On May 18, public health officials reported that the number of new cases of syphilis in Seattle and King County nearly doubled between 2003 and 2004, from 76 to 140 cases. The disease continues to expand its reach within the area's gay and bisexual community.

Dr. Matthew Golden, director of the STD program for Public Health-Seattle & King County, said the rate has been increasing since 1997 despite department efforts. Golden said use of drugs, especially methamphetamine, appears to be associated with rising syphilis cases.

A recent survey found the majority of gay and bisexual men in Seattle/King County use condoms and practice safe sex. Dr. Robert Wood, director of HIV/AIDS programs for the department, said a core group -- mainly HIV-positive, substance-using individuals -- appears to be taking risks and exposing others to disease.

"Any slip-up in this population is extremely risky," Wood said. So far, there is no evidence that rising syphilis rates are contributing to rising HIV infection, Wood noted, although HIV may have a role in syphilis' spread.

Wood suggested that many people having unsafe sex are dealing with a new HIV diagnosis and other difficulties such as substance use or socioeconomic problems, adding that some people might risk infection because they no longer view HIV as an automatic death sentence.

Golden noted syphilis might be spreading because many are not aware that, unlike HIV, it can easily be transmitted through oral sex. He cited a Chicago study showing 20 percent of all syphilis cases in men who have sex with men arose from oral sex.

That is "why frequent STD testing is so important," Golden said, adding that the department has expanded testing, screening and treatment for syphilis, encourages better partner notification, and continues to promote safe-sex education.

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