Syphilis at ‘epidemic’ levels

After being virtually eradicated from Sydney’s gay population in the 1990s, syphilis has increased ten-fold in the inner city in recent years, in a trend largely confined to homosexually active men, a new report has found.

And Melbourne is witnessing a similar increase, amid predictions syphilis outbreaks could spread to gay populations in other Australian cities.

Syphilis notifications in inner Sydney increased from six in 1999 to 162 in 2003, according to a report published this week in the Medical Journal Of Australia.

We would certainly classify it as an epidemic, Dr Andrew Grulich, a study author and associate professor at the National Centre in HIV Epidemiology and Clinical Research told Sydney Star Observer.

The research analysed NSW Health syphilis notifications from 1998 to 2003, as well as a survey of 57 gay men diagnosed with early syphilis in inner Sydney clinics between December 2002 and January 2004.

It also drew on a study of 1,333 HIV-negative gay men recruited between 2001 and 2003.

The analysis suggested a greater incidence of syphilis infection among HIV-positive gay men, and pointed to oral sex as key route for transmission.

More than half of the 57 men diagnosed with the infection in inner city clinics -“ who accounted for almost 50 percent of all men reporting early syphilis in the period -“ were HIV-positive.

Ninety percent of the men reported oral sex with casual partners, and about half believed they had contracted syphilis through oral sex.

In the survey of the 1,333 HIV-negative men, insertive oral sex was commonly linked with syphilis, which is curable but can lead to internal organ damage if left untreated.

Seeking partners at beats or through telephone sex were also important risk factors for syphilis, the study said.

Grulich said riskier sex practices over the past decade and recent syphilis outbreaks in international gay centres helped explain the Sydney figures.

Syphilis was virtually eradicated from gay men in Sydney during the 1990s [as gay men took up the safe-sex message], he told the Star.

And now we’re seeing well over 200 cases a year in Sydney.

On top of that, for the last five years or more, there have been outbreaks of syphilis in many cities in northern Europe and the USA.

I suppose it is international travel that’s led to the introduction of the organism to Sydney.

Grulich said the syphilis rise could spread to other urban centres in Australia, as Melbourne researchers reported the beginnings of a possible epidemic there.

Also in the current Medical Journal Of Australia, Victorian scientists reported syphilis had increased five-fold in the state since 1995, and 74 percent of diagnoses last year were among gay men.

Regular testing for syphilis -“ whose symptoms can include a sore in the area of infection and later a rash -“ was the best way to head off the epidemic, Grulich said.

We need to ensure that men who are very highly sexually active get tested very regularly -“ not just yearly, but perhaps every three or six months.