue for conducting STD/HIV prevention and control," Dr. Getahun Aynalem, an author of the first Los Angeles study, said. Health officials can use the Internet to notify sexual partners and conduct STD prevention education through chat rooms, according to Reuters (Reuters, 3/11).

Gonorrhea
Dr. Hunter Handsfield of the Seattle-King County Health Department and the University of Washington reported an increase in the number of gonorrhea cases resistant to the antibiotic ciprofloxacin, which is commonly prescribed to treat the disease. The percentage of ciprofloxacin-resistant gonorrhea cases reported in the Seattle area rose from 3.8% in the period from July 2003 to September 2003 to 16.5% in the period from October 2003 to December 2003, the study showed. The "overwhelming majority" of the drug-resistant cases were among MSM, Handsfield said, according to the Times. Similar cases of drug-resistant gonorrhea have been reported in Boston and New York City, the Times reports. Many doctors are now prescribing the antibiotic cefpodoxime, which has not been well studied as a gonorrhea treatment, Handsfield said (New York Times, 3/11). The problem of drug-resistant gonorrhea could easily "jump to the general population," Dr. Ronald Valdiserri, deputy director of CDC's National Center for HIV, STD and TB Prevention, said, adding that CDC is "very concerned about this," according to the Journal-Constitution (Atlanta Journal-Constitution, 3/11).

Reaction
"The increased threat of syphilis and other STDs among gay and bisexual men is being driven in part by a troubling combination of drug use and complacency," Valdiserri said, adding, "We have a real challenge here dealing with the American public that is clearly uncomfortable talking about sexually transmitted infections" (Hurdle, Reuters, 3/10). The studies should "wake people up in the general community," Dr. Kenneth Mayer of Fenway Community Health in Boston said, adding, "They may be impacted by these increases over the next few years." Health officials said that new programs are being developed to target MSM, including conducting STD testing outside of bars, distributing vouchers for free screening tests, making it possible for MSM to schedule testing appointments over the Internet and using social marketing to raise STD awareness, according to the Journal-Constitution (Atlanta Journal-Constitution, 3/11). The National Coalition of STD Directors on Wednesday released a statement calling on the public health community to use the Internet to stem the spread of STDs among MSM. The statement recommends using the Internet to gather information about how MSM meet partners in order to better focus outreach and testing, develop online partner notification and self-disclosure systems, establish chat rooms with health counselors and post banner ads on MSM-frequented Web sites (NCSD release, 3/10).

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