STD Rates on the Way Up

According to a Reuters article, STD rates are on the rise. In gay and bisexual men, it's syphilis; in blacks, it's chlamydia. (For those out of the field, the two big places we tend to see changes in STD rates first are gay/bi men and black people. Sad but true. If only we could all get along over our love for unprotected sex.)

For syphilis, we are talking about the fun topic of serosorting as the reason for the spread:

Douglas said many cases are occurring in HIV-positive men who are choosing other HIV-positive men as sexual partners.

"Within that relationship, they are less concerned about the transmission of other conditions. They're not using condoms. They believe that their partner already has got the worst they can get -- they've got an HIV infection," he said.

Serosorting is this whole thought that if two men are HIV+, they can have unprotected anal sex without the risk of transmission. As a prevention effort for HIV, it works great for known HIV+s... it's probably less so for "known" HIV-s -- i.e., I think most people who are HIV- would prefer sex with someone who is HIV-, especially unprotected sex. We see now, even without the superinfection theory that, perhaps, this isn't a great policy for HIV+ men.

A CBS News story highlights the fact that a lot of this has to do with better testing protocols:

"The issue with chlamydia is the more test, the more you'll find," Zenilman said.

And I'll tell you this: these numbers are grossly underreported. Here in the Emergency Department, if you are a male, and come in saying you may have been exposed or may have symptoms of an STD, you get what's affectionately known as the love cocktail -- a dose of several drugs used to wipe out gonorrhea, chlamydia, and trichomonas. From a public health stand point, it's sketchy -- we're just adding to bacterial resistance. From an epidemiological perspective, it's sketchy -- while we're reporting the female cases (we test women because of the high risk of infertility and PID), we report almost no male cases. And I would say, in an average night shift, we will see between one and four men getting the drugs without getting tested.