Syphilis and HIV: A Dangerous Duo Affecting Gay and Bisexual Men

Content From: Gail Bolan, M.D., Director of the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and PreventionPublished: December 13, 20123 min read


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Trend data released today in CDC’s 2011 STD Surveillance Report show that primary and secondary syphilis rates are increasing among gay and bisexual men, who now account for more than 70% of all infections. During the 1990s, syphilis primarily occurred among heterosexual men and women of racial and ethnic minority groups. However, the tide shifted and cases began to increase among gay and bisexual men, referred to as men who have sex with men (MSM) in CDC data systems. A growing number of these cases have been reported among young MSM, with the highest rates being found in men 20-29 years old. What is causing this shift? And what should we be doing differently?

Syphilis & HIV

Annual syphilis surveillance data published in the just released 2011 STD Surveillance Report continue to emphasize the disproportionate burden of disease among gay and bisexual men. While the health problems caused by syphilis in adults are serious in their own right, it has been shown that the genital sores caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis is present, and studies have also shown that syphilis will increase the viral load of someone who is already HIV infected. This is especially concerning, as data from several major cities throughout the country indicate that an average of four in 10 MSM with syphilis are also infected with HIV. The stakes are too high to ignore these health disparities. It is critically important that syphilis infections among MSM be promptly diagnosed and treated in order to decrease the rates of subsequent HIV infection.
Moving Forward: MSM and Syphilis Prevention
If we are to tackle the root causes of health disparities among gay and bisexual men, we must confront the underlying conditions that place this population at greater risk for STDs. Risk behavior alone does not explain the disproportionate STD burden these men face—complex issues like homophobia and stigma also help fuel the infections. CDC is working with program partners to take action to confront the underlying causes of STD disparities. One example is the movement to go beyond disease-specific prevention approaches and provide more comprehensive, holistic sexual healthcare through Program Collaboration and Service Integration—an effort to organize and blend interrelated health issues (like HIV and STD prevention), activities, and prevention strategies to facilitate comprehensive delivery of services. Action plans guided by the best available science and input from partners are also being implemented to help individuals and communities overcome environmental forces that increase the risk of acquiring an STD. However, governments’ efforts cannot do it alone—broader action is also needed by all parties involved. Many Americans are reluctant to discuss sexual health issues, though STDs are very common. Together we can bring these conversations out of the shadows:

Health Care Providers should…

  • Assess their patients’ risk for STDs, especially MSM
  • Test patients according to CDC’s STD testing recommendations at the site of exposure

Individuals should…

  • Talk openly with your doctor or health care provider and ask to be tested--your health depends on it
  • Talk openly with partner(s) about STDs and testing
  • Get tested for STDs—go to or call 800-CDC-INFO to find a site near you
  • Use a condom correctly each time you have sex and/or practice mutual monogamy with an uninfected partner to reduce your risk of getting syphilis

Community leaders should...

  • Engage other sectors (business, transportation, housing) to help promote STD prevention and sexual health
  • Speak out about STDs and fight stigma
With timely diagnosis and appropriate treatment, syphilis is curable. By remaining vigilant and promoting greater awareness and action, we can turn the tide against this disease and help stop the spread of HIV. We can help ensure good health for gay and bisexual men who are disproportionately impacted by STDs as well as HIV.