The SF Chronicle, 4/19/03:

Syphilis rate skyrockets in Palm Springs

Health workers to attend annual gay party

With 30,000 gay revelers expected for this weekend's "White Party" in Palm Springs, public health officials and some gay leaders openly worry that it will fan the spread of syphilis.

"We're nervous that they're going to take it there, and we're nervous that they're going to bring it home," said Dr. Peter Kerndt, director of sexually transmitted disease control in Los Angeles County.

They have reason to be nervous. For the last two years, cases of the sexually transmitted disease have risen dramatically in the Palm Springs area and throughout California, driven primarily by gay and bisexual men.

Statewide, the number of new infectious syphilis cases nearly doubled last year, to 1,035. Los Angeles County reported 362 cases, up from 199 a year earlier. San Francisco logged 316 cases, more than two times the 2001 tally, according to preliminary estimates. County health officials found the majority of the new cases were among gay and bisexual men.

But Palm Springs, which is far smaller than either metropolitan area, has in one year developed one of the highest per capita rates of syphilis in the nation.

Riverside County in 2002 reported 54 new infectious syphilis cases -- 48 of them in the eastern part of the county that includes Palm Springs. The entire county reported only 17 cases of infectious syphilis a year earlier, said Barbara Cole, director of disease control for Riverside County.

The California Department of Health Services issued an alert in late January warning health authorities nationwide of the Palm Springs problem and asking them to report syphilis cases among people who recently traveled to the area. In part, the upsurge can be traced to the area's growing popularity among gay men for retirement and recreation.

"The disease is spreading dramatically here," said Robert Farrell, director of medical services at the Desert AIDS Project.

Syphilis, though easily treatable with antibiotics, can lead to blindness, neurological problems and even death if left untreated. But the disease is most worrisome, in the near term, for what it signifies: a breakdown in safe- sex practices that can lead to other sexually transmitted diseases, including HIV.

Many men with syphilis already are co-infected with HIV. In both San Francisco and Los Angeles County, at least half of those testing positive for syphilis are HIV-positive. Moreover, the sores caused by syphilis facilitate transmission of the AIDS virus.

Public health officials hope that by promoting syphilis prevention and testing at the 14th annual White Party, they will reach men at risk for HIV or those who have the virus but don't know it.

Volunteers are distributing laminated wallet-sized cards warning, "Check him out! Syphilis is spreading rapidly among gay men in the Coachella Valley. The increase in cases is dramatic and is impacting the health of individuals who are infected."

The reverse side of the cards includes information about symptoms, prevention strategies and treatment. In addition, hotels and bars are being asked to distribute condoms and lubricant, which helps prevent condoms from breaking, Cole said.

White Party founder Jeffrey Sanker -- whose Web site touting the event contains many photos of muscular, shirtless men -- said he is working with local health officials and volunteers to promote safer sex.

"The safety and comfort of my patrons is my No. 1 priority," Sanker said. "The continued risk of HIV infection as well as the recent outbreak of syphilis cases in the Palm Springs area are both issues we certainly cannot ignore."

Some White Party veterans said they are aware of the risks, and they take precautions.

"I've been to the White Party many times," said Riverside businessman Darren Conkerite, 36. "You need to be safe . . . but that shouldn't take away from the fun."

Officials in Los Angeles County and San Francisco are sending health workers to the party to help with education and testing -- although they acknowledged feeling somewhat helpless to control the spread of syphilis even in their own communities.

Charles Ornstein, Louis Sahagun, Los Angeles Times

Commentary by Bill Weintraub of The Man2Man Alliance.

Why is the distribution of condoms and lube not a good idea?

For starters, because it's been shown that condoms have a failure rate during *vaginal* sex of 20%.

That doesn't mean they break 20% of the time.

It means that over the course of a year, 1 person in 5 *becomes infected* with HIV during vaginal sex despite using a condom.

And that's during vaginal sex. Anal penetration is a lot rougher on a condom, and condoms fail more frequently during anal.

And that's when they're used. Since condoms are inconvenient and limit sensation, their use is spotty at best.

So -- distributing condoms and lube has two negative effects:

1. It once again tells men that sex between men has to anal, which increases the prevalence of anal and thus of HIV; and

2. It induces a false sense of security and consequently is dis-inhibiting -- the last thing you want to be around anal penetration.

We Men of the Alliance have a better idea:

Tell men the truth about condoms and failure, the truth about anal sex and promiscuity, and the truth about Frot and Fidelity.

And let them decide for themselves.

The Boston Globe, 4/21/03:

Syphilis Rebounds in Massachusetts

Syphilis, a disease once on the brink of elimination in Massachusetts, is rebounding dramatically, with cases of the sexually transmitted condition nearly doubling in the past two years. More troubling than the disease itself, public health authorities fear the resurgence could foreshadow an explosion of new HIV infections. Although the number of patients is relatively small- 197 people tested positive for infectious syphilis last year- disease specialists and community groups and clinics are so alarmed that they have united in a statewide campaign to halt the infection. Syphilis can result in brain damage and other serious health consequences if left untreated for years.

The outbreak in Massachusetts, which is concentrated in Boston, follows a reemergence of syphilis in San Francisco, Los Angeles, and New York, with the bacterial disease especially evident in gay communities. "Once an infection is well-established in a particular population, it can spread very easily and quickly," said John Auerbach, executive director of the Boston Public Health Commission. "The challenge is always to mobilize when the numbers are small enough so that a disease does not become firmly entrenched."

Through much of the 1990s, syphilis cases declined in Massachusetts and across the nation. A disease that once afflicted millions across the globe, syphilis had been contained by the grandfather of all antibiotics, penicillin. In fact, treatment proved so successful that eradication of syphilis not only became a feasible public health objective, it became the stated goal of the US Centers for Disease Control and Prevention to largely eliminate the disease by 2005.

The ease with which syphilis spreads became clear in recent months. In 2001, Massachusetts recorded 105 cases of infectious syphilis. A year later, it tracked an 87 percent rise in the disease. And the trend is continuing: Through the first three months of 2003, 52 infectious syphilis cases had been reported, up from 32 in the same period last year. Of the 197 cases in 2002, 113 patients told disease investigators they contracted the disease through sex with other men. That constituted a profound reversal since the early 1990s, when syphilis was overwhelmingly found in the heterosexual community, and gay men accounted for fewer than 1 percent of all infections.

The reasons, specialists said, for the reemergence of syphilis in the gay community are complex, reflecting everything from the erosion of prevention campaigns targeting sexually transmitted diseases to the resumption of risky sexual behavior in an era when AIDS is no longer viewed as an inevitable death sentence.

"Untreated syphilis can cause damage to virtually every organ in the body, from the eyes to the knees," said Dr. Alfred DeMaria, the states' director of communicable disease control.

More menacing today is the interaction between syphilis and HIV. People with syphilis have sores that look like small cavities in the skin. While appearing relatively harmless, those sores can actually act as dangerous portals directly to the blood stream- and, potentially, to the virus that causes AIDS. That makes the sores, known as chancres, more likely to transmit HIV than semen or other fluids. Syphilis sores can manifest on the lips or in the mouth, but most frequently form on the genitals, vagina, anus, or rectum.

A health advisory issued to physicians across Massachusetts last week alerted doctors to the syphilis outbreak and urged them to provide counseling to patients who might be at risk. Starting next month, representatives from AIDS Action and other associations will begin distributing information about syphilis prevention at nightclubs and at major events in the gay community. Vouchers will also be distributed for free to people who want to be tested for syphilis but can't afford it. That sort of testing represents another vital step in halting the spread, because it can take up to 90 days before symptoms develop, meaning someone can be infected and not even know it.

[The Boston Globe, 4/21/03]