Sexually transmitted diseases in the HIV care setting: what's really going on down there?

Syphilis epidemics are occurring in a number of cities in the United States and worldwide. In New York City, the number of cases primary or secondary syphilis has increased from 130 in 1999 to 434 in 2002. The majority of new cases occur in men, with most of these occurring in men who have sex with men. The presentations of primary and secondary syphilis are varied and can be overlooked or confused with other diseases. Health care providers should be aware of atypical presentations of sexually transmitted diseases (STDs), screen for nonapparent STDs, and know how to treat such diseases once they are identified. Client-centered counseling may be successful in reducing risky behaviors and the transmission of STDs. This article summarizes a presentation given by Jeanne Marrazzo, MD, MPH, at the October 2003 International AIDS Society-USA course in New York.