The 2004 National STD Prevention Conference, held this week in Philadelphia, showcased more bad news on sexually transmitted diseases among gay and bisexual men and it included one report of an emerging disease trend among men who have sex with men (MSMs).
Syphilis cases increased nationally in 2003 for the third consecutive year, with most of the increase over the 2002 data attributed to cases among men who have sex with men.
“Those increases have been among men only, in particular among gay and bisexual men,” said Dr. John Douglas, director of the Division of STD Prevention at the federal Centers for Disease Control and Prevention (CDC), during a March 8 telephone briefing.
The CDC estimated that more than 60 percent of the 2003 cases occurred among gay and bisexual men compared with 1999, when those men accounted for just five percent of the syphilis cases.
In an HMO era, when doctors spend less time with patients, it is likely that sexually transmitted diseases are only diagnosed when patients come forward with systems. Most observers agree that doctors never routinely test for them, and that many doctors fail to file required reports with health officials. The CDC numbers are probably low.
“I think we’ve been pretty clear that we consider these to be underestimated,” said Dr. Ronald O. Valdiserri, deputy director at the CDC’s National Center for HIV, STD and TB Prevention, in a March 10 telephone briefing.
“Clearly, CDC is very concerned about these data. This is not the first time we’ve reported increases in STDs among MSMs.”
The New York City health department reported on March 10 that syphilis among gay and bisexual men increased in 2003 over 2002. There were 531 syphilis cases in 2003 compared to 434 in 2002, a 22 percent increase. Previously, the city had a “nearly threefold increase from 117 cases in 2000 to 434 cases in 2002,” according to a city press release.
“More than 95 percent of the syphilis cases were among men, particularly gay and bisexual men and white men who live in Manhattan,” the health department said.
Also during the March 10 CDC briefing, researchers reported new data on crystal meth, Viagra, and unsafe sex.
A CDC study of 388 gay and bisexual men found that crystal users were twice as likely as non-users to report engaging in “unprotected receptive anal intercourse.”
A study from San Francisco’s health department found that gay and bisexual men who used crystal and Viagra together were 6.2 times more likely to be diagnosed with syphilis than their peers who did not use either drug.
A second San Francisco health department study found that men who have sex with men who used crystal were twice as likely to be HIV-positive, 4.9 times more likely to have syphilis, and 1.7 times more likely to have gonorrhea than gay and bisexual men who did not use the drug.
The CDC does not have the data to show whether crystal, as it has spread from the West coast to the East coast, is driving the increases in HIV infections among gay and bisexual men across the country.
“We don’t see a direct link, but we do see changes co-occurring,” said Gordon Mansergh, a CDC behavioral scientist.
The March 10 briefing included particularly disturbing data from Seattle, where public health authorities reported that gonorrhea resistant to treatment by some antibiotics went from zero percent of their cases at the start of 2003 to 16.5 percent by the end of 2003. Ninety percent of the resistant cases were among gay and bisexual men.
“The resistance is spreading most rapidly in that population that is most efficient at spreading it, and that is unfortunately gay men,” said Dr. H. Hunter Handsfield, director of the STD Control Program at the Public Health Seattle and King County. “This is a significant concern that we want to stay on top of.”
This type of resistance has previously appeared in Hawaii and California. Another study set to be issued this week reports such resistance among gay men in Massachusetts.
