by Peter DelVecchio

The rate of syphilis infections in the United States surged for the seventh consecutive year in 2007, driven mostly by gay and bisexual men, according to a report entitled “Sexually Transmitted Disease Surveillance 2007,” released by the federal Centers for Disease Control and Prevention Jan. 13.

Chlamydia, long the most commonly reported disease in the United States, soared to record levels; the 2007 total “represents the largest number of cases ever reported to CDC for any condition,” according to a fact sheet accompanying the report. Gonorrhea rates remained stable, but at extremely high levels. The report “shows persistent racial disparities” for chlamydia and gonorrhea, “and a particularly heavy burden of disease among women,” a CDC release states.

“The report shows that [sexually transmitted diseases] remain a persistent although preventable threat, both to the health of women—with infertility—and for the health of men,” said Dr. Hillard Weinstock, a CDC medical epidemiologist, in an interview with IN Los Angeles magazine. “And certainly, in addition to that, these data continue to show that while all racial [and] ethnic groups are impacted by sexually transmitted infections, minorities again continue to bear the greatest burden of those infections, and with regard to syphilis, men who have sex with men continue to bear the greatest burden.”

The rate of primary and secondary syphilis, the disease’s most infectious stages, “decreased throughout the 1990s, and in 2000 reached an all-time low,” to the point where the disease was “once on the verge of elimination” as a public health threat, according to a CDC release. It “began re-emerging as a threat in 2001,” however, “and increased 15.2 percent between 2006 and 2007,” the release says.

The syphilis surge is apparently being driven in large part by gay and bisexual men, referred to in the report as “men who have sex with men,” or MSM.

“About 85 percent of syphilis cases in 2007 were in men, and we estimate about 65 percent of primary and secondary syphilis cases were among men who have sex with men,” Weinstock said.

The primary and secondary syphilis rate among men increased 17.9 percent in 2007, and is now six times the rate among women. “[T]he rates were almost equivalent a decade ago, suggesting that increases in men have largely been among men who have sex with men,” the CDC fact sheet states.

“The data themselves don’t explain why” syphilis rates are rising among MSM, Weinstock said. But “there’s been speculation about a number of factors, perhaps prevention fatigue in the gay and bisexual community, the fact that gay and bisexual men have heard these messages over and over and over again and aren’t hearing them anymore. Perhaps substance abuse is playing a role. Perhaps [it’s] the beneficial outcomes related to [HIV/AIDS drugs] as more HIV-infected men are feeling healthier and engaging in riskier behavior.”

Many new syphilis infections are occurring in HIV-positive men who have sex with HIV-positive partners, Dr. John Douglas, head of the CDC’s STD division, told Reuters. “Within that relationship, they are less concerned about the transmission of other conditions. They’re not using condoms. They believe that their partner already has got the worst they can get—they’ve got an HIV infection,” Douglas said.

Syphilis, along with chlamydia, gonorrhea and herpes, has been associated with increased HIV transmission, according to the CDC fact sheet.

The CDC recommends that MSM be tested at least annually not only for HIV, but for syphilis, chlamydia and gonorrhea. The agency is implementing “new strategies” aimed at MSM in the hardest-hit cities that “range from new Internet-based strategies for notifying sexual partners to education campaigns targeted to high-risk populations and healthcare providers.”

Los Angeles County ranked number one in the nation in terms of the absolute number of reported primary and secondary syphilis cases, with 919 cases. This was more than double the 454 cases reported by the number two location, Harris County, Texas. At 9.2 reported primary or secondary syphilis cases per 100,000 population, Los Angeles County’s rate was more than double the national rate of 3.8, but far below the apparent high of 52.4 reported for Orleans County, Louisiana.

The national chlamydia infection rate in 2007 was 370.2 per 100,000 population, up 7.5 percent from 2006, but the CDC believes the increase is “more likely a reflection of the continued expansion of screening and use of more sensitive tests, rather than an increase in the total burden of the disease in the United States.” The CDC also believes that most chlamydia cases go undiagnosed.

The U.S. gonorrhea infection rate for 2007 was 118.9 per 100,000 population. The rate declined by 74 percent from 1975-1997, but has remained relatively stable for the past decade.

Females, especially young and minority women, are most affected by chlamydia and gonorrhea. The 2007 chlamydia rate for women was three times that of men; women’s gonorrhea rate was also higher. Both diseases can be asymptomatic, and each can cause ectopic pregnancy, chronic pelvic pain and other serious health issues, including pelvic inflammatory disease, which the CDC estimates causes as many as 50,000 women to become infertile each year.

The report also demonstrates that, as in the past, STDs take the highest toll on minorities, especially African-Americans. Blacks make up 12 percent of the U.S. population, but represented roughly 70 percent of 2007 reported gonorrhea cases, and almost half of all chlamydia and syphilis cases.