Bill Weintraub

Super Gonorrhea, Drug Resistant Syphilis

3-21-2004

Two more potentially fatal diseases which, among men who have sex with men, are primarily anally-transmitted:

Resistant Form of Gonorrhea Gains Foothold

[Boston Globe, 3/10/04]

In Massachusetts, disease trackers have reported a strain of gonorrhea that cannot be treated with standard antibiotics. First discovered in the state in 2002, the drug-resistant bacteria affected one of every seven gonorrhea patients in the state last year. Maine reported its first case in January, and although other New England health departments do not routinely test for the new strain, health officials suspect its presence.

Infectious disease specialists fear cases of drug-resistant gonorrhea will spread exponentially as patients are unwittingly prescribed drugs that do not work. Thinking they are cured, patients may resume ?unsafe? sex practices and pass on the infection. Federal health officials are monitoring the spread of the drug-resistant bacteria, first discovered on the West Coast about four years ago. CDC investigators said the Massachusetts outbreak appears more severe than clusters recently reported in Seattle, Las Vegas, Chicago, Dallas and Philadelphia.

CDC investigators predict the new gonorrhea strain could increase HIV infections, because people with gonorrhea's open sores can more easily contract and spread HIV.

The resistant gonorrhea strain is emerging as STDs have begun to rebound, and state funding cuts have reduced the number of Massachusetts STD clinics. Gonorrhea cases had declined slightly in Massachusetts over the past two years. However, the 3,010 diagnoses reported in 2003 represent a 45 percent increase since 1997, when cases were at a historic low. Nationally, gonorrhea cases grew by 7 percent from 1997-2002.

Drug resistance has long been a problem with gonorrhea, and infectious disease doctors fear that eventually gonorrhea may become resistant to all the antibiotics available to treat it.

We're burning through antibiotics," said Dr. Jeffrey Klausner, director of STD prevention and control services for the San Francisco Department of Public Health. "What happens when we burn through them all?" he asked.

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Gay Men with Syphilis Diagnosed Later and Remain Infectious Longer

[Advocate.com, 3/13-15/04]

Gay and bisexual men who have syphilis tend to get diagnosed later and remain infectious longer than heterosexuals, according to a study presented by the Centers for Disease Control and Prevention at the National STD Prevention Conference in Philadelphia.

Gay men are 45 percent less likely to be diagnosed with the disease during the primary stage of infection, allowing them to potentially expose sex partners to the virus [sic] for longer periods of time.

Researchers analyzed data from 201 primary and secondary syphilis cases diagnosed in San Diego County between January 2000 and December 2003.

Seventy-two percent of the cases were reported among gay and bisexual men.

In addition to being diagnosed later, gay and bisexual men with syphilis also tended to have a higher number of sex partners than heterosexual men and were less likely to have contact information for their sex partners, either because they met them online or had anonymous sex.

The CDC researchers called for targeted prevention programs to address the health needs of gay and bisexual men, including campaigns to urge them to be tested for syphilis infection to better diagnose the disease at its earliest stages.

Primary syphilis is marked by the appearance of small, painless open sores-- or chancres--on the genitals, anus, or in the mouth, if the bacteria is transmitted through oral sex. Secondary syphilis is marked by the spread of the bacteria throughout the body about two to eight weeks after primary infection, and includes such symptoms as a skin rash that commonly appears on the palms of the hands and soles of the feet; lesions in the mouth or on the penis; and such general symptoms as fever, fatigue, loss of appetite, and swollen lymph nodes.

Although syphilis is most easily spread through the open sores during primary infection, the sexually transmitted disease can still be transmitted during secondary infection. Tertiary or late-stage syphilis generally occurs within three to 15 years of infection and includes neurological and cardiac complications that can result in death. Syphilis can be cured with antibiotic treatment.

[Except when it can't; see next story:]

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Syphilis Developing Resistance to Antibiotic

[Reuters, 3/11/04]

A federal study released on Thursday found that syphilis may be developing resistance to one of the antibiotics used to treat it. San Francisco health officials documented eight cases in 2002 and 2003 in which single oral doses of azithromycin apparently did not cure the infection, according to a report published by CDC.

All the patients were gay males, five of whom had HIV. They were later successfully treated with either doxycycline or penicillin, the CDC's preferred antibiotic for treating syphilis.

Dr. Samuel Mitchell, a CDC epidemiologist and one of the authors of the study, said the San Francisco City Clinic has since dropped azithromycin for treating most cases of primary, secondary or early-latent syphilis. Azithromycin's apparent failure to cure syphilis is a disappointment to infectious disease specialists, who had hoped a single 1- or 2-gram oral dose would offer a more convenient, better treatment for many syphilis infections. It is easier to administer than benzathine penicillin, an antibiotic that is usually injected.

"The downside of azithromycin becoming less useful is that it will probably limit our ability to do in-the-field prophylactic treatment," said Mitchell. He urged doctors still prescribing the drug for syphilis to follow patients closely. Several studies have shown that azithromycin was effective in patients who did not have HIV.

The new study came out three days after CDC reported that the nation's syphilis rate appeared to have risen for the third consecutive year, mostly due to rising infections among gay and bisexual men. CDC estimated that 60 percent of cases last year occurred among men who have sex with men, compared to 5 percent in 1999.

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I've posted these as a cautionary tale for men into Frot.

Because I'm seeing too much promiscuity among you.

And although your chances of getting gonorrhea or syphilis through Frot are extremely low, the more partners you have, the more likely you are to acquire something.

As Frot becomes better known, more and more gay male sexual omnivores are adding it to their repertoire.

So a man may post in a club like this one, saying he's looking for c2c, but have an online profile somewhere else which lists his interests as anal, oral, rimming, frottage, JO, etc.

That sort of man, who's trolling for internet "hook-ups," is a real problem.

Because the likelihood is that he's got multiple STIs.

And that's why I'm so strict with our boards.

But there's no way I can weed out every bad character.

So:

Limit yourself to one partner whom you know well.

If you're married, you're probably better off with another married man, because the rate of promiscuity is lower among straight-identified men and so is the rate of STIs.

Yes, it matters *greatly* what you do:

If you don't do anal or oral, you're far safer.

But it also matters how many partners you have.

One is best.

Fidelity and Frot

That's the winning combination physically, emotionally, and spiritually.

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