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Dr. Asbell added that "Some people do have a different partner
every week. Some people have many partners. Some people have
one or two. Most of our syphilis cases have several partners. Having
multiple partners is a big risk factor for syphilis."
If untreated, syphilis can spread to the eye, the nervous system,
the brain. It can cause hearing loss, blindness, stroke, and it increases
the person's risk at getting HIV and giving it to others. Syphilis, gonorrhea and chlamydia can be cured with antibiotics. But a person can
get the disease again by having sex with someone who has an STD.

Causes for Syphilis Rate Among MSM
The CDC says there are several causes for the high rate of syphilis
among MSM: many partners, often anonymous; unprotected sex;
the social stigma of having sex with many partners which prevents
many people with syphilis from seeing a doctor; drug use; poverty
and unstable housing, and slashed funding for STD programs
across the country.
The CDC says the best way to not contract an STD is "abstinence,
or not having oral, vaginal or anal sex."
But the CDC adds, "if you have sex choose only one partner
who you know well and trust. Someone who only has sex with you.
This is called 'mutual monogamy.' Limiting your number of sex
partners helps reduce the risk of getting an STD.
"If you choose to have sex use latex condoms from start to finish,"
although the CDC says condoms "are not a full-proof protection
against STDs." The CDC goes on to say that most people who have
STDs usually don't have symptoms. "A test from your doctor or local
health clinic may be the only way to tell for sure if you're infected."

She has seen some doctors who are uncomfortable prescribing
PrEP, because they believe it encourages reckless sexual behavior.
PrEP - pre-exposure prophylaxis - is prescribed for people who
have a very high risk of contracting HIV. These patients take HIV
medicines daily to lower their chances of getting infected. PrEP can
stop HIV from taking hold and spreading through the body. It's
highly effective when used as prescribed.

Accepting Patients Where They Are
Alvarez says that providers have to accept patients where they
are, not judge them. "We have to get the message out there that
they're a stake in this. It's very treatable. It's very common. It should
not be underlined in any way that it's promiscuous. Saying if you're
on this site or that site, it's wrong. The message comes across wrong."
Alvarez singled out the CDC for criticism. She believes that it
doesn't have enough people working for it who have had personal
experiences in the LGBTQ community. "I think the CDC needs to
start hiring and making sure that the people making decisions are
reflective of the people most affected by syphilis and HIV and all
the things the CDC is responsible for. They need to start listening."
The CDC declined to respond directly to Alvarez's comments.
But in a statement made when the newest STD statistics came
out in the fall of last year, the CDC's Dr. Bolan said, "This is affecting
the health of our nation. It takes a village, and we need all sectors
really involved in trying to reverse these trends." *

Dr. Asbell says PDPH recommends several ways to protect against
STDs, including a monogamous relationship, using condoms and
getting regular checkups. "We recommend that high-risk individuals
get screened often. "

Alvarez: Doctors Need Better Training in STDs
Alvarez believes that a significant part of the problem is that not
enough doctors are trained to treat STD cases. The CDC reports
that about one in three doctors has not received any post-medical
school training in STDs. And Alvarez says some physicians are just
biased when it comes to treating members of the LGBTQ community.
"We need to talk about more education and acceptance among
the providers. We can't expect people to feel safe coming in and
getting tested if they can't find a safe space, and they feel judged
when they come in."
Alvarez thinks the emphasis on monogamy keeps many gay men
away from the doctor's office. "I think a majority of people would
love to have a monogamous relationship. But the fact of the matter
is it's not what the majority of people are doing. Some people just
can't find a monogamous relationship. And there are just some
people who don't want a monogamous relationship. So, why are
we putting the message out there that the right thing to do is to
have such a relationship?"

Spring 2020 : Philadelphia Medicine 15


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Philadelphia Medicine Spring 2020

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