“Syphilis can have very serious complications when left untreated…Most people who have chlamydia don’t know it since the disease often has no symptoms…ANYONE who is sexually active can get gonorrhea.”
These are the current PSA banners featured on the Sexually Transmitted Diseases (STDs) homepage of the Centers for Disease Control and Prevention (CDC) website, www.cdc.gov.
Across the U.S., gay and bisexual men face the “highest and rising” number of syphilis infections, according to a November 2015 CDC trends report.
“While rates have increased among both men and women, men account for more than 90 percent of all primary and secondary syphilis cases. Men who have sex with men (MSM) account for 83 percent of male cases where the sex of the sex partner is known,” the report states.
Dr. Steven Santiago, chief medical officer of Care Resource, a nonprofit and health center for uninsured and under-insured LGBT patients in Miami-Dade and Broward counties, gave his opinion on more cases of syphilis among gay men in South Florida.
“It’s the increase in use of recreational drugs, such as crystal meth, ‘molly,’ and ‘bath salts.’ These drugs, and alcohol, cause increases with high-risk unprotected/condomless sex,” Santiago said.
He added, “It is common to diagnose someone with an STD and HIV at the same time. The risk is increased even further if the person uses recreational drugs.”
Syphilis is an STD that can cause long-term complications if not treated correctly. Symptoms in adults are divided into stages – primary, secondary, latent, and late syphilis – according to the CDC.
Syphilis can be contracted through direct contact with a syphilis sore during vaginal, anal or oral sex. Sores can be found on the penis, vagina, anus, in the rectum or on the lips and in the mouth.
“The CDC reported recently that condomless sex had increased by 20 percent over the past decade amongst gay men. This can absolutely contribute to a rise in STD cases,” said Stephen Fallon, executive director of Latinos Salud, a gay men’s health and advocacy organization with offices and STD testing facilities in Wilton Manors and Miami Beach.
In 2014, general population increases were seen in all three nationally reported STDS – chlamydia, gonorrhea and syphilis (primary, secondary and congenital) – the CDC said.
Nationally, chlamydia cases in 2014 were at almost 1.5 million, an increase of 2.8 percent in 2013. Gonorrhea cases were around 350,000, an increase of 5.1 percent. Syphilis (primary and secondary) cases were at 20,000, an increase of 15.1 percent, while syphilis (congenital) cases were at nearly 500, an increase of 27.5 percent from previous year.
“STDs are a substantial health challenge facing the United States. CDC estimates that nearly 20 million new sexually transmitted infections occur each year in this country, half among young people aged 15-24, and account for almost $16 billion in health care costs,” the CDC trends report states.
“Each of these infections is a potential threat to an individual’s immediate and long-term health and well-being. In addition to increasing a person’s risk for acquiring and transmitting HIV infection, STDs can lead to severe reproductive health complications, such as infertility.”
Chlamydia is a common STD that can infect both men and women, according to the CDC. It can be contracted by having vaginal, anal or oral sex with someone who has the STD. If a sex partner is male, chlamydia can still be contracted even if he does not ejaculate (cum).
Gonorrhea, which can infect men or women, can cause infections in the genitals, rectum and throat, the CDC reports.
Federal, state and local health agencies are aware of an uptick in STDs and are working to address the increase through educational campaigns, improved testing and better reporting methods.
Many STD cases go undiagnosed and unreported, and a majority of cases when discovered are in private physician offices or health maintenance organizations, according to the CDC.
Miami-Dade and Broward counties collectively accounted for the largest number of primarily chlamydia cases, followed by gonorrhea and syphilis cases in South Florida and statewide from 2005-2014, according to data from the Florida Department of Health’s Division of Public Health Statistics.
During this time period, Miami-Dade County STD cases increased from 5,721 to 13,440. Broward County cases increased from 6,490 to 11,791. Palm Beach County had a smaller increase in cases from 3,085 to 5,955.
Statewide, there was an upward trend from 64,321 to 105,461 STD cases.
Mara Gambineri, spokeswoman for the state health department, said that population increases should be considered when examining data.
“Miami-Dade is the largest county, and it is not unexpected that they have the highest number of cases. The vast majority of the increase in bacterial STDs is from reported chlamydia cases, which increased significantly statewide from about 40,000 cases in 2005 to over 70,000 cases by 2009,” Gambineri said.
Gambineri additionally attributed an increase in chlamydia cases to improved testing technology for screening.
Prior to 2006, culture was previously considered to be the “gold standard for diagnosis of infection.” Nucleic acid amplification testing (NAAT) was adopted by most Florida health-care providers in 2006 and has resulted in better accuracy, she said.
“It provides superior sensitivity and specificity and is now the recommended method for diagnosis of chlamydia,” Gambineri said. “Moreover, NAAT requires a urine sample rather than an invasive swabbing of the suspected infection site, a far more acceptable option for clients who opt for testing.”
Gambineri further noted that the state health department has implemented a new surveillance and case management system for STDs that has been in place since 2006, and today is at almost 100-percent reporting with testing laboratories.
“This new system has the ability to incorporate laboratory results through electronic transmission,” she said. “In 2015, approximately 95 percent of all positive STD lab reports received by the department were electronic.”
State-level data for this STD trend is not broken down by age groups, gender or sexual orientation; however, the state health department estimates that almost 200,000 gay men live in South Florida, according to Latinos Salud.
Fallon, from Salud, said gonorrhea and chlamydia cases are highest among heterosexual women, but that’s “largely a matter of missed opportunities for diagnosis… Studies show that if screening for gay men doesn’t include self-collected rectal specimens, up to 60 percent of infections will be missed. We’re in negotiations to add that screening to our service rooster.”
Fallon added that Salud has a new program called “DIversiSafe,” which empowers gay men to choose their preferred method of protection against STDs.
“For some, that will be condoms. For others, who are never going to be comfortable with condoms, we educate them about choices like negotiated safety, PrEP and TasP (treatment as prevention). Properly implemented, any of these will lower new HIV infections, though only negotiated safety would likely lower STDs. For those using any of the ‘condomless’ risk reduction methods, we recommend vaccination against hepatitis A and B, and against HPV,” he said.
Santiago, from Care Resource, doesn’t necessarily agree with this approach.
“This is also somewhat controversial. I believe that ‘normalizing’ unprotected sex in this manner will decrease the perception of the risk that it carries,” Santiago said.
Gambineri said STDs are preventable and that state and county health departments are “committed to educating communities… on how to prevent STDs by making positive choices, as well as knowing how and where to receive testing and treatment.”
She added, “Detecting and treating STDs early is key to protecting population health. All county health departments offer STD testing services; some even have mobile health units that go into communities with high-risk populations.”
Find free STD health clinics for testing and treatment in Florida by visiting www.yourstdhelp.com/florida.html.