Syphilis is on the rebound in Massachusetts -- new cases have nearly doubled in the past two years -- and public health officials fear that its resurgence could foreshadow an explosion of new HIV infections. Although just 197 syphilis cases were reported last year, disease specialists and community advocates are uniting to mount a statewide campaign to stop the spread of the disease.

The Massachusetts outbreak, concentrated in Boston, follows a pattern similar to the reemergence of syphilis in San Francisco, Los Angeles and New York, with the disease especially evident in the gay community. “Once an infection is well-established in a particular population, it can spread very easily and quickly,” said John Auerbach, executive director of the Boston Public Health Commission. “The challenge is always to mobilize when the numbers are small enough so that a disease does not become firmly entrenched.”

Of the 197 cases in 2002, 113 patients told investigators that they contracted syphilis through sex with other men. That is a marked reversal from the early 1990s, when gay men accounted for fewer than 1 percent of all syphilis infections. Public health officials said that the outbreak in the gay community is a complex issue. “We’re dealing with a new generation that hasn’t seen the same kind of death and destruction and an older generation that has tired of the challenge it takes to be careful. And we’re going to have to figure out a new strategy in this context,” said Jean Flatley McGuire, director of the state’s HIV/AIDS Bureau.

Because syphilis sores can act as portals directly to the blood stream, they are more likely to transmit HIV than semen or other fluids. Next month, a broad-based campaign will target the gay community, with HIV advocates distributing syphilis prevention information and testing vouchers to nightclubs and at major gay events.

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