Source: Washington Blade, New York Times, Associated Press via Yahoo News
ATLANTA -- After reaching its deathbed at the turn of the century, syphilis is once again a "significant burden" in the U.S., with gay and bisexual men making up the majority of domestic syphilis cases, according to the Centers for Disease Control & Prevention.
U.S. syphilis cases climbed for the seventh straight year in 2007, and increases in the disease among gay men and blacks largely contributed, government researchers reported at a conference last week. 
Screening for sexually transmitted infections is a critical part of medical care for sexually active men. The CDC recommends annual blood tests for HIV and syphilis, and other tests for gonorrhea and chlamydia.
But many cases of sexually transmitted diseases are escaping detection because gay men are not being tested each year as advised, federal health officials said Wednesday. And if the men do show up, the officials added, many doctors and clinics are not following screening recommendations.
But more cases could be detected if the government approved new ways to use a type of DNA test that is already on the market, the officials and researchers said in a news conference at the scientific meeting in Chicago.
They said the test, used in new ways, could detect twice as many cases of gonorrhea and chlamydia as standard tests.
Those diseases, along with syphilis, whose incidence continues to increase, are "a major threat to gay and bisexual men's health," said Dr. Kevin Fenton, a top official of the Centers for Disease Control and Prevention. Dr. Fenton noted that such diseases increased the risk of contracting and spreading HIV., the virus that causes AIDS.
While the number of syphilis cases still is relatively low -- 11,181 last year -- the trend worries public health officials, who say better awareness and screening is needed. But local health activists say the spike also indicates problems with prevention messages from the CDC and other government agencies.
The CDC's funding structure is one of the reasons it struggles to disperse safer sex messages to broad segments of gay and bisexual men, said Bill Stackhouse, director of the Institute for Gay Men's Health at the Gay Men's Health Crisis in New York.
"The CDC and other government funding sources have established a protocol where they are primarily funding interventions that reach individuals and groups - they are not funding enough . large scale attempts to reach people at the community level," Stackhouse said.
On Wednesday, GMHC launched a new social marketing campaign called "I Love My Boo" that features the tagline "Safer sex is one way we show our love." The images target young black and Latino gay and bisexual men, but are on display on telephone kiosks in diverse neighborhoods throughout New York City.
The only HIV/AIDS prevention messages approved by CDC are known as DEBIs, or the Diffusion of Effective Behavioral Interventions. Many of the DEBIs are structured in a way that delivers the prevention message only to people participating in a small group, usually facilitated by a community-based AIDS organization.
The CDC must move beyond targeting gay men at community organizations, bars, and sex venues, and begin investing in campaigns that have the potential to reach gay people wherever they are, Stackhouse said.
In 1999, the CDC unveiled its "National Plan to Eliminate Syphilis," which mainly focused on curbing the disease among heterosexual females.
During the eight years of CDC's syphilis elimination project, gay and bisexual men experienced a spike in syphilis rates, and "largely account" for the STD's national resurgence during that time.
Primary and secondary cases of syphilis increased 16 percent from 2006 to 2007, with an estimated 60 percent of cases occurring among gay and bisexual men. Gay and bisexual men comprised only 5 percent of syphilis cases in 1999.
The main symptom is painless sores at the site where the syphilis bacteria entered the body. It is easily treated with antibiotics if caught early; if not, complications can include blindness and organ damage. Syphilis also increases susceptibility to AIDS infections, and can be fatal to infants who get it from infected mothers during pregnancy.
The CDC hopes to stimulate awareness of syphilis among gay and bisexual men and urges those men to get tested for STDs at least annually, but the agency has had limited success making sure its messages reach the population most at risk for STDs and HIV/AIDS. Last summer, the CDC announced that only 20 percent of all gay and bisexual men ever came in contact with a CDC-sponsored HIV prevention intervention.
"CDC is starting to believe that as we move forward with an integrated platform for prevention, that we need to really have a strengthening of our preventive services to interact with men at all points -- where they live, work and play," Kevin Fenton, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, said last week.
"It means partnering more effectively with our community-based organizations to do some of this outreach work," said Fenton, who is gay. "It means going into venues where we can actually find high populations of men who have sex with men, for example, circuit parties, bathhouses."
In a time of scarce resources, it's important the CDC and its partners go where they know gay and bisexual men are, said Rudy Carn, executive director of the National AIDS Education & Services for Minorities in Atlanta.
"[Club promoters] come in contact with about 80 percent of the black gay population at one point," said Carn, who added that bathhouses and sex parties are also appropriate priorities. "I know it's something people may not condone, but sex parties do exist and that's a venue that needs to be addressed."
But the CDC will continue missing many gay and bisexual men with its prevention messages if it relies exclusively on institutional venues, Carn said.
"The majority of people at risk for HIV and STDs are not going to go to a health clinic," Carn said.
The CDC also realizes the limitations of relying heavily on bars and bathhouses for data on gay men, Woliski said.
"Obviously, where someone is recruited can make a big difference," he said. "If only high-risk venues are used for recruitment, the results would not be representative of all [gay and bisexual men]."
Another problem discussed at the Chicago conference is that public health departments that run sexual disease clinics do not have adequate staffs and budgets to do comprehensive testing.
"Let's be honest, resources are a challenge at a federal, state and local level," said said Dr. John M. Douglas Jr., who directs the Division of STD Prevention at the disease control centers. "We are trying to be as innovative as we can with public health resources," but "we need help from others."
The CDC has increasingly been turning to the Internet as a way to reach as many gay people as possible, especially those who may not frequent gay organizations and clubs.
"If the Internet is where people are, then that's where public health has to be," said Mary McFarlane, an Internet specialist in the CDC's division of STD Prevention.
Full article: Public health system struggles to reach gay `hidden population' - Washington Blade
US syphilis up for seventh straight year | Yahoo News (AP)
Sex Diseases in Many Gay Men Go Unfound, Experts Say | New York Times