Syphilis: An Old Enemy Is Back

Thought to be on its way out just four years ago, syphilis is back. Outbreaks from Miami to Seattle concern health officials, who are putting the public on alert. Syphilis sores increase the risk of HIV transmission two- to five-fold, and the fact that people are getting infected suggests the erosion of safe sex practices. "Every case of syphilis might mean one more transmission of HIV," according to Dr. Thomas Frieden, New York City's health commissioner. New York saw a 50 percent increase in syphilis diagnoses between 2001 and 2002.

National syphilis rates declined steeply in the 1990s, but rose by 2 percent between 2000 and 2001, from 5,979 cases to 6,103. While the actual numbers are small, the increase is almost exclusively among gay and bisexual men. In Chicago, MSM accounted for 63 percent of syphilis cases last year, compared with 14 percent in 1998.

Although easily diagnosed and cured, syphilis can go undetected. Condoms protect against transmission, but the advent of powerful AIDS drugs has tempted many men to let their guard down regarding safe sex practices. Health officials concur that anonymous sex is part of the problem, with bathhouses, sex clubs, circuit parties and the Internet contributing to an increase in unsafe sexual behavior. In San Francisco, half of all men diagnosed with syphilis last month reported meeting sexual partners online.

"Syphilis is just the tip of the iceberg," said Dr. Gail Bolan of California's health department. About 70 percent of MSM with syphilis also have HIV. New York data show that two-thirds of co-infected men engage in unsafe sex. Some of the men might also be having sex with women. "A bridge into the heterosexual community could wipe out the gains we've made," noted Dr. Peter Kerndt of Los Angeles County health department.

Several cities have launched provocative awareness campaigns in an effort to encourage testing. Funding and debates over the efficacy of safe-sex initiatives are among the challenges health officials face in their efforts to contain the outbreaks.

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