"This is an urgent situation," said Dr. Alonzo Plough, Director, Seattle-King County Department of Public Health. "Gay and bisexual men must renew their efforts to avoid risky sex if we are to win the battle against HIV and other sexually transmitted diseases."

Syphilis was eliminated from King County in 1995 and 1996, but 60 cases -- mostly in gay and bisexual men-- have occurred in the past two years. In 1998, there were 35 reported cases in gay and bisexual men, including 6 cases in December--the highest number for any month in several years. Almost all syphilis cases in gay and bisexual men have been acquired through unsafe sex with anonymous partners.

 "This makes standard prevention strategies very difficult", said H. Hunter Handsfield, MD, Director of the Public Health Department’s STD Control Program. "It’s almost impossible to notify an infected person’s sex partners when he doesn’t know who they are."

In addition, cases of gonorrhea among gay and bisexual men seen at the Public Health Department's STD Clinic more than doubled, from 64 cases in 1997 to 148 cases in 1998. Chlamydia cases increased by 50 percent. Reported cases of rectal gonorrhea in men outside the STD Clinic rose fourfold, from 6 reported cases in 1997 to 25 cases in 1998. In men, gonorrhea of the rectum only occurs in those who have sex with other men.

About 70 percent of the gay and bisexual men with syphilis and about 20 percent of those with gonorrhea or chlamydia in 1998, also were infected with HIV. This is what makes the problem so alarming, according to Public Health officials. Not only is the behavior that transmits STD the same that spreads HIV, but risk of HIV skyrockets in the presence of other STDs. This happens because in someone with HIV plus another STD, the resulting sores or discharge are loaded with HIV. Also, the discharge and sores from other STDs contain cells that are especially susceptible to HIV infection. So, it is an explosive mix.

"The rise in STDs among gay men is alarming and a wake up call to all of us that the fight against HIV is not over," said Executive Director of the Northwest AIDS Foundation, Terry M. Stone. "We must work together to reverse this trend." The Northwest AIDS Foundation is the largest private AIDS prevention and services organization in the Northwest.

The present problem is extremely dangerous.

Clearly, the frequency of unprotected anal sex has increased dramatically among gay and bisexual men in our community; and, of course, unprotected anal sex is the main way that HIV is transmitted in gay and bisexual men. Some cases are transmitted by oral sex. This behavior change does not involve all gay and bisexual men -- the large majority probably continue to be sexually safe.

Nonetheless, it is likely that right now HIV is spreading rapidly in gay and bisexual men in King County, perhaps more rapidly than at any time in the past 15 years.

Plough and Handsfield say that the reasons for the change aren’t known, but they speculated that some gay and bisexual men might have become complacent about the dangers of HIV and AIDS because of the dramatic advances that have occurred in treatment. Most of the reported STD cases in gay and bisexual men were in men over age 25, and the average age was 33. Therefore, the problem is due mostly to behavior relapse in men who formerly practiced safer sex, not unsafe sex among young men who recently became sexually active.

Recommendations for gay and bisexual men:

• Avoid anonymous sex.
• Use a condom or other barrier every time (and all the time) for any sex outside a permanent relationship in which both persons are HIV-negative.
• Learn about and be aware of STD symptoms. Do not have sex when you or a partner have symptoms that might indicate an STD, such as discharge from the penis or rectum, sore on the genitals, anus, or mouth, and unexplained skin rash.
• If you have symptoms of an STD, don't have sex. Get diagnosed. See your regular health care provider, or call the Public Health Department’s HIV/STD Hotline (206-205-STDS) for a referral to a public health or community clinic.
• Get tested. Know if you have HIV and other STDs. Tell your partner if you have any of these infections.
• Finally, don't be complacent about HIV and AIDS. HIV infection remains a devastating disease, even though treatment is more effective than ever before. Many people with HIV will still die of it, often in only a few years and sometimes in a matter of months. And the treatment is no picnic; just ask anyone taking it.