Syphilis cases in King County reached a 30-year high in 2010, prompting public health officials to call for increased testing and education for high-risk populations, especially men who have sex with men. In 2010, 283 cases of syphilis were reported, an 82 percent increase from 2009. Syphilis had been virtually eliminated in King County in the early-1990s.
Public health officials do not fully understand what is causing the upswing in cases, but are actively working to investigate possible causes, increase syphilis testing, speed-up treatment, and improve partner notification. Rates of syphilis among gay and bisexual men also appear to be increasing in other areas of the U.S.
Gay and bisexual men – especially those who are HIV-positive – have the highest rates of syphilis. Of cases diagnosed, 90 percent in 2010 were in men who have sex with men, with HIV-positive gay and bisexual men making up 58 percent of those cases.
“Public Health, medical providers and the gay and bisexual community need to work together to solve this important problem,” said Dr. Matthew Golden, Director of the Public Health- Seattle & King County HIV/STD Program. “We need medical providers to test their gay and bisexual patients for syphilis often and to be vigilant in looking for signs of the infection. However, perhaps more than anything, we need men who have sex with men to take action.”
Public Health urges men who have sex with men to use condoms, to test for STDs often, and to immediately seek medical attention if they develop a sore on their genitals or any kind of new rash.
“Men who have sex with men need to ask their medical providers to test for syphilis,” said Golden. “Don’t assume that providers will test for syphilis in a routine STD screening or that they will recognize the rash.”
Syphilis causes a broad range of symptoms that can make it hard to diagnose, particularly for providers who don’t see a lot of patients with syphilis. Importantly, syphilis is caused by a bacterial infection and is curable with antibiotics.
Shortly after infection, syphilis causes an ulcer on the genitals, anus or mouth. However, the ulcers often go unnoticed because they are painless or in areas of the body that aren’t easily seen. After the sore heals, syphilis causes a body rash that can include the palms of the hands and soles of the feet. This, too, can go unnoticed by men and their medical providers.
Once the rash resolves, men have no symptoms but are still infected and are still at risk for severe medical consequences, including vision loss, loss of hearing and stroke. Among recent cases, at least six persons have suffered some loss of vision, though most affected persons’ symptoms improved with treatment.
Condoms can prevent the spread of syphilis. However, many men are unaware that syphilis can be spread through oral sex. The Public Health HIV/STD Program advises that all sexually active men who have sex with men should be routinely tested for STDs, including syphilis, gonorrhea, chlamydia and HIV. All men who have sex with men should be tested annually, and men with higher risk should be tested once every three months. Since syphilis increases the risk of acquiring and transmitting HIV infection, anyone diagnosed with syphilis should be tested for HIV.
STD testing is available in primary care medical providers’ offices, Gay City Wellness Center, the King County STD Clinic, and other public health clinics. For more information, please visit the Public Health – Seattle & King County HIV/STD Program website at www.kingcounty.gov/health/std.
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