Syphilis, a sexually transmitted disease once on the cusp of extinction in the United States, continues a dramatic and dangerous rebound both nationally and regionally, and disease trackers fear that the rise could herald an explosion of new HIV cases.
Federal disease investigators reported yesterday that after a decade of steadily plummeting, syphilis cases rose in 2002 for the second straight year, climbing 12.4 percent, with much of that increase rooted among men who have sex with other men. Boston had the 15th highest rate of syphilis among US cities, with eight cases per 100,000 people, a figure double that of Los Angeles and substantially higher than New York.
The figures released by the US Centers for Disease Control and Prevention chronicle a shift in a disease that once was identified mainly as a scourge of African-Americans in the South. Now, even as levels of syphilis drop significantly in black communities, they are soaring in gay enclaves in urban centers.
The increase in syphilis cases among men, specialists said yesterday, reflect complex changes in sexual behavior and the means of meeting sexual companions two decades deep into the AIDS epidemic, and they fear those same changes may foreshadow a new wave of HIV.
"We are extremely concerned about that possibility when you look at these outbreaks, and also combine that with other important information like the increased rate of HIV diagnoses among men who have sex with men," said Dr. Ronald O. Valdiserri, deputy director of the CDC division devoted to preventing sexually transmitted diseases. "The job of eliminating syphilis in the United States is not done."
Massachusetts provides a telling snapshot of the challenges confronted by disease specialists. Despite initiatives to prevent the bacterial illness -- with everything from condoms to vouchers for free syphilis tests distributed at bars, cafes, and other venues frequented by gay and bisexual men -- the number of cases in the state nearly doubled from 2001 to 2002, from 106 to 197.
"We're talking about small numbers still, but numbers that are going in the wrong direction," said Dr. Alfred DeMaria, the state's director of communicable disease control.
Because the numbers are relatively small, an increase by a few cases -- attributable, for instance, to more vigilant reporting by doctors -- can easily change a city's ranking, said Dr. Anita Barry, director of communicable disease control for the Boston Public Health Commission. That attention to testing and reporting, Barry said, may explain why Boston reports a higher rate of syphilis than New York or Los Angeles.
Still, specialists said, there's no denying that syphilis has returned to the gay and bisexual communities with a ferocity not seen for more than 20 years. In fact, while 50 percent of syphilis cases in Massachusetts in 1981 were traced to men having sex with men, that figure dropped to fewer than 1 percent by 1991.
It was AIDS that led to the adoption of safer sexual practices in the 1980s, and it is the changing profile of that epidemic that may explain the resurgence of syphilis.
"We have a different epidemic now than we did 20 years ago -- 20 years ago it was a crisis," said Louise Rice, director of prevention at AIDS Action Committee of Massachusetts. "A lot of people were motivated to change."
Today, with the arrival of powerful drug cocktails, AIDS is just as likely to be viewed as a chronic illness that can be controlled. That belief, in turn, has led to a resumption of unsafe sexual practices, fueled by the use of club drugs such as ecstasy and sexual liaisons arranged over the Internet.
Those risky behaviors can result in exposure to syphilis, a condition that can be cured with penicillin. Left untreated it can spawn rashes, sores, and, in the most extreme cases, brain damage. The sores can serve as portals for direct entry into the bloodstream of other pathogens -- including HIV.
CDC investigators are examining whether strategies used to reduce syphilis levels among African Americans can be used to battle the infection among gay men. While syphilis rates among blacks remain 8.2 times higher than among whites, cases in the African-American community are declining, falling 10.3 percent from 2001 to 2002.
In many respects, CDC authorities said, the spread of syphilis among blacks represents a different array of medical and economic issues than in the gay and bisexual community, requiring different approaches.
"Now, having said that," Valdiserri said, "it is important to underscore that better surveillance, community awareness campaigns, and improved access to testing and treatment are equally important in terms of addressing syphilis increases among gay and bisexual male communities."
Federal disease investigators reported yesterday that after a decade of steadily plummeting, syphilis cases rose in 2002 for the second straight year, climbing 12.4 percent, with much of that increase rooted among men who have sex with other men. Boston had the 15th highest rate of syphilis among US cities, with eight cases per 100,000 people, a figure double that of Los Angeles and substantially higher than New York.
The figures released by the US Centers for Disease Control and Prevention chronicle a shift in a disease that once was identified mainly as a scourge of African-Americans in the South. Now, even as levels of syphilis drop significantly in black communities, they are soaring in gay enclaves in urban centers.
The increase in syphilis cases among men, specialists said yesterday, reflect complex changes in sexual behavior and the means of meeting sexual companions two decades deep into the AIDS epidemic, and they fear those same changes may foreshadow a new wave of HIV.
"We are extremely concerned about that possibility when you look at these outbreaks, and also combine that with other important information like the increased rate of HIV diagnoses among men who have sex with men," said Dr. Ronald O. Valdiserri, deputy director of the CDC division devoted to preventing sexually transmitted diseases. "The job of eliminating syphilis in the United States is not done."
Massachusetts provides a telling snapshot of the challenges confronted by disease specialists. Despite initiatives to prevent the bacterial illness -- with everything from condoms to vouchers for free syphilis tests distributed at bars, cafes, and other venues frequented by gay and bisexual men -- the number of cases in the state nearly doubled from 2001 to 2002, from 106 to 197.
"We're talking about small numbers still, but numbers that are going in the wrong direction," said Dr. Alfred DeMaria, the state's director of communicable disease control.
Because the numbers are relatively small, an increase by a few cases -- attributable, for instance, to more vigilant reporting by doctors -- can easily change a city's ranking, said Dr. Anita Barry, director of communicable disease control for the Boston Public Health Commission. That attention to testing and reporting, Barry said, may explain why Boston reports a higher rate of syphilis than New York or Los Angeles.
Still, specialists said, there's no denying that syphilis has returned to the gay and bisexual communities with a ferocity not seen for more than 20 years. In fact, while 50 percent of syphilis cases in Massachusetts in 1981 were traced to men having sex with men, that figure dropped to fewer than 1 percent by 1991.
It was AIDS that led to the adoption of safer sexual practices in the 1980s, and it is the changing profile of that epidemic that may explain the resurgence of syphilis.
"We have a different epidemic now than we did 20 years ago -- 20 years ago it was a crisis," said Louise Rice, director of prevention at AIDS Action Committee of Massachusetts. "A lot of people were motivated to change."
Today, with the arrival of powerful drug cocktails, AIDS is just as likely to be viewed as a chronic illness that can be controlled. That belief, in turn, has led to a resumption of unsafe sexual practices, fueled by the use of club drugs such as ecstasy and sexual liaisons arranged over the Internet.
Those risky behaviors can result in exposure to syphilis, a condition that can be cured with penicillin. Left untreated it can spawn rashes, sores, and, in the most extreme cases, brain damage. The sores can serve as portals for direct entry into the bloodstream of other pathogens -- including HIV.
CDC investigators are examining whether strategies used to reduce syphilis levels among African Americans can be used to battle the infection among gay men. While syphilis rates among blacks remain 8.2 times higher than among whites, cases in the African-American community are declining, falling 10.3 percent from 2001 to 2002.
In many respects, CDC authorities said, the spread of syphilis among blacks represents a different array of medical and economic issues than in the gay and bisexual community, requiring different approaches.
"Now, having said that," Valdiserri said, "it is important to underscore that better surveillance, community awareness campaigns, and improved access to testing and treatment are equally important in terms of addressing syphilis increases among gay and bisexual male communities."
