By Paul Simao

ATLANTA (Reuters) - Syphilis, a sexually transmitted disease that is on the rise in the United States, may be developing resistance to one of the antibiotics used to treat it, according to a federal study released on Thursday.

Health officials in San Francisco documented eight cases in 2002 and 2003 in which single oral doses of azithromycin apparently failed to cure the infection, according to a report published by the Centers for Disease Control and Prevention.

All of the patients were gay males and five were infected with HIV, the virus that causes AIDS. They were subsequently treated successfully with either doxycycline or penicillin, the antibiotic preferred by the CDC for syphilis treatment.

The San Francisco City Clinic has since dropped use of azithromycin in most cases of primary, secondary or early-latent syphilis, said Dr. Samuel Mitchell, a CDC epidemiologist and one of the authors of the study.

Untreated syphilis can cause arthritis, heart disease, insanity and death as well as miscarriages, stillbirths and severe infections in newborn babies. It also has been shown to help spread HIV.

The apparent failure of azithromycin is a blow to infectious disease specialists, who had hoped that a single 1-gram or 2-gram dose would provide a more convenient and better treatment for many syphilis infections.

Several studies have shown that the treatment was effective in patients who were not infected with HIV. It is also much easier to administer than benzathine penicillin, which is usually injected into patients.

"The downside of azithromycin becoming less useful is that it will probably limit our ability to do in-the-field or prophylactic treatment," said Mitchell, who urged doctors still prescribing the drug for syphilis to closely follow patients.

The study came just three days after the Atlanta-based CDC reported that the nation's syphilis rate likely had risen for the third consecutive year, mostly due to a rise in infections among gay and bisexual men.

In 2003 there were 7,082 confirmed cases of primary and secondary syphilis, the initial stages of the disease, compared with 6,862 cases in 2002, according to preliminary CDC data. The rate of syphilis rose to 2.5 cases per 100,000 people from 2.4 cases per 100,000 during the period.

The CDC estimated that 60 percent of the cases last year occurred among men who had sex with men, compared with 5 percent in 1999.

By JASON STRAZIUSO, Associated Press Writer

PHILADELPHIA - Public health advocates rallied on Wednesday against President Bush's plan to expand abstinence-only education, calling instead for teaching youngsters about condoms and prevention of sexually transmitted diseases.

The advocates also criticized an upcoming congressional hearing on whether condoms should carry labels warning that they do not protect against a little known, but widespread, sexually transmitted disease. They fear such warnings would lessen use of condoms.

About 200 people attended the rally at the close of the National STD Prevention Conference, chanting: "Bush get wise, condoms save lives."

Bush has proposed doubling funding to $270 million for abstinence programs, saying in his State of the Union address in January that abstinence is "the only certain way to avoid sexually transmitted diseases."

Independent researchers studying such programs for the federal government said in a report two years ago that no reliable evidence exists that abstinence programs work.

"The Bush administration needs to fund comprehensive sex education programs," said Lauren Oshman, president of the American Medical Student Association, a co-sponsor of the rally.

The public health advocates also spoke out against a congressional hearing planned Thursday on whether condoms should carry labels warning they do not protect against human papillomavirus, or HPV.

At some point in their lives, more than 50 percent of sexually active Americans will contract HPV, a little known STD that can be transmitted even when condoms are used. Most never have any symptoms and clear the infection without treatment.

Rep. Mark Souder, an Indiana Republican who called the Washington hearing, wants the Food and Drug Administration to uphold a law that says condoms must have "medically accurate" labeling. His spokesman, Martin Green, said Americans need the information to protect against HPV, which can cause cervical cancer in a small number of cases.

"People like Rep. Souder are taking this small piece of the puzzle and running with it, saying condoms don't work ... instead of saying condoms are really good at preventing HIV and other diseases," said Julie Davids, the executive director of CHAMP, a New York-based HIV/AIDS organization.

By Jon Hurdle

PHILADELPHIA (Reuters) - The Internet has played a significant role in the latest increase in cases of syphilis among gay men by introducing partners more likely to practice high-risk sex, according to a study released on Wednesday.

About 22 percent of homosexual men diagnosed with early stage syphilis reported meeting one or more of their sexual partners through the Internet around the time they were infected, said the study by the Los Angeles Health Department.

Researchers at a national conference in Philadelphia on the prevention of sexually transmitted diseases also said they found gays who used the Web to meet sex partners were almost four times as likely to have anonymous sex than non-Internet users. They were also more than twice as likely to use injected drugs as those who found partners more traditionally.

Of gay men who met their partners online, 67 percent were HIV positive, according to the study.

"The Internet is an important venue for conducting STD/HIV prevention and control," said Dr. Getahun Aynalem, an author of the Los Angeles Health Department study.

"Potential public health prevention and control efforts should include interventions like online outreach."

The Internet was one of a number of factors contributing to the rise in syphilis and other sexually transmitted diseases among gay men, Aynalem said. Other contributors included the increasing use of the recreational drug crystal methamphetamine and the erectile dysfunction medication Viagra.

Nationally, the incidence of reported syphilis has increased by 18 percent in the last three years, according to the Centers for Disease Control and Prevention. For male homosexuals it has multiplied 12-fold.

Between 1999 and 2003, the proportion of all U.S. syphilis cases among gay men jumped to 60 percent from 5 percent.

The Los Angeles research found that men who went online to find sex partners were more likely to engage in risky sexual behavior than those who found partners elsewhere. For example, of those who said they were the dominant partner in anal sex, 91 percent were Internet users compared with 80 percent who were non-browsers.

The Web can also help control the spread of STDs, researchers said. Online, partners can be notified of a person's sexual history and chat rooms where health counselors can discuss STD prevention and control can be set up.

According to Shima Samazadeh, the head of women's affairs in the Islamic republic's interior ministry, the CD or digital video disk (DVD) under production will seek to give newly-weds an idea of "how to act when in a couple".

Quoted by the Etemad newspaper, she said a "very poor knowledge of sexual matters" had caused a range of problems, including rising HIV/AIDS infections, mental illness or, more simply, dissatisfaction in married life.

She also pointed out that while sex education lessons are given in schools in the West, in Iran the issue has been subject to "red lines within the family".

No details on the content of the discs were given, nor on how they would be distributed. However, when applying for a marriage license young couples in Iran are obliged to sit through a brief course on family planning.

"We certainly hope that an effective vaccine would eventually help many of our people," Innocent Nyaruhirira, minister in charge of HIV/AIDS and related diseases, told Reuters.

The Rwanda trial would be carried out in the capital Kigali over a 10-month period by 45 volunteers in conjunction with the International AIDS Vaccine Initiative (IAVA), a global scientific organization looking for a vaccine, Nyaruhirira said.

He said of the 1994 genocide: "Militiamen who knew very well that they were infected intentionally raped women."

Rape as an instrument of war during the genocide accelerated the HIV infection rate. Extremists from the Hutu majority butchered some 800,000 minority Tutsis and politically-moderate Hutus.

Between 10-13 percent of Rwanda's population of eight million are infected by HIV/AIDS, Nyaruhirira said. He put the rate of infection in urban areas at around 13 percent and five percent in rural areas.