Trend has long been a concern for public health officials
The increase in syphilis cases among gay men, particularly among those who are HIV-positive, has concerned public health officials for years, especially the occurrence of early neurosyphilis, when the infection reaches into the central nervous system and the brain.
Now, a review of 170 possible neurosyphilis cases in four cities Los Angeles (74), New York (47), Chicago (32) and San Diego (17) has shed new light on the risks for HIV-positive men who have sex with men.
A report on the study was published in the June 28 issue of the Centers for Disease Control’s Morbidity and Mortality Weekly Report.
The study looked at cases over the 30-month period between January 2002 and June 2004, and winnowed them down to 99 patients who had evidence of syphilis in their blood and physical symptoms compatible with neurosyphilis. Of the total, 57 self-identified as men who have sex with men, while 49 were HIV-positive.
About 75 percent of the patients reported visual disturbances or new onset of headaches, while 12 percent had symptoms of acute meningitis. About half had no other clinical symptoms of the infection, while almost a quarter did not know they were infected with HIV.
The findings come as no surprise to Dr. Christopher Hall, chief of clinical affairs for the California STD Control Branch of the Department of Public Health.
He sees it as an indictment of medical providers for not routinely screening gay men for syphilis.
“Gay men who are sexually active with more than one partner should be screened for syphilis at least every six months, and those who are more active should be screened as frequently as every three months,” he says, citing guidelines issued by the CDC.
“If health care providers adhered to these guidelines, we would interrupt both new infections and the development of more severe symptoms such as neurosyphilis,” Hall said.
When the blood test for syphilis comes back positive, Hall urges health care providers to carefully examine patients for subtle signs that the infection may have reached the central nervous system, “to identify that small cohort of individuals who are going to go on to develop early neurosyphilis.”
The other thing that needs to be done is follow up testing after treatment, to make sure that the treatment worked.
“Follow up just doesn’t happen,” Hall says, noting that lack of follow up makes if difficult to determine if persons with recurrent syphilis have it because the treatment failed, or they became infected again.
This article appeared in the Dallas Voice print edition, July 13, 2007.