Rise in Sexual Diseases May Signal Return of Unsafe Sex

From the WebMD Archives

June 29, 2000 -- Public officials are concerned that people who are at high risk of contracting sexually transmitted diseases (STDs) may think that the need for safe sex is over.

Recent data showing that the incidence of gonorrhea increased in 1998 after 12 years of decline, along with reports of a syphilis outbreak among gay men in Los Angeles, are prompting these experts to ask why this is occurring and what can be done to prevent forestall the trend.

Some experts suggest that people are abandoning the safe-sex practices they adopted to prevent AIDS transmission because there are now drugs available that make AIDS seem less fearsome. With this in mind, what's needed now is more aggressive awareness campaigns aimed at encouraging condom use, they say.

Gonorrhea causes a variety of conditions, including pelvic inflammatory disease, infertility, and ectopic pregnancy. The infection also makes it easier to transmit HIV, the virus that causes AIDs. Syphilis is a bacterial infection transmitted through vaginal, anal, and oral sex. It is marked by painless red/brown sores on the mouth, genitals, breasts, and hands, followed by a rash and flu-like symptoms. If not treated, syphilis can cause heart disease, brain damage, blindness, and potentially death.

Published in a recent issue of the Morbidity and Mortality Weekly Report, the new data show that gonorrhea rates increased 9% nationwide from 1997 to 1998. From 1985 to 1997, gonorrhea rates had declined by 64.2%, the report shows.

Overall, Midwestern states had a 16.4% increase in gonorrhea cases, while cases in the South increased by 8.7% and cases in the West rose by 6.5%. Only the Northeast states showed a decline, the report found. Mississippi had the highest gonorrhea rate, with 391.5 cases per 100,000 people, and Maine the lowest, with 5.4 cases per 100,000 people.

From January through late March of this year, 93 syphilis cases were reported in Los Angeles. Of these cases, 53 people were also HIV-positive. Typically, there are only 100 syphilis cases reported in the city per year.

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Gonorrhea study author Debra Mosure, PhD, an epidemiologist in the division of sexually transmitted disease prevention at the CDC in Atlanta, says that at least part of the increase in gonorrhea rates is due to improved access to care, better reporting, and a switch to more sensitive screening tests.

"Unfortunately, there is a real increase in some populations, particularly among gay and bisexual men, which is possibly due to an increase in unsafe sex" because of the availability of more effective AIDs drugs, she says.

"We need to continue to strengthen our efforts to prevent STDs among certain subpopulations," she says.

The increase in gonorrhea rates and the reported return of syphilis is a problem, says Jeffrey Laurence, MD, a consultant for the American Foundation for AIDS Research and an associate professor of medicine at the New York Hospital-Cornell Medical Center. He says there is a tendency to lapse into earlier habits, especially among young gay men.

The latest gonorrhea statistics only go through 1998, so no one knows what has happened since, Laurence says. Preliminary data from 1999, however, show that the disease may once again be on the decline.

Recent studies have shown that 50% of gay men and 50% of women in high-risk groups use condoms all of the time, and that 20-30% of gay men and high-risk women use condoms often, but not always, Laurence says. High-risk groups mainly include people with multiple sex partners and those who use IV drugs.

"That's still a high number, [but] there are pockets of people in San Francisco, particularly young gay men, who feel that HIV is not in their population," Laurence tells WebMD.

According to Laurence, their attitude is: "'Well, I can practice safe sex for 30 to 40 years, or do exactly what I want, get infected, live 10 to 15 years without any signs or symptoms of the disease, then take protease inhibitors or whatever drug is available at that time. So why should I be celibate or good when I can take risks and the worst thing that can happen is that I shave a few years off my life?'"

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But protease inhibitors -- the antiviral drugs that interrupt the way HIV uses a healthy cell to make more virus -- are not miracle drugs, he says. They only work half the time, and people can develop resistant strains of the virus, Laurence says.

Also, he says, despite some misconceptions, the AIDS crisis is far from over.

As of the end of 1999, an estimated 33.6 million people worldwide were living with HIV/AIDS, according to the National Institute of Allergy and Infectious Diseases in Bethesda, Md. Worldwide, approximately one in every 100 adults aged 15-49 is HIV-infected, and in 1999 more than 7,500 people aged 15-24 became infected with HIV every day.

"We have heard about the rise of certain STDs in the gay community anecdotally, and we are concerned because it means that people are not using condoms, and this may be a precursor to more HIV/AIDS cases," says Marty Algaze, spokesman for the Gay Men's Health Crisis in New York. "We know that people are letting their guards down because they feel that the AIDS crisis is over because of the new medications."

He tells WebMD that the new thinking may be that the worst that can happen is that a person goes to the doctor's office and is put on medication to treat HIV/AIDS. But "even though there are treatments, there is still no cure for HIV/AIDS," he says.

"Our biggest concern is for young gay men, who did not have all their friends die of AIDS, who think they can act recklessly and engage in risky behavior like anal intercourse without a condom," Algaze says. "That's a big mistake."

For more information from WebMD, visit our Diseases and Conditions page on Sexual Conditions

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