Gonorrhoea and syphilis have reached epidemic proportions among gay men in Australia, leading epidemiologist Dr Andrew Grulich told the Annual Conference of the Australasian Society for HIV Medicine (ASHM) in Sydney this week.
With the Gay Games due to commence in Sydney on November 2nd, Brent Allan, Director of Community Health at the AIDS Council of New South Wales told aidsmap that men coming to Sydney should be aware that unprotected anal or oral sex could put them at risk of these sexually transmitted infections.
Of particular concern to gay health educators such as Mr Allan is the high rate of ciprofloxacin-resistant gonorrhoea in Sydney. Ciprofloxacin is the standard antibiotic treatment for gonorrhoea in much of the world. In New South Wales (the state in which Sydney is located), 11.6% of new cases of gonorrhoea in the first quarter of this year were resistant to ciprofloxacin – and in most cases high level resistance was present.
As a result of the prevalence of drug-resistant gonorrhoea among gay men in Sydney, guidelines issued by the Sexually Transmitted Infections in Gay Men’s Action (STIGMA) Group recommend intramuscular injections of ceftriaxone as first-line therapy for gonorrhoea. Click here to see the STIGMA guidelines.
Gay men who plan to use ciprofloxacin to prevent gonorrhoea while in Sydney should be aware that this type of prophylaxis might not be effective. Dr Debbie Marriott of St Vincent’s Hospital, Sydney, told aidsmap that ciprofloxacin would not prevent infection with the highly ciprofloxacin-resistant gonococci.
“If you contract gonorrhoea while in Sydney, you may want to advise your clinician that you have picked up gonorrhoea in an area with high prevalence of resistance to standard antibiotic treatments” Mr Allan said.
The syphilis and gonorrhoea epidemics among gay men in Sydney have implications for HIV transmission. As previously reported on aidsmap HIV viral load may rise in men who contract gonorrhoea, making HIV transmission more likely.
Mr Allan said that HIV-positive men who contract gonorrhoea may be at risk of systemic disease, including a painful, arthritis-like condition. See the NAM Gonorrhoea factsheet for more details.
Despite the epidemic of gonorrhoea and syphilis among gay men in Sydney, and the associated increase in unsafe sexual practices, there has been no concomitant rise in the number of new HIV cases in Australia. Dr Grulich told the ASHM Conference that several factors may be contributing to this steady HIV incidence.
Dr Grulich said that Australia’s high rate of HIV testing among gay men and the widespread uptake of antiretroviral therapies, which has reduced viral load and thus infectivity, may have offset the increase in unsafe sexual behaviour.