Syphilis and HIV: A Dangerous Duo Affecting Gay and Bisexual Men
December 13, 2012 |
By Gail Bolan, M.D., Director, Division of STD Prevention, Centers for Disease Control and Prevention
Trend data released today in CDC's 2011 STD Surveillance Report show that primary and secondary syphilis rates are
increasing among gay and bisexual men, who now account for more than 70% of all infections. During the 1990s, syphilis primarily
occurred among heterosexual men and women of racial and ethnic minority groups. However, the tide shifted and cases began to
increase among gay and bisexual men, referred to as men who have sex with men (MSM) in CDC data systems. A growing number
of these cases have been reported among young MSM, with the highest rates being found in men 20-29 years old. What is
causing this shift? And what should we be doing differently?
Syphilis & HIV
Annual syphilis surveillance data published in the just released 2011 STD Surveillance Report continue to
emphasize the disproportionate burden of disease among gay and bisexual men. While the health problems caused by syphilis in adults are
serious in their own right, it has been shown that the genital sores caused by syphilis make it easier to transmit and acquire HIV
infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis
is present, and studies have also shown that syphilis will increase the viral load of someone who is already HIV infected.
This is especially concerning, as data from several major cities throughout the country indicate that an average of
four in 10 MSM with syphilis are also infected with HIV. The stakes are too high to ignore these health
disparities. It is critically important that syphilis infections among MSM be promptly diagnosed and
treated in order to decrease the rates of subsequent HIV infection.
Moving Forward: MSM and Syphilis Prevention
If we are to tackle the root causes of health disparities among gay and bisexual men, we must confront the underlying conditions that place this
population at greater risk for STDs. Risk behavior alone does not explain the disproportionate STD burden these men face-complex issues
like homophobia and stigma also help fuel the infections. CDC is working with program partners to take action to confront the
underlying causes of STD disparities. One example is the movement to go beyond disease-specific prevention approaches and
provide more comprehensive, holistic sexual healthcare through Program Collaboration and Service Integration -an effort
to organize and blend interrelated health issues (like HIV and STD prevention), activities, and prevention strategies to facilitate
comprehensive delivery of services. Action plans guided by the best available science and input from partners are also being
implemented to help individuals and communities overcome environmental forces that increase the risk of acquiring an STD.
However, governments' efforts cannot do it alone-broader action is also needed by all parties involved. Many Americans
are reluctant to discuss sexual health issues, though STDs are very common. Together we can bring these conversations
out of the shadows:
Health Care Providers should.
- Assess their patients' risk for STDs, especially MSM
- Test patients according to CDC's STD testing recommendations at the site of exposure
- Talk openly with your doctor or health care provider and ask to be tested-your health depends on it
- Talk openly with partner(s) about STDs and testing
- Get tested for STDs-go to FindSTDTest.org or call 800-CDC-INFO to find a site near you
- Use a condom correctly each time you have sex and/or practice mutual monogamy with an uninfected partner to reduce your risk of getting syphilis
Community leaders should.
- Engage other sectors (business, transportation, housing) to help promote STD prevention and sexual health
- Speak out about STDs and fight stigma
With timely diagnosis and appropriate treatment, syphilis is curable. By remaining vigilant and promoting greater awareness and
action, we can turn the tide against this disease and help stop the spread of HIV. We can help ensure good health for gay and
bisexual men who are disproportionately impacted by STDs as well as HIV.
- Viral Hepatitis: A Health Concern for Gay and Bisexual Men Deserving Attention During LGBT Pride Month
- Focusing HIV Prevention Efforts on Gay and Bisexual Men
- HHS Consultation on HIV among Black Gay and Bisexual Men
- Addressing the HIV Epidemic among Gay and Bisexual Men
- Working with the Community to Reduce New HIV Infections Among Gay and Bisexual Men and Transgender Women
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