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Are antiretrovirals increasing the risk of gay men contracting syphilis? – study suggests they could be

Taking antiretrovirals as treatment may increase the risk of a gay man contracting syphilis‚ according to new research by American scientists and a South African researcher.

But other scientists warn that there are many reasons that can explain ongoing spikes in syphilis across the globe and ARVs cannot be blamed.

 The researchers‚ writing in a journal called Sexually Transmitted Infections‚ tried to explain why the rate of syphilis in HIV positive gay men in the US and Western Europe continues to increase‚ but it appears there hasn’t been the same increase in other sexually transmitted infections such as chlamydia and gonorrhoea.

 The scientists didn’t think behaviour was the only factor that explained a spike in one disease and not others.

Their mathematical modelling showed that ARV treatment may be linked to a spike in these cases.

One theory is the ARV-treatment suppresses the activity of a certain type of immune system cell‚ called a T-cell‚ which is involved in fighting syphilis.

 The same cells are not as involved in fighting chlamydia and gonorrhoea.

 “Overall‚ these findings suggest a possible link between antiretroviral therapy and an increased risk for selected diseases of infectious and non-infectious origin‚ a potential unforeseen consequence that warrants further study‚” the researchers said in a news release.

But other scientists from the John Hopkins University School of Medicine‚ writing in an editorial accompanying the study‚ warn that the rise of one sexually transmitted infection and not others may just be because doctors are missing chlamydia and gonorrhoea cases. These are asymptomatic and could be increasing undetected.

 They note there have been syphilis outbreaks among straight men and women in the 1980s and 1990s suggesting it is not ARVs driving the increase but that spikes in this disease do occur.

They continue: “We are living in an era where [antiretroviral therapy] is being used to effectively treat and prevent HIV infection. To some extent this seems to have tempered the urgency to control other [sexually transmitted infections]. As history has shown many times over‚ that would be a costly mistake.”

And they conclude: “Over the past 15 years‚ syphilis rates [among gay and bisexual men] have been rising unabated.”

 South African doctor from NGO Anova Health Kevin Rebe urged that the results be treated with caution.

“Firstly‚ it is a mathematical modelling study and it is not real-life data from cases” he said.

Syphilis rates may also increase not because there is more syphilis‚ but because more cases are detected‚ when people are in the health system receiving HIV treatment.

“What the study says is‚ stay on ARV treatment but make sure you are screened for syphilis.”

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