New CDC report shows disproportionate risk of syphilis among gay men in Florida

By : Billy Manes
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Though its symptoms may be considered minor in relation to other sexually transmitted diseases, syphilis has raised concern among scientists at the Centers for Disease Control. Among the general population, syphilis infections jumped 15 percent between 2013 and 2014. The growing scourge led the CDC to present its first study of syphilis transmission among gay men, Rates of Primary and Secondary Syphilis by State Among Men Who Have Sex With Men, at its 2016 STD Prevention Conference. The disease is treatable, though often ignored.

“CDC has tracked syphilis through the National Notifiable Diseases Surveillance System since 1944,” CDC epidemiologist and author of the study Alex de Voux Ph.D., says in an email. “Once nearly eliminated in the U.S., syphilis continues to increase among gay and bisexual men. Based on this data, we believe the number of reported cases of primary and secondary (P&S) syphilis among men who have sex wih men (MSM) has been increasing since at least 2001. Among states that reported sex of sex partner data for at least 70 percent of all cases from 2007 to 2014, cases among MSM increased nearly nine percent from 2013 to 2014, and 48 percent from 2010 to 2014.

The new statistics reveal that Florida has a rate of 370.1 per 100,000 gay and bisexual residents infected with syphilis, which far surpasses the national average of 309 per 100,000. It should be noted, however, that syphilis is creating a larger problem for other states, largely in the south: North Carolina reports a 748.3 per 100,000 rate among the MSM population, Mississippi, Louisiana and South Carolina follow.

“The state rate of P&S syphilis among MSM does not necessarily correspond with the population size of MSM in the state,” de Voux says. “The state-level syphilis rates do show that syphilis disproportionately affects gay and bisexual men in the South and the West, with four of the five states with the highest rates of P&S among MSM located in the South. This may be because people in the South often experience poorer health outcomes than the rest of the nation, due to multiple factors including income inequality, poverty, and high numbers of people without health insurance. Additionally, high prevalence of syphilis within their sexual networks means that MSM in these areas face a greater risk of infection with each act of sexual intercourse.”

The report also reveals that syphilis cases among gay and bisexual men have been on the rise for a decade, and it suggests that this is not a matter to be taken lightly. Left untreated, syphilis can lead to organ damage, nerve damage, liver damage and more. The key means of prevention is condom use, but often condoms are improperly used, de Voux says, and contact with a sore outside of the condom can easily lead to infection.

Condoms prevent the spread of syphilis by preventing contact with a sore, however sometimes sores can occur in areas not covered by a condom, so it’s possible to get syphilis even if a condom is used properly. Proper condom use Dos and Don’ts can be found [at cdc.gov]. This includes unrolling the condom all the way down the penis, using a latex condom every time one engages in sexual intercourse, putting the condom on before having sex, proper storage, and using a water-based or silicone-based lubricant to prevent breakage.

But the correlation to causation on condom-use in this study isn’t necessarily clear, the CDC admits.

“Neither study on MSM and syphilis presented at the 2016 STD conference looks at the correlation between MSM condom use and STDs,” CDC epidemiologist Cyprian Wejnert PhD says. “We do know there are a number of factors that could put MSM at increased risk for syphilis, including higher background prevalence. Data from CDC’s National HIV Behavioral Surveillance do indicate that condom-use decreased among MSM from 2005 to 2014, however these data do not confirm a correlation between condom use and increasing syphilis diagnoses among MSM.”

At least for now, there is no real panic. The CDC recommends that sexually active gay and bisexual males get tested annually as a precaution. Planned Parenthood of Southwest and Central Florida vice president Dr. Suzie Prabhakaran makes it clear that syphilis is indeed treatable by antibiotics, and should be, given the consequences. However, her offices haven’t seen any real uptick in cases, she says.

“We have not yet seen an increase in cases of syphilis with our patients,” she says. “At Planned Parenthood, we always include syphilis testing in the recommended STI testing for appropriate groups according to guidelines provided by the Centers for Disease Control and Prevention. Syphilis often has no symptoms and protecting yourself from syphilis is similar to any other sexually transmitted infection. This includes condom use and screening if you think you may be at risk. This is another reason why access to Planned Parenthood services are so critical, especially for MSM who may not have many healthcare providers they feel comfortable visiting.”

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