CDC Blames Serosorting for Syphilis Increase

[edfu]

http://www.reuters.com/article/domesticNews/idUSTRE50C5XV20090113?sp=true

Very upsetting. 

[GSOgymrat]

Syphilis has increased each year since 2000 -- its rate is up 81 percent -- with gay and bisexual men representing 65 percent of cases, the CDC said.

Douglas said many cases are occurring in HIV-positive men who are choosing other HIV-positive men as sexual partners.

"Within that relationship, they are less concerned about the transmission of other conditions. They're not using condoms. They believe that their partner already has got the worst they can get -- they've got an HIV infection," he said.


This makes sense. As has been stated by many people on AIDSmeds HIV is not the only STD out there.

[David_CA]

Syphilis has increased each year since 2000 -- its rate is up 81 percent -- with gay and bisexual men representing 65 percent of cases, the CDC said.

Douglas said many cases are occurring in HIV-positive men who are choosing other HIV-positive men as sexual partners.

"Within that relationship, they are less concerned about the transmission of other conditions. They're not using condoms. They believe that their partner already has got the worst they can get -- they've got an HIV infection," he said.


This makes sense. As has been stated by many people on AIDSmeds HIV is not the only STD out there.

I'd say that's correct; HIV is the worst STD.  At least syphilis is treatable / curable.  I guess that increase (in gay and bisexual men) is part of why my Dr. orders full STD tests at least twice a year when I go for labs.  Luckily, those labs have always been 'clean', except for the one that the Dept. of Health forced on me.  According to them, it showed that I had syphilis, but my Dr. doesn't think I did. 

[aztecan]

Annual syphilis tests are standard of care and everyone should get them.

For those who are sexually active and have multiple partners, or who have partners who have multiple partners, having one done more than once a year might be desirable.

By the way, and annual TB tests are also standard of care, but I often wonder how many people actually get them.

HUGS,

Mark

[bear60]

Mark said: "For those who are sexually active and have multiple partners, or who have partners who have multiple partners, having one done more than once a year might be desirable."
.................................
Absolutely,  the most important thing is twice a year if you are sexually active and have multiple partners.  I have a friend who has HAD SYPHILLIS TWICE THIS PAST YEAR. The second time he caught it from a guy who was bisexual and married and came in his mouth and he developed a hugely swollen uvula that the doctors took pictures of because they had never seen anything like it,
Oh ...and he has HIV/AIDS.
The first time he had wierd symptoms that his doctor couldnt diagnose and treated him with the wrong drugs.  Guess by now he is familiar with syphilis.!

[allopathicholistic]

depressing. a lot of us wanna meet a nice sexy witty regular serosimilar (is that a word?) person to fool around with on a n on going basis and now we need to worry bout THIS ugggh

it's bloody unfair

[hotpuppy]

What isn't being said is that Syphillis drastically increases (800%) the risk of catching HIV for negative serosorters.  It is probably why I caught HIV as a top. 

My hunch is that where syphillis rates go, so too will hiv infections.

The bright side is that it's just a shot in the butt to clear up syph.  I think it's more important that we get regular screening and treatment for syphillis.  All activities have risk and sex is one such activity.  I'm not downplaying the risk as much I'm stating the obvious.  I regularly remind my neg friends that you can catch syph in a myriad of ways besides anal sex.  I'll refrain from listing them and instead suggest that if the prospect of syphillis worries you (and it should) then you need to go read how you can catch it from the CDC guidelines.

http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm#spread

[denb45]

I'd say that's correct; HIV is the worst STD.  At least syphilis is treatable / curable.  I guess that increase (in gay and bisexual men) is part of why my Dr. orders full STD tests at least twice a year when I go for labs.  Luckily, those labs have always been 'clean', except for the one that the Dept. of Health forced on me.  According to them, it showed that I had syphilis, but my Dr. doesn't think I did. 

Yeah My Partner somehow came down with syphilis last yr. 2008, He was treated, I was tested by my ID Doctor, twice in the yr. but never came down with it, but, the Dept. of Health called both of us in and my partner was treated a 2nd time, but, I was also treated and given them terrible 2 SHOTS  even tho I never tested POZ for syphilis, so, Yeah, its a big problem, and the Dept. of Health is very SERIOUS about this here in New Mexico, as they say, it's a real problem around here. but ya know, after this ordeal, I just look now-a-days and don't wanna touch anymore, ( If you know what I mean)  as i told my partner "I'm not going thur this shit with you anymore" to date he still does not know where he got it from, it's even a mystery to his GM-Doctor..........he's lucky he's still HIV-NEG form this ordeal..........

[denb45]

Mark said: "For those who are sexually active and have multiple partners, or who have partners who have multiple partners, having one done more than once a year might be desirable."
.................................
Absolutely,  the most important thing is twice a year if you are sexually active and have multiple partners.  I have a friend who has HAD SYPHILLIS TWICE THIS PAST YEAR. The second time he caught it from a guy who was bisexual and married and came in his mouth and he developed a hugely swollen uvula that the doctors took pictures of because they had never seen anything like it,
Oh ...and he has HIV/AIDS.
The first time he had wierd symptoms that his doctor couldnt diagnose and treated him with the wrong drugs.  Guess by now he is familiar with syphilis.!

YUCK!!  Joel.......this is the kinda thing that makes me wanna just look, but not touch anymore 
if that means staying monogamous, then so be it , safer that way 

[Ann]

The bright side is that it's just a shot in the butt to clear up syph. 

Hiv positive people are at greater risk for syphilis turning into  neurosyphilis. Treating neurosyphilis entails more than "just a shot in the butt" - it's walking around for two weeks with a bum-bag full of antibiotics which are pumped into your bloodstream throughout the day. At least one forum member that I can recall has had to do this. It's no walk in the park.

Neurosyphilis: This occurs when T. pallidum infects the brain or spinal cord (central nervous system). Infection can occur during any syphilis stage and can cause serious neurological damage, including paralysis, numbness, gradual blindness and deafness. Neurosyphilis can be serious enough to cause permanent disability or death. Studies have found that HIV-positive people infected with T. pallidum are more likely to develop neurosyphilis, even during the early stages of infection.

Treating neurosyphilis often requires hospitalization. The treatment consists of penicillin administered through an intravenous (IV) line every four hours for up to two weeks.

Penicillin injections are administered directly into the butt muscle. Your butt may feel sore for several days after each injection. If you have a known allergy to penicillin, make sure you tell your doctor before you receive an injection. There are other antibiotics that can be given if you are allergic to penicillin.

Some people become ill after receiving their first penicillin injection. This is because of a "Herxheimer reaction," named after a German doctor who first noted it in 1895. Because penicillin injections are so fast-acting against the bacterium that causes syphilis, it can cause the bacteria to release high levels of toxins as they die. This can cause symptoms such as high fever, profuse sweating, night sweats, nausea, and vomiting. The symptoms of Herxheimer reactions usually end within a few hours, and can often be managed with the use of aspirin, NSAIDs (non-steroidal anti-inflammatory drugs), Benadryl, pain medication, muscle relaxers, or others remedies—you should talk with your doctor or a nurse about your options.

It is very easy to miss the symptoms of primary syphilis - or any stage of syphilis, for that matter. As Pup says, regular screening is very important.

Ann

[BlueMoon]

Hiv positive people are at greater risk for syphilis turning into  neurosyphilis. Treating neurosyphilis entails more than "just a shot in the butt" - it's walking around for two weeks with a bum-bag full of antibiotics which are pumped into your bloodstream throughout the day. At least one forum member that I can recall has had to do this. It's no walk in the park.

Neurosyphilis: This occurs when T. pallidum infects the brain or spinal cord (central nervous system). Infection can occur during any syphilis stage and can cause serious neurological damage, including paralysis, numbness, gradual blindness and deafness. Neurosyphilis can be serious enough to cause permanent disability or death. Studies have found that HIV-positive people infected with T. pallidum are more likely to develop neurosyphilis, even during the early stages of infection.

Treating neurosyphilis often requires hospitalization. The treatment consists of penicillin administered through an intravenous (IV) line every four hours for up to two weeks.

Ann

Well thank you, Debbie Downer.   


Just kidding, that's interesting and useful information which I did not know, but should.

Even the regular type of syphilis is actually three shots in the butt, a week apart, for HIV-positive people. 

I get tested for it along with my HIV labs every three months.  Good thing I do . . . .     

[denb45]

 Ann.........My partner had to have a pic-line put into his chest and had a pump-infused treatment for a total of 14 days, everyday I had to change the batteries, bag of antibiotics , and sometimes during the night, his alarm would go off at 4 am in the morning,  I also had to change his pic- line, and clean out his line every 2 to 3 days, He was a BSRN, and I'm  EMT-1 certified, so, it wasn't a problem as we both new what to do, without having to have a Home-heath nurse, at the end of his 14 days treatment I even pulled out the pic-line, and he did his own follow up with his GM Doctor.......His Heart Doctor seem to think he got
syphilis form a Blood-transfusion when he had Open Heart Surgery back in 2002, but they cannot comfirm this as of yet........and, we think that they never will.........the fact that I didn't get syphilis form my partner  is still a mystery to me , Him, and even my ID Doctor......and the Dept. of Health.......

[fearless]

The bright side is that it's just a shot in the butt to clear up syph. 

That's the American way. Doctors tend to be far more radical in their approach in Aus, especially if you are HIV +ve.

I was diagnosed with 2ndary syphilis just on New Years. Rather than 1 shot in the butt, I have just finished a course of 10 shots in the butt (one each day) - OUCH. This is meant to ensure that I clear the infection in the blood stream but also in the brain, just in case it had already got in there.

And, oh yeah Ann - I had the "Herxheimer reaction" from hell. The barely visible rash I had on my stomach turned into the most fiery ugly looking rash I've ever had and the headache and pains and sore throat. OUCH.

Butt (pardon the pun), I just had my last shot today and am as happy as Larry about that.

[denb45]

You aussies are a lott more butcher than USA american guys are  ( I'm only being sarcactic to all my fellow US Guys here in the States)  Tee hee hee.....

[fearless]

You aussies are a lott more butcher than USA american guys are  ( I'm only being sarcactic to all my fellow US Guys here in the States)  Tee hee hee.....

I should have qualified that and said "My doctor is far more radical in his approach following the 'gold standard'", apparantely.

My boyfriend, who also tested +ve for syphilis, only received two shots in the butt on day 1 from his doctor. I'm starting to think my doctor is just a sadist who likes to inflict pain on me. Thankfully, I'm a masochist so didn't mind at all. 

[denb45]

I should have qualified that and said "My doctor is far more radical in his approach following the 'gold standard'", apparantely.

My boyfriend, who also tested +ve for syphilis, only received two shots in the butt on day 1 from his doctor. I'm starting to think my doctor is just a sadist who likes to inflict pain on me. Thankfully, I'm a masochist so didn't mind at all. 

Or maybe your Doctor thinks you have a nice ASS 

[madbrain]

Mark said: "For those who are sexually active and have multiple partners, or who have partners who have multiple partners, having one done more than once a year might be desirable."
.................................
Absolutely,  the most important thing is twice a year if you are sexually active and have multiple partners.  I have a friend who has HAD SYPHILLIS TWICE THIS PAST YEAR. The second time he caught it from a guy who was bisexual and married and came in his mouth and he developed a hugely swollen uvula that the doctors took pictures of because they had never seen anything like it,
Oh ...and he has HIV/AIDS.
The first time he had wierd symptoms that his doctor couldnt diagnose and treated him with the wrong drugs.  Guess by now he is familiar with syphilis.!

I have luckily escaped syphilis (though I have been with partners that had it), but I have had other STDs besides HIV (chlamydia, gonorrhea), most likely acquired through oral sex too. Once, the chlamydia didn't disappear even after treatment. I found out because my symptoms weren't gone and I asked my doc to retest, and it was still there IMO, everyone should get retested after they are treated for an STD to make sure it's really gone. Sometimes there are resistant strains and a different med is needed. It would seem rather obvious to retest to confirm the treatment worked, but that doesn't seem to be standard of care. Perhaps your friend didn't really have it twice, but the treatment just didn't work the first time around. My doc said in HIV+ people the syphilis can be much harder to treat, especially if it turns into neurosyphilis.

[denb45]

 My Partner and I had the standard re-testing-follow up, and were in the clear, he also test for HIV every 3 to 4 months, and at least twice a yr. or more, but, we've decided not to play-the-field-anymore, (after what happened in 2008) and just keep it Safe so, he won't get HIV+ it's been 16 yrs. and so, far he hasn't 

[madbrain]

depressing. a lot of us wanna meet a nice sexy witty regular serosimilar (is that a word?) person to fool around with on a n on going basis and now we need to worry bout THIS ugggh

it's bloody unfair

IMO, this whole serosorting is completely misguided.

Even if you and your partner only have HIV and nothing else, are you going to compare your respeective genotype/phenotype test results to make sure you really have the same bug and you aren't putting each other at risk of superinfection ?

Using condoms seems a lot simpler if you are worried about your health.

However when it comes to other STDs than HIV, many of them can easily be transmitted through oral sex, much more easily than HIV. And I don't know many gay men who want to practice safe oral sex. I bought a bunch of flavored condoms and lube back in october for that purpose. The supply is nearly exhausted, and for the most part they weren't used for oral sex. So if you are going to practice unprotected oral sex, you do need to get retested for the standard treatable STDs regularly ...

[madbrain]

Annual syphilis tests are standard of care and everyone should get them.

For those who are sexually active and have multiple partners, or who have partners who have multiple partners, having one done more than once a year might be desirable.

By the way, and annual TB tests are also standard of care, but I often wonder how many people actually get them.

Who says that about annual syphilis tests ? I don't get them unless I ask for them.
I only had a TB test when I first tested poz. Same for my bf.

[madbrain]

Yeah My Partner somehow came down with syphilis last yr. 2008, He was treated, I was tested by my ID Doctor, twice in the yr. but never came down with it, but, the Dept. of Health called both of us in and my partner was treated a 2nd time, but, I was also treated and given them terrible 2 SHOTS  even tho I never tested POZ for syphilis, so, Yeah, its a big problem, and the Dept. of Health is very SERIOUS about this here in New Mexico, as they say, it's a real problem around here. but ya know, after this ordeal, I just look now-a-days and don't wanna touch anymore, ( If you know what I mean)  as i told my partner "I'm not going thur this shit with you anymore" to date he still does not know where he got it from, it's even a mystery to his GM-Doctor..........he's lucky he's still HIV-NEG form this ordeal..........

I have been through those shots too even though I never tested positive for syphilis either. I met a guy about 2 years ago and hooked up with him. We had safe sex. He had never been tested for anything and I took him to the local free clinic because he reported having a lot of unsafe sex before. He came down HIV-, but poz for syphilis. I got retested for syph too, and was negative. But the health dept still asked my doc to give me the shots, as well as to my bf since we don't play safe. I don't really mind the shots but my bf is not crazy about them

[fearless]

Who says that about annual syphilis tests ? I don't get them unless I ask for them.
I only had a TB test when I first tested poz. Same for my bf.

Madbrain,

If you are sexually active you really should be getting a full std screen at least twice a year. I tend to just have them done each quarter with my HIV blood draws.

This is really important for something like syphilis which can go undetected without regular testing - many people exhibit no symptons, or the symptoms misdiagnosed, for both the primary and secondary stage of infection when it is relatively easy to treat. Tertiary (or latent) syphilis is particularly nasty and can be life threatening.

And, as I've just found out syphilis is very contagious. One very very brief and ultimately unsatisfactory encounter was enough for me to become infected with syphilis.

[hotpuppy]

IMO, this whole serosorting is completely misguided.

Serosorting works if you are poz.  It does not work well for HIV neg people.


While I agree with everything Ann said... interesting about Neurosyph.... many people missed my point completely.

Please read the CDC fact sheet.  Particularly the part about how you can catch it.  To be blunt, you can get syphillis from sucking dick.  Many people consider oral sex to be safe and thus do not use condoms.  My whole point here was that syphillis is very easy to catch and increases your risk of other STDs including HIV.

If you are going to engage in sex that has risk, be sure you get tested regularly so that you can get treatment, not spread anything you catch, and live a longer healthier life.

[Ann]

Please read the CDC fact sheet.  Particularly the part about how you can catch it.  To be blunt, you can get syphillis from sucking dick.  Many people consider oral sex to be safe and thus do not use condoms.  My whole point here was that syphillis is very easy to catch and increases your risk of other STDs including HIV.

You can get it from simple skin to skin contact as well. I don't mean holding hands, I mean anytime sexual organs come into contact. While condoms greatly reduce your chance of getting syphilis, they don't rule it out completely.

For example - you can get syphilis lesions (chancres) on your balls. Condoms won't cover your balls. If you're blowing a guy who has a chancre on his sack, chances are good you're not going to notice it but yet have your lips come into contact with it. You get the picture (hopefully)

And to give a male/female example, women can get chancres on their labia lips, just like men can get chancres on their balls. Condoms won't protect in this instance either (labial/scrotal contact).

These are just two examples. I'm sure you can come up with more.

And the main reason most people don't realise they have syphilis? It's because the chancres are generally painless and therefore not noticed. Another reason is having the chancre in a place that's hidden, such as in the mouth, anus or vagina.

Oh, and sorry to be such a Debbie Downer.   But, knowledge is power, so pay attention!

I'm not trying to dissuade anyone from having whatever type of sex they want. I just want to encourage anyone who has sex to get regularly screened for STIs. I do. It's easy for a syphilis blood test to be included in your quarterly labs, like Steve does - and it can save you a hell of a mess. The sooner ANY (bacterial) STI is treated, the easier the treatment and the better the outcome.

Ann

PS - Syphilis shares a three month window with hiv for a conclusive negative result. That's why QUARTERLY tests for syphilis are extra important when you're hiv positive and playing the field, or have a partner who is.

[madbrain]

Madbrain,

If you are sexually active you really should be getting a full std screen at least twice a year. I tend to just have them done each quarter with my HIV blood draws.

Thanks. I do get tested regularly, and more than twice a year, but not unless I ask the doc to do it. I guess it would make sense for it to be part of the quarterly labs.

[Denver Toad]

IMO, this whole serosorting is completely misguided.

Even if you and your partner only have HIV and nothing else, are you going to compare your respeective genotype/phenotype test results to make sure you really have the same bug and you aren't putting each other at risk of superinfection ?

Misguided by what (who's)  standard? The desire for intimacy, desire to have a normal sex life, wanting to respond to sexual needs without worrying whether there's a condom immediately available; are these all not reasonable and healthy needs? HIV serosorting done within the context of a committed relationship is a valuable and appropriate  means of measured risk valuation. IMO.

At the International Aids Conference in Bangkok, Thailand, U.S. scientists presented findings that appear to show no evidence of superinfection after researchers spent a year tracking 33 HIV-positive couples, 28 with HIV strains distinct from their partners, and 30 HIV-positive singles. The volunteers reported over 20,000 collective sexual encounters, many of them unprotected, and were tested periodically to see whether they acquired any new HIV strains. "We estimated that there would be 89 new infection events that we would've observed," says molecular epidemiologist and lead researcher, Robert Grant, of the Gladstone Institute for Virology and Immunology at the University of California at San Francisco. "Instead, we found no evidence of transmission of variants of HIV from one partner to the other if both partners are already infected with some form of HIV at the beginning of the study."
If and when superinfection does happen---there are a handful of cases world-wide--- it may be limited to a window following a person's initial HIV infection when "they may be susceptible to acquiring a second variant or a third variant [of HIV]" possibly because of the body's immune response, Grant says. Dual infection, or simultaneous infection with two strains of HIV, may be what Grant says that some doctors are now calling superinfection. "What we do not know about any of these [superinfection] cases is whether they could've had a dual infection from the beginning and that the second virus emerges because the first virus is suppressed by the immune system or somehow is less fit than the second virus," he explains. One reason superinfection appears to be a no-show in Grant's study may be that the U.S. has one strain of HIV, HIV-1, that predominates. Much of the rest of the world contends with HIV-1 and HIV-2, which divide into "subclades" or subtypes. Some experts agree that more strains make superinfection more nuanced outside the U.S., asRoger Pomerantz, a virologist at Thomas Jefferson University Medical College explains: "Superinfection may be rare in certain areas based on the strain and more common in other areas because, remember, the world's pandemic of HIV is not just one strain. There are many different strains and many different changes in virus." Pomerantz, an unpaid scientific advisor to the Gladstone Institute, is cautious about Grant's work for that reason. "It may be true in California, but it may not be true in Sub-Saharan Africa or in Thailand," he warns. "We have to take his work, which I think is excellent, but not over-generalize it and continue to look around the world and make sure the epidemic which is heterogeneous, is looked at carefully."

[denb45]

Misguided by what (who's)  standard? The desire for intimacy, desire to have a normal sex life, wanting to respond to sexual needs without worrying whether there's a condom immediately available; are these all not reasonable and healthy needs? HIV serosorting done within the context of a committed relationship is a valuable and appropriate  means of measured risk valuation. IMO.

AMEM! to that 

[madbrain]

Misguided by what (who's)  standard? The desire for intimacy, desire to have a normal sex life, wanting to respond to sexual needs without worrying whether there's a condom immediately available; are these all not reasonable and healthy needs? HIV serosorting done within the context of a committed relationship is a valuable and appropriate  means of measured risk valuation. IMO.

Yes, they are reasonable needs, I just don't agree that serosorting is the answer.

[madbrain]

Serosorting works if you are poz.  It does not work well for HIV neg people.

It doesn't take a genius for a bug chaser to pretend to be poz so that he can bb with some poz guys. I wouldn't want to be responsible for infecting one.

And as has been pointed out, even between poz guys, there are other bugs around. Not all of them easily curable depending on the stage of infection. Would you want to be coinfected with HIV, syphilis, HSV1, HSV2, HPV, hepatitis C , not to mention A and B if you didn't get vaccinated.

[fearless]

And as has been pointed out, even between poz guys, there are other bugs around. Not all of them easily curable depending on the stage of infection. Would you want to be coinfected with HIV, syphilis, HSV1, HSV2, HPV, hepatitis C , not to mention A and B if you didn't get vaccinated.

Well, considering that I had all of these except hep C and syphilis (which I've now had post HIV) prior to my HIV infection serossorting seems to work well for me. For me, the advantages of a good condomless fuck with my boyfriend and whoever else we have along far outway any possible negatives.