MRSA Outbreak and Rise in Syphilis and HIV Linked to Risky Activity Among Some Homosexual Men

The study, which examined data from a population based survey, revealed a higher rate of infection among gay men living in zip codes featuring a high rate of homosexual couples.    While the average infection rate in the other 18 zip codes was 4 cases per 100,000, the rates of infection in these 8 zip codes was 59 per 100,000 persons.

The Castro District, which has the highest percentage of homosexual couples in any single zip code across the US (25.7), had  an incidence of of 170 cases per 100,000 persons.
 

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And the higher prevalence among homosexual men isn't an isolated coincidence - a community health clinic in Boston found that of those infected with USA 300, all were gay men.  There weren't any cases of this strain among the 3000 men who were seen at this clinic and had not engaged in homosexual activity.

OUTBREAK IN BOSTON

The study also makes a possible connection between the outbreak in San Francisco and Boston, noting that "men who have sex with men and frequently travel between Boston and San Francisco may facilitate the clonal spread of multi-drug-resistant USA 300..."  The study further describes a possible connection between the spread of disease and those who have sexual partners in other cities:

Since the beginning of the AIDS epidemic, sexual contact by men who have sex with men from Boston with partners from New York City, Los Angeles, and San Francisco has been associated with the dissemination of infectious pathogens (49). ...The recent emergence of multidrug-resistant community-associated MRSA with similar antimicrobial susceptibility profiles to multidrug-resistant USA300 was recently noted among men who have sex with men in New York City (32) and Los Angeles (Miller LG, Diep BA. Unpublished data), indicating the potential for rapid, nationwide dissemination of multidrug-resistant USA300 among men who have sex with men. (emphasis added)

The study also mentions the fact that gay men have adjusted their sexual behaviors as a result of better treatments for HIV infections via antiretroviral therapy.   This increase in risky behavior has led to a resurgence of syphilis, gonorrhea, and new HIV infections in these two cities (and elsewhere).

The change in behavior resulting from a perception of reduced risk is known as risk compensation, and at the population level, it may have offset efforts to reduce the spread of HIV.  The analysis Risk compensation: the Achilles' heel of innovations in HIV prevention summarizes this problem

SYPHILIS AND HIV ON THE RISE DUE TO RISKY ACTIVITY

The increase in sexually transmitted diseases is not limited to USA 300 - HIV and syphilis infections are on the rise also, and a majority of these infections are among gay men.

The increase in the incidence of syphilis is a significant turn of events  - at one point in time, it looked like it was going to be eradicated in the United States, but now the situation has changed.

According to the CDC, the estimated proportion of syphilis cases among homosexuals increased from 4% in 2000 to 62% in 2004.    And for 2006, 64% of all cases from 29 states and Washington, DC were among gay men.  According to the CDC,   "Several sources of data suggest that increased transmission of P[rimary] &S[econdary]  syphilis among MSM [men who have sex with men] may be largely responsible for these increases."

Many states are having problems with increases in the incidence of syphilis.  Arizona has declared that there is a syphilis crisis among gay men - in Maricopa County, the rate for the first half of 2007 was 25 times higher than seven years ago.  Vermont and Maine have also experienced increases in syphilis, especially among gay men.

New York is experiencing a rise in syphilis and  HIV infections in homosexual men under 30.    Between 1998 and 2003, the number of recorded syphilis infections increased by 500%.   In the first quarter of 2007, the number of syphilis cases in NYC were twice as high as the first quarter of 2006.  Syphilis has spread among the heterosexual population as well, and it's theorized that  bisexual men may be spreading the disease among women.

In Los Angeles, the number of new cases increased by more than 40% in 2005, with homosexual men accounting for  two thirds of the new cases.  Bisexual men are also thought to be contributing to the spread among women as well:

The resurgence isn't isolated to the United States either - syphilis has also made a comeback in Europe, especially among gay men.  Between 2000 and 2003, the number of cases in France increased by almost 16 times.  In Netherlands, the number of cases doubled between 2000 and 2004. 

COMMENTARY - A THREAT TO THE PUBLIC'S HEALTH

It is reasonable to believe that all of the men who caught USA 300, syphilis, or HIV knew about the use of condoms for disease prevention - yet it may be that many of failed to use them.  Even so, condoms don't offer fool proof protection against diseases such as syphilis and MRSA, which can be spread by skin to skin contact. 

The increases in STDs among these men, and the subsequent spread to the heterosexual community, highlights the fact that high risk homosexual activity is a threat to the public's health.

When it comes to the spread of STDs, heterosexuals are not out of the woods either.

As long as sex among unmarried heterosexuals is celebrated, promoted, encouraged, and tolerated, progress made in eradicating syphilis, HIV, gonorrhea, and other sexually transmitted diseases will continue to be hampered.  And as long as reproduction is seen as a secondary and optional feature of premarital sex, our society will continue to experience high rates of abortion and out of wedlock pregnancy - despite widespread access to contraceptives.

Maybe one day we will come to grips with the fact that the sexual revolution has been a bust, and that all along it was a serious threat to the public's health.  Until then, we'll keep closing our eyes and hoping that teen pregnancy, abortion, STDs and AIDS related deaths will magically disappear.