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A new warning about syphilis

Doctors remind HIV-positive gay and bisexual men what can happen if the disease is left untreated.

July 06, 2007|Mary Engel | Times Staff Writer

The medical community has a new warning for HIV-positive gay and bisexual men.

With syphilis rates in that population increasing dramatically, a study has found that, if left untreated, the sexually transmitted disease leads to mental confusion, blurred vision, difficulty walking or other serious neurological complications in about 1 in 50 HIV-positive men.

For about 1 in 200 of those who develop neural symptoms, the complications persist even six months after treatment, according to the study published last week by the U.S. Centers for Disease Control and Prevention.

"There's this perception out there that if you already have HIV, why worry about other STDs?," said Dr. Peter Kerndt, director of Los Angeles County's sexually transmitted disease program and one of the study's authors. "Well, this is a very serious reason to worry about other STDs."

The CDC and public health departments from four urban areas, including Los Angeles County, reviewed health department surveillance reports and interview records in Los Angeles, San Diego, New York and Chicago from January 2002 through June 2004. The study, published in the CDC's Morbidity and Mortality Weekly Report, confirmed neurosyphilis in 49 HIV-positive gay or bisexual men.

One in 50 "is a minimum estimate of what the problem is really like out there," Kerndt said. "We need to alert physicians about it. They need to be looking at this and educating their patients about it."

Neurosyphilis all but disappeared in the United States after the introduction of penicillin in the late 1940s. Previously, it was seen only in the late stages of syphilis, years into the infection. Experts have seen signs of neurosyphilis' reemergence since the AIDS epidemic began in the early 1980s.

The CDC study did not address whether people with HIV are more likely to develop neural complications from syphilis than people without HIV, as many experts suspect.

But it did attempt to quantify the risk for HIV-positive gay and bisexual men because of the steep rise in syphilis cases in that population since 2000, said Dr. Tom Peterman, a CDC epidemiologist and another of the study's authors.

"The key here is for men to try to avoid getting syphilis," Peterman said. "Cut down on the number of partners, particularly anonymous partners, and use condoms."

Syphilis among gay and bisexual men in Los Angeles County has increased 365% since 2001, county health department officials say. Six in 10 gay and bisexual men with syphilis report being HIV-positive.

Experts attribute the dramatic surge in the disease to the effectiveness of HIV drugs that have led some to abandon condoms and safe-sex practices adopted in the early years of the AIDS epidemic.

"People need to be aware of the symptoms [of neurosyphilis]: Hearing loss, problems seeing, problems walking," said Dr. Jeffrey D. Klausner, who heads STD Prevention and Control Services for San Francisco's Public Health Department and who was not involved in the study. "If they have those symptoms, they need to see their physician."

Treatment for neurosyphilis often requires a hospital stay and 10 to 14 days of intravenous penicillin.

"Syphilis is thought of as a disease like polio, almost extinct. That's not true," said David Langness, whose firm, Fraser Communications, designed Los Angeles County's recently launched public health campaign against syphilis.

A typical poster in the campaign features a man with a towel around his waist standing before a shower, with the slogan, "Check yourself: Don't assume you're coming off clean."

The poster also says, "Left untreated, syphilis can cause brain damage and permanent vision loss in less than a year."

--

mary.engel@latimes.com

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