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"Syphilis Role in HIV Being Studied in California: STD and HIV
Surveillance Working Together"
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CDC HIV/STD/TB Prevention News Update, Thursday, May 08, 2003
AIDS Alert (05.01.03)
Are syphilis outbreaks facilitating HIV transmission among men who have
sex with men, or is syphilis contained mostly to MSM who are already
HIV-positive? California's STD and HIV health
officials hope to answer that question with assistance from CDC and its new
detuned testing technology.
In March, the state requested CDC to conduct an Epidemic Intelligence
Service (EIS) investigation - also known as an Epi Aid - which can quickly
mobilize resources for a health problem that needs immediate attention. CDC
is providing two EIS officers, and California's own EIS officers will help
coordinate the effort.
While it is clear the US syphilis epidemic is starting a new cycle, the
HIV epidemic is harder to qualify, said Gail Bolan, MD, the state's director
of STD control. CDC behavioral surveillance suggests so far that the US
syphilis outbreaks have not facilitated HIV transmission in MSM because many
men appear to be engaging in "sexual positioning" (HIV-positive men having
sex with other positive men). But information from syphilis partner
notification interviews suggests differently, Bolan said. "We talk to a lot
of men who claim they are having a lot of sex
with partners of unknown status," she said.
Previously, this research has not been easy. Controlling for behaviors
is difficult, and it is hard to know which infection came first: syphilis or
HIV. With detuned testing of specimens,
the time of HIV infection can be pinpointed more precisely. The easiest way
to measure the syphilis impact on HIV transmission is to conduct HIV testing
in a cohort of MSM recently infected with primary syphilis, Bolan said. "That
would tell you if the infection was more likely related to an ulcer," she
explained. "You could then compare the results with people who are not
infected with primary syphilis but who have similar behaviors."
So far, traditional syphilis control efforts have not been able to
quell the outbreaks. "Unless there is a collective approach between HIV and
STD prevention, it's going to be hard
for STD control to do it alone," Bolan said. "We can use our control, but we
really need some new innovative strategies," she said. The state could have
preliminary results by this summer,
Bolan added.
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