Australia: Syphilis Reaching Epidemic Status Among Gays

New research reports that syphilis notifications in inner Sydney rose more than 10-fold from 1999 (six cases) to 2003 (162 cases).

In the study, researchers conducted a case series of 57 inner Sydney gay men with syphilis in 2003 and prospectively studied cases of the STD associated with sexual behavior among 1,333 HIV-negative Sydney gay men from June 2001 to December 2003. Sixty-four percent of the 57 men reported more than 10 sexual partners in the previous six months. Most of the men met partners in sex-on-premises venues. More than 90 percent reported oral sex with casual partners, and around half believed they had contracted syphilis through oral sex. Among the HIV-negative men in the prospective study, those who reported seeking sex partners in public places and via telephone had a increased risk of contracting syphilis.

Common among gay men until the early 1980s, syphilis declined rapidly in Australia and other industrialized nations with the onset of the AIDS epidemic. But a reported resurgence in risky sexual behavior in gay communities worldwide has been reported since the mid-1990s, leading to new syphilis outbreaks, said Andrew Grulich, of the National Center in HIV Epidemiology and Clinical Research, and colleagues.

"Practices such as oral sex, which are considered safe in terms of HIV transmissions, are not effective for preventing syphilis transmission," wrote the study's authors. "The fact that the risk factors for syphilis that we have described are broadly similar to risk factors for HIV is of concern. The ulcers caused by syphilis may potentially increase susceptibility to and transmissibility of HIV."

The full report, "Epidemic Syphilis Among Homosexually Active Men in Sydney," a related editorial, "Syphilis: Back on the Rise, but Not Unstoppable," and a letter, "Sustained Increase in Infectious Syphilis Notifications in Victoria," were published in the Medical Journal of Australia (2005;183(4):179-183, 172-173, and 218, respectively).

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