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You never know what you might catch

As 'safe-sex fatigue' kicks in, sexually transmitted infections increase

by Rowan Hooper

The physician’s report might have gone something like this: “The patient, H., was perhaps the most powerful man in the world and, as such, enjoyed the best medical care available. Despite this, in his late 30s he became irrational and insecure and developed tyrannical tendencies. H.’s illness may have been responsible for the miscarriages and stillbirths suffered by two of his wives, who were both executed on H.’s orders.”

King of England from the age of 17, Henry VIII died in 1547, after growing obese and ever more demented. He spent the last eight days of his life in bed, too weak even to lift a glass of water. According to a contemporary account, his deathbed stank of his bursting leg ulcers.

The descriptions of his illness and behavior led several doctor-historians to retro-diagnose Henry VIII as suffering from syphilis, a sexually transmitted infection caused by the bacterium Treponema pallidum. Specifically, it is thought that the king died from tertiary neurosyphilis, which develops when the bacterium spreads to the central nervous system. Syphilis in the brain would account, at least, for his dementia.

Today syphilis is thought of as a disease found only in history books. Beside Henry VIII, other celebrated sufferers are believed to include Beethoven, Mozart, Napoleon, Catherine the Great and Pope Sixtus IV (who, on top of contracting syphilis, founded the Sistine Chapel and fathered two children by his older sister, though not all in the same week).

Those famous (alleged) sufferers of syphilis died long ago — HIV/AIDS is what commands our attention today.

But cases of syphilis are rising again. In last week’s British Medical Journal, Lorraine Doherty and colleagues report that between 1998 and 2000 cases in the United Kingdom more than doubled in men (from 172 to 372) and rose by more than 50 percent in women (from 102 to 156).

The authors of the paper, researchers at the Communicable Disease Surveillance Centre in London, note that syphilis infections increased in the 1960s and ’70s as public attitudes toward homosexual behavior liberalized. Infections fell dramatically in the ’80s as safe sex came to be widely practiced in response to HIV/AIDS.

The recent increases are due to several localized outbreaks in different parts of Britain, in different social classes and among homosexual men and heterosexual men and women.

Both the public and health professionals, Doherty and colleagues say, should be aware of the dangers and symptoms of syphilis. One serious consequence is that infected women can pass the disease on to their unborn children. There has already been one such case of congenital syphilis linked to one of the recent outbreaks.

“Until now, most clinicians will never have seen a case of syphilis as it was believed to be close to elimination,” said Doherty in an e-mail interview. However, she added, “The medical literature over the last few years includes articles on local increases in outbreaks of syphilis in the United States, Baltic States, Nordic countries, Netherlands, France and Ireland.”

The researchers found that those infected had a number of common features, one being that infections had been picked up from unprotected sex. (A similar increase in syphilis cases no doubt occurred in Rome after Pope Leo XII banned the use of condoms in 1826. The pope said that sheaths prevented “the immoral evildoers from suffering diseases that are the just punishment for their Sin.”)

“These outbreaks indicate that unsafe sexual behavior continues among both the heterosexual and homosexual populations in England,” the study says. One of the reasons for this, said Doherty, is that young people see the threat of HIV/AIDS as having receded.

“The public health campaigns regarding HIV prevention, which were seen in the 1980s and early 1990s, may now be losing their impact. In addition, young gay men may well have missed these prevention campaigns. There is also some evidence of ‘safe-sex fatigue.’ “

Co-author Kevin Fenton agreed. “After nearly two decades of safer-sex promotion, it is possible that both governments and the public, particularly in developed countries, have seen AIDS fall from priority on the public and personal agenda.”

Their paper, he says, was intended to raise awareness among health professionals and the public that syphilis remains an important STI.

Japanese health professionals face similar problems. Japan is the only developed country where HIV infection rates are still increasing.

“Young people appear to be the same everywhere,” said Masahiro Kihara, a professor at Kyoto University School of Public Health. “Japanese young people [like their Western counterparts] are less worried about or aware of HIV, shown by the fact that only 20 percent or less reported that they are using condoms to prevent HIV/STIs.”

Like Doherty’s study in the BMJ, a survey of more than 7,000 clinics in Japan found that between 1998 and 2000, eight major STIs increased by 14 percent in women and 21 percent in men. Young people in developed countries may be suffering “safe-sex fatigue,” but they’d better wake up to the consequences soon.