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"The issue was that quite a few of his partners were anonymous.
He met them through dating apps. Messages were deleted after the
encounters. I was able to get information on some of the partners,
but concerning the dating apps, it was difficult."
Amorim said the number of sex partners the man had is not
unusual. "I would say it's probably common. I would say more
the norm. Not near the highest."

but to help them. "Day to day it's about the client's willingness to
change his sexual behaviors."

CDC Guidelines

The CDC has issued guidelines for men having sex with men.
The CDC encourages them to be "in a long-term, monogamous
relationship with a partner who has been tested and has negative
Since most of the man's encounters were anonymous, AmSTD test results."
orim would not be able to find many of the partners to tell them
The CDC adds that partners should use "latex condoms
that they had sex with a man who has syphilis. And they are very
likely having sex with other men, potentially dozens of other men, the right way every time you have sex, (and) if you have sex with
who in turn have sex with dozens of other men. Cases such as the more than one partner, and don't use condoms, or engage in risky
one Amorim described can quickly turn from simple addition to behaviors, then you should get tested more frequently (e.g., every
a geometric progression. "This can really mushroom," Amorim three to six months)."
says. "This person is infected by someone, and that person infects
Syphilis also increases the risk of getting HIV. In the United
someone, and quite a few people end up exposed to an infection." States, about half of MSM with primary and secondary syphilis

MSM Syphilis Cases Caused in Part by
the Number of Sex Partners
Amorim says the syphilis outbreak among MSM appears to
be fed in part by the sheer number of sex partners and the sporadic
use of protection. "Having a large number of partners adds to the
risk of getting or being exposed to an infection. Having a lot of
partners can have far-reaching repercussions."
Amorim does what he can with each case. "I try to talk to
them about safe-sex practices. Talk to them about what they can
do to prevent exposure to the risks of getting infected again. The
higher risk of using the dating apps. Being exposed to infections
seems to go hand in hand with anonymous sex through dating
apps. I stress using protection. Give them locations where they
can go for protection and for routine checkups."
A CDC summary of the syphilis problem among MSM
states that "socioeconomic factors can impact someone's ability to
get tested and treated in a timely manner. Stigma, homophobia,
discrimination and poverty may make it difficult for some gay and
bisexual men to access health care services, including testing and
other preventive services."
The man Amorim was counseling decided to get the antibiotic
shots. But he was not ready to alter his sex habits. "He was on the
fence as far as changing sex practices. He was aware of the risks,
but his immediate gratification was more important to him than
the potential health effects."
Which means that he has a very good chance of getting
syphilis again from an anonymous sex partner, and then once again
spreading it around. Amorim said his job is not to judge his clients
14 Philadelphia Medicine : Summer 2018

are also living with HIV. That reality has prompted the CDC
to also recommend that MSM talk to their doctor about PrEP -
pre-exposure prophylaxis. It's a drug cocktail for people at a very
high risk of contracting HIV. Taken daily, PrEP can dramatically
lower the chances of getting HIV.

Growing Number of Congenital Syphilis Cases
Although men having sex with men causes the largest percentage of syphilis cases, an increasing number of cases involve
pregnant women. Congenital syphilis - the disease that occurs
when a pregnant woman with syphilis passes the infection to her
unborn child - has increased by 87 percent from 2012 to 2016.
About 40 percent of babies born to women with untreated syphilis
are stillborn or die shortly after birth.
All pregnant women in Philadelphia are required to be tested
for syphilis. And when a pregnant woman is found to have the
disease, she is urged to take antibiotics immediately.
Another aspect of the problem is that many physicians are not
attuned to STDs. Most doctors haven't seen a syphilis case since
the late 1990s. The CDC reports that one in three physicians have
not received post-medical school training in STDs. Dr. Asbell says
there's a growing awareness in the medical community that it needs
to go to school on the disease.
"There may still be doctors who are reticent to ask or test
some patients," she added. "But it's not like physicians are not
doing a good job." *
Unless otherwise stated, the source for statistics in this article is the
Centers for Disease Control and Prevention.
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