Although HIV receives much attention in the press – particularly following last week’s announcement by the actor Charlie Sheen that he is HIV positive – it is not the only sexually-transmitted infection that gay and bisexual men need to be aware about.
Syphilis has been around far longer than HIV, and, if left untreated, can also be fatal.
Fortunately, if caught early enough, treatment is a usually effective course of antibiotics. Despite this, health authorities around the world have seen a dramatic increase in infection rates among gay men.
This is not only concerning because syphilis is a serious condition in itself, but because half of those who test positive for syphilis also text positive for HIV. Syphilis can cause open sores in the genital area, which can increase the chances of transmitting or acquiring HIV.
Last week, the Center for Disease Control and Prevention (CDC) in the US reported a rise in rates of the most common sexually-transmitted diseases, including syphilis.
Syphilis infections amongst gay and bisexual men has been increasing annually since 2000.
‘STDs affect people in all walks of life, particularly young women and men, but these data suggest an increasing burden among gay and bisexual men,’ said CDC’s Jonathan Mermin, M.D.
Syphilis infections rose 15.1% between 2013 and 2014 in the US, and men who have sex with men accounted for approximately 83% of the 19,999 reported cases in 2014.
Two weeks ago, Australia media reported that syphilis infections in south-east Queensland have risen 40% in the last 12 months, with most cases being identified among gay men in Brisbane.
This followed a report earlier in the year that said syphilis rates in Australia were at an all-time high; rising 30% since 2009.
This comes ten years after the disease was regarded as being almost eradicated in the country.
Similarly, in the UK, in the 1990s, syphilis infections among gay men were relatively rare. However, in 2014, the number of gay men diagnosed with syphilis in UK sexual health clinics had risen to 3,477.
What is syphilis?
Syphilis is a bacterial infection that, among gay men, is most commonly transmitted through unprotected anal sex and oral sex. It can also be caught through rimming and practices such as fisting.
The primary sign of infection will be a painless sore, ulcer or hardened lump near the point of infection. Sometimes, those infected may not even notice this primary infection or dismiss it as insignificant.
The sore or lump will disappear, but that doesn’t mean that you’ve got rid of the infection. You will become infectious to others, and although the bacteria may lay dormant in your system for several months or even years, it will eventually cause serious health problems; these can include blindness, deafness, brain damage and heart attacks.
Why is it on the increase?
There are several reasons why syphilis is increasing among gay men. Some have pointed to the rise of hook-up apps leading to an increase in no-strings, brief encounters.
Others have said that the advent of PEP and PrEP medication has meant that an increasing number of gay men are having sex without the use of condoms.
Although having an undetectable viral load of HIV means that your chances of transmitting the virus are extremely low, it offers no protection when it comes to the syphilis bacterium.
Anthony Hayes, of Gay Men’s Health Crisis (GMHC) in New York, told Gay Star News that the organization, ‘Welcomes PrEP in terms of a tool to prevent HIV, but everyone has to understand that it doesn’t prevent other STIs.
‘We’ve been seeing this rise in syphilis rates among gay men for several years, so it’s not just down to PrEP. But it’s important for everyone to realize that in order to take responsibility for their sexual health, they have to continue to include condoms in addition to PrEP; you want to make sure you’re protecting yourself from everything.’
Healthcare provider, OnlineClinic.co.uk echoed this view, with a spokesperson advising that men ‘think twice’ before having sex without a condom.
‘Although most STIs can be treated, not all can be cured and growing antibiotic resistance means it is more important than ever to avoid contracting an infection in the first place. Therefore whenever you engage in sexual activity make sure you use appropriate barrier contraception.’
As well as PEP and PrEP, there’s been an increased reporting in many urban areas of some gay men exploring ‘chemsex’ – attending parties, taking drugs and having sex with multiple partners, often believing that the advent of effective HIV medication can minimize the chances of transmitting or acquiring the virus.
Matthew Hodson, of gay men’s health charity GMFA, told Gay Star News, ‘One of the main reasons for our domination in this field is that we’re more likely than our hetero brothers to have lots more sexual partners.
‘In recent years it has become much easier for us to meet other gay men and to have sex with lots of them. Dating apps and chem-fuelled sex parties mean that infections can be spread efficiently to large numbers of men in a very short time.’
Depending on where you live, local cutbacks in sexual health funding and screening may also play a role.
Realistically, it’s the cumulative effect of all these factors, as confirmed by the CDC, which said last week that, ‘Gay and bisexual men face a combination of social, epidemiologic, and individual risk factors that can fuel high levels of STDs,’ and that homophobia and stigma can act as a barrier for some in receiving adequate healthcare.
What to do?
The most important advice for any gay or bisexual man who has an active sex life is to have a regular sexual-health screening; regardless of whether you think you have any symptoms and even if you always use condoms.
The CDC recommends being tested for syphilis at least once a year. If you have multiple partners, do not feel ashamed or embarrassed to be tested twice a year or even more often than that.
Staff at sexual health clinics are not going to judge you and would prefer you to be diagnosed and treated promptly.
If you are diagnosed with syphilis, it’s also important to notify anyone that you’ve recently had sex with. Depending on where you live, some clinics or health agencies may offer to notify people anonymously, so ask staff for advice on this.