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If you're not careful sex can be dangerous, and there's more than one reason for gay men to be cautious right now. Health experts in major cities across the United States and Canada are warning of a major outbreak of syphilis among the men who have sex with men population.

The numbers are staggering. New York City has seen nearly a 375 percent increase in the total number of syphilis cases diagnosed since the year 2000. In 2002, the city saw 436 cases, whereas in 2000 they saw 117, according to figures released by public health officials.

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Other major urban centers have also seen a dramatic increase. In San Francisco, the total number of syphilis cases diagnosed among men who have sex with men has jumped from 74 in the year 2000, to 484 in 2002. That's an increase of 654 percent.

Los Angeles saw 106 cases in 2000, compared to 375 cases in the men who have sex with men category in the year 2002. That's an increase of 354 percent; and men who have sex with men accounted for 65 percent of the total number of syphilis cases in that city.

Toronto has seen the biggest increase with a jump of nearly 700 percent in one clinic alone. The Hassle Free Clinic, located in the heart of Toronto's gay district, reported 70 cases in 2002 and only ten in the year 2000. Fifty-six of those 70 new cases were diagnosed in the second half of 2002 alone.

The apparent reason for the increase is just as worrisome as the numbers themselves- experts are saying men are giving up on safer sex practices.

Bob Kohn is an epidemiologist with the San Francisco Department of Public Health. He says studies they've done recently paint the "picture that people are not as concerned about HIV" as they used to be.

He says the perception is out there that new drugs mean that AIDS is not "the horrible fatal disease" is was once thought to be. "People think it's no worse than having a chronic manageable disease like diabetes," he says.

Experts are saying that HIV and unsafe sex are playing a definite role in the current syphilis outbreak. Health officials in New York City sent out a press release to reporters saying, "The most prominent risk factors for syphilis included HIV infection and unprotected anal intercourse with multiple partners."

Statistics from Los Angeles show that six out of every ten men infected with syphilis were also infected with HIV. That's partly because the presence of syphilis makes the transmission of HIV more likely through open sores caused by syphilis, and because a large number of HIV positive men infected with both HIV and syphilis are engaging in unsafe sex practices.

Not mindful

The New York press release also stated: "Of great concern is the fact that more than 70 percent of [the men interviewed] who were HIV infected reported knowingly engaging in behaviors that put others at risk for HIV as well as syphilis."

San Francisco epidemiologist Bob Kohn says that men "are also having more sex than in the 1970s." He says the ease with which men can meet over the internet, the re-emergence of the bathhouse culture, and the popularity of private sex parties have lead to an increase in anonymous sex. But, he says, that "fraction of the population who have exceptionally large numbers of partners are what sustains an epidemic" such as syphilis and AIDS.

Just like in the battle against HIV, the thing to do with syphilis is to know your enemy and be vigilant.

Syphilis, or Treponema pallidum, as it is known to scientists, is a bacteria spread through direct contact with a syphilis sore. Sores can appear on the genitals, anus, in the rectum, in the mouth or on the lips and can be spread through oral or anal sex.

The symptoms of infection at the primary stage appear between 10 to 90 days after infection (average 21 days). Usually a single round, firm, small and painless sore will develop, but multiple sores can also appear. This chancre will last between three and six weeks and will go away on its own even if not treated and progress to the next stage.

In the secondary stage, a rash will appear as the sore is fading or can be delayed for weeks. The rash appears as a rough, red or reddish brown spots on the palms of the hands and the bottoms of the feet. Again, this may disappear on its own even without treatment. Other symptoms may include: fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness.

The latent stage begins when the secondary symptoms disappear. You are still infected with syphilis even though there may be no visible symptoms. At this point, the disease may begin to damage internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. The signs include not being able to co-ordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This stage of the disease may end in death. A single dose of penicillin will cure syphilis, although a larger dose may be required for later stages of the disease.

Sex is fun, but it can also have serious consequences if you're not careful. Now is not the time to abandon safer sex practices. By all means, have fun. But stay safe by playing safe.

Author Profile:  Joseph Couture

Joseph Couture is a journalist based on London, Ontario.