Increased Rates of Syphilis in San Francisco Have Not Resulted in Increased Rates of HIV, Report Finds

An increase in syphilis cases in San Francisco among men who have sex with men has not resulted in an increase in HIV infections, according to a CDC report presented Tuesday at the 11th Conference on Retroviruses and Opportunistic Infections, the San Francisco Chronicle reports. The number of syphilis cases reported annually in San Francisco increased from 40 in 1998 to more than 600 in 2003, "raising concern because the disease is spread by the same kinds of unprotected sex that transmit" HIV, according to the Chronicle (Russell, San Francisco Chronicle, 2/11). Health officials said that the majority of syphilis cases reported last year were among men who have sex with multiple male and female partners, and two-thirds of new cases were reported in HIV-positive people, indicating that individuals might be engaging in unprotected sex despite their HIV-positive status (California Healthline, 9/29/03). San Francisco in 2002 had a higher syphilis rate that any other U.S. city, according to a previous CDC report (California Healthline, 11/21/03). Researchers on Tuesday reported that HIV incidence at two clinics that treat syphilis infections in MSM remained level or were decreasing. According to Dr. Jeffrey Klausner, director of Sexually Transmitted Disease Prevention and Control Services for the San Francisco Department of Public Health, it might take a greater number of syphilis cases, not just an increase in the rate of syphilis infection, to affect HIV infection rates. Klausner noted that about 5% to 25% of new syphilis cases in San Francisco were transmitted through oral sex. According to the Chronicle, syphilis is "readily spread" through oral sex, unlike HIV. In a separate presentation at the conference, Dr. Willi McFarland, an AIDS epidemiologist at the city public health department, said that the percentage of HIV-negative men who have sex with HIV-positive partners decreased 21.5% in 2002 from 35% in 1998 (San Francisco Chronicle, 2/11).