After a decade long decline that led to an all time low in 2000, the Centers for Disease Control (CDC) is reporting a rise in syphilis rates for the second year in a row. The CDC is saying the increase is due in large part to increases in reported syphilis cases among gay and bisexual men. As rates in that group are on the rise, they continue to decline in African-Americans and women, pointing to the success of STD prevention efforts in some areas and populations.

According to the CDC, syphilis cases among men increased from 4,134 to 5,267 cases between 2001 and 2002.

“The campaign against syphilis in the United States is now being waged on two fronts,” said Dr. Ronald O. Valdiserri, deputy director of CDC’s HIV, STD and TV prevention center. “We’re working on one front to sustain the progress made among populations formerly hardest hit by syphilis, including African-Americans and women. On the second front, we are combating new challenges among gay and bisexual men.”

Through October 2003 there were 85 reported cases of syphilis in San Diego, with 72 of those cases among the MSM population. Most cases were found in men 30 years of age and above, with an average age of 36. Early predictions for 2003 were for 116 cases, but current trends, if they stay steady will be closer to 102. This is a 300 percent increase over the 37 cases reported in 2002.

“Which was more than the 25 we had in the last three or four years,” said Dr. Robert Gunn, director of the county’s Sexually Transmitted Diseases and Hepatitis Prevention Program. “Before that we were at real low levels, almost what they call elimination levels.”

Of the 85 reported cases, 44 of them were in people who had HIV and 60 percent of those were among MSM.

“It’s just a small portion of the gay community,” Gunn noted. “Especially HIV-infected gay men who are pairing up … but because of that they are not using safe sex during those encounters and they’re transmitting syphilis to each other. Plus about 40 percent of the cases are not HIV-positive … and at the same time you transmit syphilis you have an increased risk of transmitting HIV.”

The CDC research has highlighted increases in unprotected sex among the MSM population, as well as high rates of HIV co-infection among men diagnosed with syphilis. “Prevention challenges for gay and bisexual men may include a low level of concern about other STDs, as well as the belief that treatment advances mean HIV is no longer a deadly illness, resulting in relaxed attitudes toward safer sex practices,” said Dr. John Douglas, director of CDC’s STD prevention programs.

“Men are getting partners through the Internet; they are soliciting anonymous partners,” Gunn said about local trends. “Some are still going to bathhouses and there are some drugs involved. We know a fair number have reported the use of methamphetamines and other drugs, which of course mess up your judgment.”

Like other STDs, syphilis helps drive HIV transmission. Recent studies of MSMs have documented increased risk-taking, increased syphilis outbreaks and a high rate of HIV co-infection. An HIV co-infection with syphilis also brings on the risk of acute neurosyphilis, which can lead to blindness or paralysis.

“It’s a tough situation,” Gunn said. “Gay men are abandoning safe sex because [they think] HIV is … if not curable it’s ‘treatable,’ and that you can live a fairly normal life.… A lot of these drugs have side effects and they still may shorten your life, and there are all sorts of complications from the drugs. It’s not as rosy a picture as sometimes gets painted, therefore it’s a tough issue to motivate gay men to have safe sex.”