Syphilis and AIDS Increasing Roughly Due to Unsafe Sexual Practices
Sexually transmitted infections (STI) are a common and serious problem worldwide. The most widely known are gonorrhoea, syphilis and HIV – the virus that causes AIDS –but there are more than 20 others. Many of these are curable with effective treatment, but they continue to be a major public health concern in both industrialized and developing countries. The World Health Organization (WHO) estimates that, globally, there are more than 340 million new cases every year.Certain STIs increase the risk of transmission of HIV – itself a sexually transmitted infection. HIV, in its turn, facilitates the transmission of some STIs and worsens the complications of STI by weakening the immune system.
Syphilis has increased dramatically in recent years, with more than 130,000 cases reported in 1990. The first symptoms of syphilis may go undetected because they are very mild and disappear spontaneously. The initial symptom is a painless open sore that usually appears on the penis or around or in the vagina. If untreated, syphilis may go on to more advanced stages, including a transient rash and, eventually, serious involvement of the heart and central nervous system. Penicillin remains the drug most commonly used to treat syphilis.
Syphilis is an infection that is usually acquired through sexual contact with another infected person. Syphilis can be frightening because if it goes untreated, it can lead to serious health problems and increase a person's risk for HIV, the human immunodeficiency virus that causes AIDS.
HIV attacks the body's immune system. It destroys infection-fighting cells. When these cells are destroyed, the immune system can no longer defend the body against infections and cancers. HIV infection becomes AIDS when you lose your ability to fight off serious infections or tumors. These infections, called opportunistic infections, might not normally cause severe or fatal health problems. However, when you have AIDS, the infections and tumors are serious and can be fatal.
Since 1987, several reports have described neurosyphilis and other complications of syphilis in patients infected with the human immunodeficiency virus (HIV), often after the patients have been treated with penicillin G benzathine, as recommended by the Centers for Disease Control and Prevention (CDC). Also, in 1987 viable treponemes were identified in the cerebrospinal fluid of two HIV-infected patients after this therapy. These observations have prompted questions about the adequacy of the CDC-recommended treatment for HIV-infected patients with early syphilis. The efficacy of the recommended therapy for patients with early syphilis who are not infected with HIV was also questioned; after this therapy neurosyphilis was reported and Treponema pallidum was isolated from the cerebrospinal fluid of patients not known to be HIV-infected. Although experience suggested that syphilis treatment rarely failed in patients not infected with HIV, data on the matter had not been systematically collected.
By far the most common mode of transmission of STI is through unprotected penetrative sexual intercourse (vaginal or anal).
Other, more rare modes of transmission include:
– during pregnancy (e.g. HIV and syphilis)
– at delivery (e.g. gonorrhoea, chlamydia and HIV)
– after birth (e.g. HIV)
– through breast milk (e.g. HIV)
-sexual partners of HIV-infected men or men in high-risk groups (such as drug abusers or bisexual men) if they do not always use a latex or polyurethane condom
unsafe (unsterile) use of needles or injections or other contact with blood or blood-products (e.g. syphilis, HIV and hepatitis).It is important to remember that the human immunodeficiency virus (HIV) is transmitted in the same ways as any other STI.
The incidence of syphilis began to rise along with the incidence of HIV/AIDS. After a brief decline in cases in the late 1990s, incidence has again been on the rise during this decade.The incidence of syphilis is highest among young adults. Rates of the disease have remained relatively steady for women, yet syphilis is on the rise in men, particularly in men who have sex with other men.
The Centers for Disease Control and Prevention (CDC) estimates that nearly two-thirds of new syphilis cases are occurring in men who have sex with men.Left untreated, syphilis can lead to serious complications or death. But with early diagnosis and treatment, the disease can be successfully treated.syphilis may affect the liver, kidneys, and eyes or cause meningitis.
Syphilis has risen sharply among gay and bisexual men in the United States this decade, driving up the country's rate for the disease and placing these men at higher risk for AIDS, federal health officials say.
Since dropping to the lowest level on record in 2000, the U.S. rate of syphilis, a sexually transmitted bacterial disease, has risen steadily, Centers for Disease Control and Prevention officials said on Friday.
The rate rose five years in a row through 2005, the most recent year for which the CDC had figures.
Gay and bisexual men accounted for 7 percent of syphilis cases in 2000 but more than 60 percent in 2005, CDC experts estimated.
"The most devastating consequence of this increase in syphilis cases would be an increase in the rates of HIV infection," said Dr. Khalil Ghanem of Johns Hopkins University School of Medicine in Baltimore.
"Syphilis and HIV have a close, deadly symbiotic relationship."
CDC epidemiologist Dr. James Heffelfinger said syphilis, like many other sexually transmitted diseases, raises the likelihood of infection by or transmission of the human immunodeficiency virus, which causes AIDS.
Syphilis raises these risks by an estimated two to five times, he said.
Condom use can greatly reduce the risk of getting syphilis, which is readily curable with antibiotics in its early stages but capable of causing severe medical problems and even death if left untreated.
"We are seeing that syphilis is on the rise among a very specific subset of gay men: those who are having a great deal of sex with multiple sex partners," said Joel Ginsberg, executive director of the Gay and Lesbian Medical Association in San Francisco.
Many are HIV-infected or test positive for HIV for the first time when they learn they have syphilis, he said.
"Among these men, there seems to be decreased condom use, perhaps related to an attitude of 'I already have HIV, so why bother?' or because HIV is seen as a chronic disease that can be managed well with medications," Ginsberg said.
Tremendous progress was made against syphilis in the 1990s. In 1999, the CDC announced an initiative to fully eliminate it from the United States.
After reaching 50,000 cases and a rate of 20.3 cases per 100,000 people in 1990 -- the highest since 1949 -- public health efforts helped drive down the rate to 2.1 per 100,000 people in 2000.
But the rate rose to 3 per 100,000 in 2005, with 8,724 cases, the CDC said.
"We're concerned that we're seeing this upturn among men who have sex with men because it could foreshadow bigger increases," CDC epidemiologist Dr. Hillard Weinstock said.
Ghanem of Johns Hopkins faulted the gay and bisexual community, public health leaders and the medical establishment for failing to get across a message of prevention, citing "safe-sex fatigue" after the advent of powerful AIDS drugs in the 1990s.
"Once these wonder drugs came along, patients no longer saw HIV as a death sentence, and clinicians unfortunately became more lackadaisical about conveying prevention messages," Ghanem said.
Use of a smokable form of the illegal drug methamphetamine known as "crystal meth" also is associated with unsafe sexual practices linked to syphilis, Ghanem said.
The syphilis rate among men is nearly six times higher than for women. The vast majority of male cases is among gays and bisexuals.
The precise extent and significance of neurologic involvement in HIV-infected patients with syphilis, reflected by either laboratory or clinical criteria, have not been well characterized. Furthermore, the alteration of host immunosuppression by antiretroviral therapy in recent years has further complicated such characterization.Confidential serologic testing can be an important source of specimens for unlinked anonymous HIV testing and surveillance. If periodic HIV testing of a sample of antenatal clinic attendees is warranted, serologic HIV and syphilis testing should be coordinated to minimize duplication in sampling.