California STD doctor speaks at Vanderbilt

Dr. Jeffrey Klausner, director of the STD Prevention and Control Services at the San Francisco Department of Public Health, spoke to the Vanderbilt and Nashville community giving a presentation on the abuse of erectile dysfunction drugs, and the link between an increase in syphilis cases and Internet chat rooms.

Researchers have shown a direct connection between gay men who use erectile dysfunction drugs such as Viagra, Cialas, and Levitra, and unsafe sex practices. These risky sexual practices often lead to an infection by HIV and/or another STD, thus causing Kalusner to petition the various drug companies to curb their free samples of the medication and to limit the number of prescription refills.

But Klausner believes we must also combat the abuse on multiple fronts by urging the Federal Food and Drug Administration into classifying the drugs as controlled substances and calling on the drug makers to educate health care providers and consumers about the links between the drugs and risky sexual practices.

Klausner also believes, and his research supports, that the growth of syphilis cases in the San Francisco Bay area has a direct link to online chat rooms. Klausner recently traced a direct path of cases to the AOL chat room SFM4M (San Francisco Men 4 Men). While he admits that the number of cases directly tied to this chat room is small so far, there remains the potential for an increase.

Several other studies share Klausner’s concern. The California Department of Health Services recently shared a report that showed that 23 percent of gay and bisexual men infected with syphilis admitted to meeting sexual partners on the Internet, compared to 21 percent who had done so in bathhouses. The Center for AIDS Prevention Studies at the University of California in San Francisco found that 39 percent of gay and bisexual males interviewed online admitted having unprotected anal sex with someone they had met on the Internet in the previous two months.

Klausner is determined to educate and prevent the spread of syphilis by getting the word out in the chat rooms and the community, "It's clear we need to reach gay and bisexual men with appropriate messages, not only in traditional high-risk settings but also online." In fact, Klausner has teamed up with PlanetOut to spread the word. After meeting with Klausner, PlanetOut began a campaign in which employees periodically visit chat rooms warning members of the outbreak, and urging them to get tested and to practice safe sex. PlanetOut believes communication from them is better received than warnings from government entities such as the Health Department.

About two-thirds of the new cases affect HIV-positive people, suggesting people are having unprotected sex despite knowing their status. Both HIV/AIDS and syphilis are sexually transmitted, but only syphilis is curable. "Many people have lost their awareness or appreciation of syphilis as a health problem," said Klausner.

Klausner further noted that, because of a perceived social stigma that discourages people from even asking their physicians for HIV and syphilis tests, many allow both their own health to suffer and the diseases to spread. Combined with this perceived stigma is the fact that too many infected people do not even tell their doctors about their sexual practices. These lies of omission are quite damaging, for without full knowledge of a patient’s risk factors, a doctor may not feel it medically necessary to run those tests.

Klausner is a board certified internist and infectious disease specialist. He practices at, and is the medical director of, City Clinic, San Francisco 's free and confidential STD clinic. He is an author of over 50 scientific articles on STDs, HIV and prevention, and he is a well-known expert in HIV prevention and STDs in men who have sex with men, gay men and young adults.

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