Bay Area Reporter (San Francisco) (02.20.2014)
The Bay Area Reporter described a 2013 increase in San Francisco’s chlamydia, gonorrhea, and early syphilis incidence for the eighth straight year, with the majority of cases occurring among men who have sex with men (MSM). Dr. Susan Philip, director of disease prevention and control for the San Francisco Department of Public Health, reported that chlamydia diagnoses increased 4.4 percent; gonorrhea increased 1.6 percent; and early syphilis diagnoses increased 13.9 percent from 2012 to 2013.
Based on 2012 data, the department’s STD Control Section estimated that 64,681 MSM lived in San Francisco and one of 79 had early syphilis. The report estimated that one of 34 MSM had gonorrhea, and one of 36 had chlamydia. Compared to heterosexual men, gay and bisexual men were 117 times more likely to have early syphilis, 8.6 times more likely to have gonorrhea, and 27.2 times more likely to have chlamydia.
Although new HIV infections have declined in San Francisco since 2006, Philip believed that changes in how gay and bisexual men practiced safer sex were driving STD rates higher. Factors included “a decrease in safer sex practices” due to “HIV prevention fatigue”; optimism about antiretroviral effectiveness; increased recreational drug use, including methamphetamines and erectile dysfunction medications; harm-reduction strategies like having unprotected sex with partners of the same sero-sorting status; and oral sex.
Emphasis on early use of antiretroviral drugs as HIV prevention could explain the difference in HIV and syphilis rates. Pre-exposure prophylaxis could widen the difference in infection rates further. MSM should use condoms, reduce the number of sex partners, seek immediate treatment at the first sign of an STD infection, inform partners of potential STD risk, and have STD testing every three to six months.