SYPHILIS, DRUG-RESISTANT GONORRHEA ON THE RISE

Gay males undertaking risky sexual activity are fueling two
disturbing trends in sexually transmitted diseases: a sharp increase
in the incidence of syphilis and a smaller but concerning rise in the
transmission of gonorrhea resistant to commonly used antibiotics,
federal researchers said today.

Those increases come at a time when STD rates among historically
important risk groups, especially women and minorities, have
declined, according to a new report from the Centers for Disease
Control and Prevention.

STDs "are a significant and ongoing threat to millions of Americans,
especially young men," said Dr. Ronald Valdiserri, acting director of
CDC's National Center for HIV, STD and TB Prevention.

Health authorities made major inroads into syphilis transmission
during the 1990s, bringing the annual number of new cases during 2000
to the lowest level since record-keeping began in 1941.

Between 2000 and 2004, however, the rate rose by 81% to a U.S. total
of 7,980 cases. Men who have sex with men accounted for 64% of the
syphilis infections in 2004, compared to only about 5% of them in
1999, said Dr. John Douglas, director of the CDC's division of STD prevention.

The absolute number of cases may seem small, but the data is
potentially alarming, experts said, because increases in STD
transmission are generally assumed to be precursors of increases in
the transmission of the AIDS virus, which is much more difficult to combat.

"We have very good and sound information showing increases in
high-risk behaviors among men having sex with men since 1999,"
fueling the increase in syphilis, Valdiserri said. Increases in risky
behavior, in turn, are being accelerated by the epidemic of crystal
methamphetamine use, he added - first on the west coast and now
spreading to the East.

"That's exacerbating the transmission of syphilis," he added.

Gonorrhea rates have fallen to 113.5 cases per 100,000 people in 2004
- - about 330,000 cases - the lowest rate since 1941. Nonetheless,
surveillance by CDC in selected cities has shown that resistance to
fluoroquinolone antibiotics - the common first-line treatment for
gonorrhea - increased from 4.1% in 2003 to 6.8% in 2004.

Most disturbing, the rate of antibiotic resistance among men having
sex with men was 23.8%, eight times the rate in heterosexuals. Last
year, CDC recommended that fluoroquinolones no longer be used to
treat the disease in men having sex with men. They are also not
recommended for use in California and Hawaii, where resistance has
been widespread for years.

The reported incidence of chlamydia also rose 5.9% last year to 319.6
cases per 100,000 people - a total of 929,462 cases. But Valdiserri
and Douglas attributed much of that growth to new and more aggressive
screening programs rather than to increased transmission.

Nonetheless, the report says that the majority of cases are still not
detected or reported to the agency, and that the actual number of
infections is as high as 2.8 million cases per year.

"Health care providers urgently need to step up screening for
chlamydia, particularly among young, sexually active women, who are
at greatest risk of infertility if the disease is not diagnosed and
treated," Douglas said.

The two other most common STDs in the United States, herpes and human
papilloma virus, are not reported to federal authorities, although
good estimates of their prevalence are available from other sources.
Taking them in account, Valdiserri said, the total number of STDs in
the United States each year is about 19 million, almost half of them
among people ages 15 to 24.