The 'Other' STD: Syphilis in Gay & Bi Men

Gay, bisexual and other men who have sex with men accounted for 75 percent of all U.S. syphilis cases in 2012. Yet, the same group was responsible for only 62 percent of all HIV cases just a year earlier.

Since the early 80s, HIV has justifiably received a singular focus in this community as the major health issue, but, as HIV has become more manageable, that singular focus has become less justifiable. This singular focus on HIV minimizes or ignores other health risks, aggravating them. Among those already infected with HIV, this singular focus could produce a "what have I got to lose attitude." In Broward County in 2012, 44 percent of all syphilis cases occurred among HIV positive people.

While syphilis can increase the chances for transmission of HIV, high rates of syphilis among HIV positive people do not necessarily indicate HIV transmission. An unknown number of HIV positive men only have sex with other HIV positive men (serosorting). A singular focus on HIV, however, dramatically lessens the motivation to use condoms between men who are both HIV positive. HIV positive serosorting without condoms could be driving the epidemic of syphilis among HIV positive people.

Syphilis rates plummeted in the 90s and people talked of being able to eliminate it, until it made a come back among gay/bi men, particularly HIV positive men. The CDC reported that, its system of tracking new syphilis infections found that among gay bi and other men who have sex with men, about 40 percent of syphilis cases in 2011 occurred among HIV positive men. According to Morbidity and Mortality Weekly, a gay/bi or other man who has sex with men is 46 times more likely to be infected with syphilis than are other men.

According to HIV Nurse, and former STD clinic worker, John Marangio, gay and bi men should be paying attention to syphilis and four other STDs: Gonorrhea, chlamydia, human papilloma virus (HPV) and herpes simplex virus (HSV).

By itself, syphilis infection threatens health, but combined with HIV infection, it produces many more problems. People died from syphilis in the centuries before HIV emerged as a disease. Syphilis can interact with HIV infection, causing a spike in viral loads from undetectable to infectious, and possibly reducing the effectiveness of treatment. A syphilis infection can also make an HIV negative man more susceptible to HIV infection.

Chronic diseases such as syphilis, HIV, cancer, or heart disease differ from acute diseases like colds, the flu or food poisoning. These chronic diseases remain active in the body for long periods of time. They damage the body without showing any observable symptoms for much of that period. Doctors describe syphilis as having four stages: primary, secondary, latent and late. While the first and second stages will resolve without treatment, the disease is damaging the body. Health literacy involves learning to distinguish between acute and chronic disease.

Syphilis, like HIV, has found a niche in our community. The difficulty of perceiving the symptoms of the disease may make this community more vulnerable to syphilis. The painless symptomatic sore inside the rectum will be more difficult to notice than one on the penis. As this sore most actively transmits syphilis, infectious bottoms and their partners will have no clue as to their risk.

Condoms can prevent both syphilis and HIV. Given the increased risk and a high rate of syphilis infection, a regular simple blood test provides a better strategy than testing in response to a known risk behavior. Unlike HIV, syphilis can be cured.