Antibiotic-resistant strain of syphilis is spreading

A fast-spreading mutant strain of syphilis has proved resistant to the antibiotic pills that are offered to some patients as an alternative to painful penicillin shots.

Since the late 1990s, doctors and public health clinics have been giving azithromycin to some syphilis patients because the long-acting antibiotic pill was highly effective and easy to use. Four pills taken at once were usually enough to cure syphilis.

But now researchers at University of Washington in Seattle have found at least 10 percent of syphilis samples from patients at sexually transmitted disease clinics in four cities had a strain resistant to azithromycin.

"That suggests that this mutation is pretty widely distributed geographically," said Sheila A. Lukehart, research professor of infectious diseases.

The percentage of samples from San Francisco with the mutant strain jumped from 4 percent in 1999-2002 to 37 percent in 2003, with the increase taking place largely among gay or bisexual men with multiple partners.

Experts say doctors should switch to penicillin or other antibiotics if azithromycin does not work. But some of those antibiotics can cause nausea and other side effects and must be taken for two weeks; some patients do not complete their treatment and are not cured.

Experts said the findings also show that syphilis patients treated with azithromycin must have follow-up tests to be sure they are cured. After syphilis sores disappear, the disease can silently attack the brain and cause dementia, paralysis and death.

Penicillin has long been the recommended treatment for syphilis. But it must be given in two buttocks injections much more painful than typical shots, because a large amount of the solution must be forced into the muscle.

Syphilis decreased in the United States through the 1990s, then climbed 19 percent from 2000 to 2003 to about 7,100 cases, according to the Centers for Disease Control and Prevention.

The CDC attributed the spike to a twelvefold rise in cases among gay and bisexual men, many of whom are also infected with the AIDS virus.

Lukehart studied 114 syphilis samples from Seattle, San Francisco, Baltimore and Dublin, Ireland, finding 28 percent were resistant to azithromycin, including 88 percent of the Dublin samples.

Dr. John Douglas, director of the CDC's division of sexually transmitted disease prevention, said the agency is formulating a plan to test for resistant strains in some areas.

http://www.thestranger.com/2003-06-05/feature.html

Thanks to the behavior of a small minority of gay men in the Seattle area, syphilis is at extremely high levels, HIV infections are spiking, cases of gonorrhea have doubled, and cases of chlamydia have tripled. What is the gay men's health movement doing about the problem? The Stranger asked local gay health leaders, and concluded they're making excuses and ducking tough questions as the problem gets much, much worse.

Fact: After years of decline, the number of syphilis cases among gay men in King County has recently risen to extremely high levels, according to the county's department of public health. The years of decline began in 1981, when AIDS scared gay men away from the orgiastic sex practices of the 1970s. By 1988, with AIDS devastating the gay community and safe sex or abstinence seemingly the only alternative to death, syphilis almost disappeared among gay men in this area. Eight years later, it had disappeared -- in 1996, there were zero syphilis cases among local gay men.

Then in 1997, the year that powerful new AIDS drugs became widely available, the number of gay men with syphilis began to climb. If the upward trend continues, there could be as many as 120 new cases of syphilis among local gay men this year. In other words, thanks to many gay men going retro in their sexual behavior, the rates of syphilis among gay men in this area are now at levels not seen since the early 1980s -- levels that are more than 100 times those found among the area's heterosexuals.

Fact: It's not just syphilis that's making a comeback in the gay community. King County's director of STD control, Dr. Hunter Handsfield, says that chlamydia and gonorrhea are also at extremely high levels. Between 1997 and 2002, Handsfield estimates, the number of cases of gonorrhea among local gay men at least doubled, and possibly increased as much as fourfold. In the same period, the number of gay men appearing in the King County STD clinic with chlamydia more than tripled. Syphilis, gonorrhea, and chlamydia are all treatable, but their increased prevalence among gay men is alarming because the same behaviors that transmit syphilis, gonorrhea, and chlamydia also transmit HIV--for which, by the way, there is still no cure. "Things are trending in a bad direction," says Dr. Bob Wood, director of the HIV/AIDS program at Public Health -- Seattle & King County, the county's public health department. "We know that people don't get these STDs without having unprotected sex."

Fact: A study of nearly 1,000 Seattle gay men conducted at health clinics between August 1999 and May 2000 found that more than one-third of the HIV-positive men and nearly two-thirds of the HIV-negative men had recently had sex with guys whose HIV status they did not know. Not surprisingly, this study found that many of the guys who were not asking for their sex partners' HIV status were also not telling. Nearly half of the HIV-positive men in the study reported being inconsistent in telling their sex partners they were positive. The nightmare scenario would be if these don't-ask-don't-tell men were having lots of unprotected anal sex, which is one of the most efficient ways to transmit HIV. And that's exactly what the study found: More than 80 percent of all the gay men surveyed reported having had anal sex recently, and more than two-thirds of the men who were HIV-positive reported using condoms inconsistently; one-third of positive guys said they never used condoms at all.

Fact: The department of public health estimates there are about 42,500 gay men in King County, and more than 2,500 of those men are living with HIV. Since the early 1990s, the county estimates, the rate of new HIV infections in gay men has remained stable at about 400 a year.

But this week, the county announced what had long been suspected, given the rising STD rates and the behavior gay men have been reporting: Over the last two years, there has been a spike in the number of people diagnosed with HIV in county health clinics. Between 2001 and 2002 there was a 40 percent increase in new HIV diagnoses. If this year's pace keeps up, the increase between 2002 and 2003 will be 60 percent.

This strongly suggests we are experiencing a wave of new HIV infections, health officials say. And with fewer people dying from AIDS thanks to the new drugs, and the rate of new infections climbing, more and more people are going to be living with HIV in our community over the coming years. Add to that the increases in reported unsafe behavior among gay men--both HIV-positive and HIV-negative--and health officials see what's coming: even more new HIV infections.

What does all this mean? It means that in 2003, more than 34 years after Stonewall, 22 years after AIDS was discovered, and after two decades and tens of millions of dollars have been invested in HIV prevention campaigns and safe-sex messages, the gay community is still a bastion of disease and unhealthiness. In Seattle and other gay centers, gay men are still getting infected with HIV and contracting other STDs at higher rates than any other group.

According to the Centers for Disease Control and Prevention (CDC), gay men are largely responsible for the fact that syphilis, which seemed on its way out of existence in this country, is now resurgent. And although we have new drugs that help those of us with HIV live longer, many of us seem to be intent upon using the existence of these drugs as an excuse to re-create the conditions that allowed AIDS to flourish in the gay community in the first place: high rates of multipartnerism, high rates of unsafe sex, high rates of drug and alcohol use.

How did we get here? Amnesia on the part of gay men and irresponsibility on the part of gay men's health organizations. In the span of a few years, gay men seem to have forgotten how bad AIDS was (and is -- just ask the guys who have it) while at the same time neglecting to realize that our present behavior makes our future bleak. As gay activist Gabriel Rotello wrote in his book, Sexual Ecology, which was published six years ago, just before the new AIDS drugs became available: "Almost every researcher studying the [AIDS] epidemic is convinced of one overarching fact: that if gay men ever re-create the sexual conditions of the seventies, the same kind of thing will happen again with other microbes." Sure enough, earlier this year a mysterious, drug-resistant form of staph infection emerged in the Los Angeles gay community. Other new infections and illnesses are surely out there, waiting to wiggle into our disease-friendly group. Which, as Rotello wrote, raises "the grim, almost unthinkable possibility that for gay men, sexual freedom leads inexorably to disease."

You might expect a "gay men's health movement" to be outraged about this state of affairs. You might expect them to be shouting and stopping people on the street and shaking them and saying, "Do you realize what's going on? Do you realize what's going to happen to our community if we keep this up?" You might expect that people like me -- young, gay, single, and living on Capitol Hill -- have been told that there are extremely high levels of STDs among gay men in Seattle, and you might expect that we've heard this from the local gay health organizations that claim to serve us. Since the problem is so serious, you might expect these local gay health leaders to be responding seriously: making serious statements, promoting serious prevention initiatives, going to serious national conferences, and behaving seriously. Well, if you expect all this you will be disappointed.

cont'd

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