Syphilis in HIV-positive gay Hamburgers

One hundred years ago the German philosopher Friedrich Nietzsche lost his mental faculties as a result of tertiary syphilis infection.

Today in the UK it is rare that the disease advances to this stage, which is typified by heart and central nervous system complications and may even result in death. Early detection and treatment of both primary and secondary syphilis cures infection.

Recent reports have documented the re-emergence of a disease that in many parts of the developed world had long been considered eradicated. Back in July, in our newsletter AIDS Treatment Update, we published current knowledge about ongoing syphilis transmission in the UK and, in particular, drew attention to the spread of the disease among gay men in London.

Over the past year, outbreaks have been described in other western European cities. These outbreaks have tended to be concentrated among gay men. In Athens today new data were presented about the recent re-emergence of syphilis in Hamburg, Germany.

Data were collected from 16 centres, 11 from the city of Hamburg and 5 from other cities in Northern Germany (Hannover, Kiel, Luebeck). Between 1997 and 1999 a total of 210 cases of syphilis were diagnosed. The overwhelming majority of which (82%) were in HIV-positive gay men.

New cases among HIV-positive gay men in Hamburg have increased year on year since 1997. In 1997 there were 19 cases diagnosed, in 1998 this had risen to 49 cases and by 1999 the total had reached 71 new cases.

Interestingly, the rise in new syphilis cases in this region has been confined to the city of Hamburg. In Hannover, Kiel and Luebeck new cases reported between 1997 and 1999 both among HIV-positive and HIV-negative individuals remained stable.

Dr Lorenzen, presenting the poster, warned that transmission is still ongoing and expressed concern that due to a much higher risk of transmission of HIV in the presence of an active syphilis infection, there may be an increase in newly diagnosed HIV infections in the near future. With regard to the confinement of syphilis to Hamburg, this is probably due to the fact that it seems likely that many of the men have contracted the disease from sex-on-the premises venues and private sex parties that are located within Hamburg.

Many of the men who have contracted syphilis in London in the past year have been active members on the London leather scene. Travelling frequently to other European cities with organised leather scenes is common. Syphilis outbreaks have already been described in the leather meccas of Amsterdam and Antwerp.

In the German Capital, Berlin, 'gay scene' doctors have this month warned that they are seeing an increasing numbers of gay men within their clinics presenting with syphilis, gonorrhoea, herpes and hepatitis. In this month's edition of Siegessaeule, Berlin's gay and lesbian magazine, gay men with more than one sexual partner are advised to take a full sexual health screening bi-annually.

As yet, in Germany, a change in the sexual behaviour of gay men living with HIV resulting in more unsafe sex has only been suspected. Studies detailing the sexual behaviour of HIV-positive gay men are eagerly anticipated.