Talk:Syphilis

Homosexual Claim

The claim in the third paragraph that the increase in cases of syphilis since the millenium "has been attributed primarily to unsafe sexual practices among men who have sex with men." is unsourced and rather ridiculous. And this page is locked so I can't even stick Citation Needed in, let alone remove it. — Preceding unsigned comment added by 68.81.36.142 (talk) 18:51, 31 July 2011 (UTC)

That sentence is attributed to "Stamm LV (February 2010). "Global challenge of antibiotic-resistant Treponema pallidum". Antimicrob. Agents Chemother. 54 (2): 583–9. doi:10.1128/AAC.01095-09. PMC 2812177. PMID 19805553. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2812177. " in the "Epidemiology" section. As to the lead section not having references is because it merely summarizes the content in the main prose. —  HELLKNOWZ  ▎TALK 18:58, 31 July 2011 (UTC)

I don't think that these verifiable and well-known facts are ridiculous. The relationship is so strong that it's used as a sentinel indicator in many public health programs, e.g., to judge the effectiveness of HIV prevention campaigns. WhatamIdoing (talk) 01:02, 1 August 2011 (UTC)

FYI, for myself, when I read your article for the first time and came to the men who have sex with men wording, I assumed it to be a moronic term in some politically correct to the extent of being meaningless way, used by the article's editors because they for some reason didn't want to use the terms gay/queer/etc; and it wasn't until I read the linked article (perhaps the next day), that I learned it to be a clinical term purposely worded in a way which (I think) would, otherwise, qualify as moronically politically correct. I'd just suggest that you consider including some wording around your first usage of the term to indicate that it is a clinical phraseology; personally I had no need, at first, to click on a link entitled 'men who have sex with men' to find out what some (presumed gay) editor (of this uncensored web-site) wished to espouse under this title.

I'm assuming, based in part on the overall quality of the article, that many of the contributing editors are health care professionals who are already fully accustomed to this clinical term; but as an uneducated outsider, the term didn't bring to my mind what the linked article explained and logically supported. And given the potential defensive response that a gay person might logically have to a (what appears to be unsupported) claim, I'd suggest duplicating the reference in the Intro paragraph even through it is fully supported by RS references further down in the article; a reader may not get that far if their first impression is that the article is unfairly biased. Still think the article is impressively, professionally well done. — Who R you? (talk) 20:03, 1 August 2011 (UTC)

If we inline attribute one statement in the lead, we'd have to inline attribute them all. Otherwise it may appear that some facts are sourced and some are not. So for articles it's usually either all inline attributed or none. Also, I don't think I agree we need to explain the term "men who have sex with men" beyond a wikilink. By that standard we would need to explain many other words which are far less likely to be understood by general readers. "Controversial" is an often brought up but a poor reason to stray from encyclopaedic prose, and explaining terms to avoid some party getting offended is biased. —  HELLKNOWZ  ▎TALK 20:29, 1 August 2011 (UTC)

This is the language we as health care providers use. I have never seen it as being political in any sense. Doc James (talk · contribs · email) 20:38, 1 August 2011 (UTC)

Was that a reply to me? I never implied it was political or biased, in fact, as far as I'm concerned, it's accurate. —  HELLKNOWZ  ▎TALK 20:46, 1 August 2011 (UTC)

No it was a reply to Who R you. I alway add my comments at the end rather than in the middle as they get lost their. Doc James (talk · contribs · email) 20:48, 1 August 2011 (UTC)

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It's entirely up to you; you (collectively) have written what I think is a very good & well written article & I doubt my comments (which were really a follow-up suggestion to you creator/editors after reading 68....'s comments) would, in any way, affect the GA review. That said, I was making a suggestion (by way of providing an alternative POV) which might improve a GA; but, it's YOUR article & I wouldn't edit it at this point.

I merely point out, while you are health care providers (HCPs), and thus use terms in a manner where you have a uniquely informed POV, that is not necessarily the same POV as that of the average reader (atleast not in my case), and unlike other clinical terms, such as pinta or chancre (which you did opt to explain); which a reader can recognize that they do not understand and can still opt to continue reading (without reviewing the link) under the mental self-disclaimer of there have been words used which I am fully aware that I do not understand and I take that into account as I continue reading; however, the "men who..." phrase is something which everyone is capable of arriving at their own (granted maybe wrong) interpretation of, yet still continue through the entire article without any real need to understand the very subtle difference between that and gay, etc, which generally, the non-HCPs of the 80-85-90-95% straight society would never differentiate between.

I merely suggest to you that, for non-HCPs, the term men who have sex with men in an article (like say if I picked up a newspaper or a hard-copy encyclopedia) would (I suggest very commonly) be intepretated (by a straight non-HCP) as someone reaching way to far in an attempt to come up with a politically correct version of "gay". You may find it hard to believe, but there apparently are some people who are bigots, and some could even be WP editors, and therefore it is just possible that a reader, who doesn't know you and who maybe hasn't decided, by the end of the third paragraph, whether you could be bigots who have no idea what the hell you're talking about, could misinterpret your wording selection. Personally, I think, after reading the entire article, you appear to be intelligent writers responsible for a quality production of an informative article about something which you obviously know and did some research and substantial hard work on. I, as an uninformed reader, stumbled across this article because I saw it mentioned on someone else's talk page with reference to a GA review & I was curious to see what qualified as a GA, and I can see why this article was nominated.

BUT, 68.... who started this thread obviously took offense to the last line of the intro; and, having read the article long before reading his comment, upon review of the area his complaint relates to, I am capable of seeing it from his (obviously defensive) POV; can you?

I also point out that your article states that atleast some part of the gay/non-gay risk variance stems from greater condom failure rates among gay men, rather than from purposely unsafe habits, so potentially your intro closing line is misleading.

Having read the line in question, and not being a HCP, I can tell you the "men who..." does not necessarily have the same default interpretation to the layman as it does to the HCP. I was only trying to point that fact out to you, in case you didn't recognize that not everyone will interpret this term in the same manner as you, given you professional exposure to the topic. But, of course, that's why you wrote the article, was to provide information to those who don't have the same insight as yourselves. But, like I said, it's your work, excellently done, and I wouldn't suppose to boldly edit it despite the fact that I might have worded things somewhat differently.

Personally, I'd suggest that this last intro sentence read something along the lines of "As the body of the article shows, this concerning trend is generally attributed to unsafe sexual practices among the clinical classification of men who have sex with men." Don't like that, don't want to change it, suit yourself; I only offer what I intended to be constructive criticism to (perhaps) improve an already great article.

And if I come across as a long winded whatever, sorry, I do that some times. Peace man (and on the off chance that some fine lady may take offence or deem me sexist, please take that farewell to be equally interpretable as "and on that note I bid you fine ladies and gentlemen a very good evening and bestow upon you wishes of happiness, good tidings, and good fortune")! — Who R you? (talk) 01:38, 2 August 2011 (UTC)

Gay applies to both females and males. MSM applies only to males. Which in the context of this article is the group we wish to refer to. We could use the term "male homosexuals" but men who have sex with men seems clear.Doc James (talk · contribs · email) 01:57, 2 August 2011 (UTC)

And I meant (and should have said) gay men where I said gay. And even the "Men who..." article points out good reasons to differentiate the general term of gay men from bisexuals, trans-sexuals, men who have sex with men but consider themselves none-of-the-above; but, on reading your article, I just don't think everyone will automatically read the (informative) linked article. So I'd just suggest some hint that the term you've (correctly) chosen isn't a restatement of gay, but rather that it is a clinical term with added inference.

BTW; the greater condom failure rates amoung gay men (attributed to anal vs vaginal sex), is actually in the men who have sex with men Sexually transmitted infections section. Don't know if/how that factors into your article, since your statement (which 68.... felt according to his Edit Summary was blatant homophobia) is straight from a source; but then, maybe your source didn't consider what "men who..." attributes to a CDC publication. — Who R you? (talk) 02:13, 2 August 2011 (UTC)

I have added "male homosexual" to the text. Gay still means happy in much of the English world.Doc James (talk · contribs · email) 02:32, 2 August 2011 (UTC)

Yeah it's been a long time since "gay" had that meaning in North America. And the differentiation of those terms was what I saw at first, and is a pretty minor thing of phrasing.

But I think 68....'s problem is the implication that "Gay/Homosexual/Men who.../whatever the term used" have caused the increased infection rates through unsafe sexual practices. And that appears to have more to do with the source than your article; but I've just tried to check the referenced source for those statements, reviewing footnotes 1 & 2, and only abstracts are available for unpaid online viewing.

And while those abstracts do mention the increase globally and in China; they do not include the portion of the source supporting that it is unsafe sexual practices among "men who..." that is the attributable cause of that increase. I assume you're likely working from the full text which does backup those statements; but given the inflammatory nature, you might want to "quote word for word" from some part of that source to back up that part of your article.

Re:increased condom failure which I referred to earlier from "men who...", that CDC references is:

"...However, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be risky. A person should use generous amounts of water-based lubricant in addition to the condom to reduce the chances of the condom breaking."

from HIV Transmission|Questions and Answers|CDC HIV/AIDS from the section entitled Can I get HIV from anal sex?

That article section also ends referring to another CDC article CDC - Condom Effectiveness - Male Latex Condoms and Sexually Transmitted Diseases which does not mention this added risk of condom failure; and only makes some reference (which you may or may not find useful), in relation to syphilis; toward the end of the article, in the Genital ulcer diseases and HPV infections section, saying:

"... Consistent and correct use of latex condoms reduces the risk of genital herpes, syphilis, and chancroid only when the infected area or site of potential exposure is protected. ..."

and follows:

"Epidemiologic studies that compare infection rates among condom users and nonusers provide evidence that latex condoms provide limited protection against syphilis and herpes simplex virus-2 transmission. ..."

Just to save you some time searching of references. Good luck with the GA! — Who R you? (talk) 03:49, 2 August 2011 (UTC)

I am still not sure what you are getting at. This paper is freely accessible http://www.ncbi.nlm.nih.gov/pubmed/19805553 I do agree that the mention of only MSM is very Western centric. Thus I have added other factors that are playing a role in other areas of the world and a lessor role in the west to the lead. Doc James (talk · contribs · email) 05:29, 2 August 2011 (UTC)

Sorry... The link was to the article abstract and whatever I clicked last time I checked asked me for fifty something dollars for the rest of the report. But I see that the link you provided to the abstract has a link to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812177/?tool=pubmed#__ref-listid2258968 the full article. And while the abstract is an RS of "Despite elimination efforts, syphilis remains endemic in many developing countries and has reemerged in several developed countries, including China, where a widespread epidemic recently occurred."; and the full paper has

"While the widespread epidemics of syphilis that occurred in Russia in the 1990s and more recently in China mostly involved heterosexuals, smaller outbreaks in the United States, Canada, and England predominately involved men who have sex with men (MSM) (5, 10, 43, 67, 77). However, recent increases in syphilis rates for U.S. women and infants suggest that heterosexually transmitted syphilis may be an emerging problem in the United States (5)."

I haven't found anything that supports "This has been attributed primarily to unsafe sexual practices among..."; you may take that as a common sense extension of the quotes above, and I might agree, but common sense extension doesn't qualify as WP:RS. I searched the full article for "practice", "unsafe", "promiscu", "prostitu", "barrier", and "condom" and found nothing supporting the statement. I will now go back and read the entire article to try to find something that supports this specific claim that the increase is attributable to unsafe practices; not that I necessarily doubt this to likely be true, but it isn't proven by this article (atleast that I've found in it yet); but as I say I'll read it now from start to finish, but in case you're looking for this response I send it now. And if I find the quote supporting it, I'll post it immediately. — Preceding unsigned comment added by Who R you? (talk • contribs) 07:30, 2 August 2011 (UTC)

I couldn't find anything to specifically support the claim that unsafe sexual practices among men who... is the source of the increase. I tried to start a search on that linked site (pubmd.gov) looking for anything with syphilis + men + unsafe, but that gave 124 responses and I'm a little to tired to read all those right now (it's 4:40am here), but I'll try to look at these tomorrow and see it there's anything citable to support this part of the article. I can see, from the few papers that I did read, why the wording in this article would seem logical, but that's not the same as having a citation to support the statement that (at least one person) interpreted as homophobic. I'll post if I find anything citable. Ciao for now. — Who R you? (talk) 08:44, 2 August 2011 (UTC)

• "This increase in primary and secondary syphilis is thought to be due primarily to an increased incidence among men. Today, more than 60% of new cases of syphilis occur in men who have sex with men (MSM), and these cases are often associated with HIV coinfection and high-risk sexual behavior." PMID 18212261

• WRT Russia "Many social changes have been hypothesized to be contributing to this recent increase including opening of borders, a rapid growth in prostitution, glamorization of sexuality from the Western world, and a partial loss of free diagnosis and mandatory treatment from the Soviet Ministry of Health." PMID 18212261

• "Main epidemiology changes, at the basis of increasing prevalence, reflect sex industry, sexual promiscuity, decreasing use of barrier protection (i.e. condoms) due to a false sense of security that today sexually transmitted disease are curable and lack of pertinent knowledge. Today, more than 50–60% of new cases of syphilis occur in men who have sex with men (MSM) and are strongly associated with HIV coinfection and high risk sexual behavior. In the Russian Federation since the fall of the Soviet Union the incidence of syphilis has shown a rapid and substantial increase. The reasons are linked to changes in sexual behavior, drug abuse, increased travel and migration which all have created the conditions for a parallel epidemic of HIV infection. Also in other European countries like Spain, syphilis has been linked in injecting drug users with high-risk sexual behavior. In China cases of syphilis have been recently observed in an increasing number and in association with less education, alcohol use, unprotected anal sex with male partners and diagnosis of sexual transmitted diseases" PMID 20596972.
• "The incidence of syphilis is rising all over the world, partly due to the increased transmission in HIV patients and other high risk groups such as men who have sex with men." PMID 19237085

I feel my summary is in line with the conclusions of this research.Doc James (talk · contribs · email) 16:04, 2 August 2011 (UTC)

MSM is preferable because it is free of "identity" and "orientation" issues. It describes a behavior. Also, "male homosexuals" is technically wrong, because MSM includes most male bisexuals and a few men who self-identify as heterosexual but still have sex with men. It also excludes some male homosexuals (those who do not have sex with men, e.g., the median 15-year-old male homosexual, who has never had sex with anyone).

I do not think that any gay man will be offended by the choice of language; they are highly likely to be familiar with the MSM terminology. WhatamIdoing (talk) 19:05, 2 August 2011 (UTC)

This may seem like splitting hairs, but the "unsafe sexual practices" doesn't bother me at all. The fact is that safe sexual practices would not result in 2% of the US population accounting for 60% of the new syphilis cases in the US. The only possible way for a group identified by sexual practice to account for 30 times its fair share of syphilis cases is if that group is engaging in unsafe sexual practices. WhatamIdoing (talk) 20:11, 2 August 2011 (UTC)

Given these citations, the statements in the article are now (I believe) fully backed up. My point had been that I could see where 68.... (gay, straight, or otherwise) or any MSM could, prior to these citations, reasonably believe that they were being persecuted and falsely accused of being responsible for a global increase in syphilis; an interpretation which, prior to your citations, I could completely understand precipitating a negative response.

I fully acknowledge, after having read men who have sex with men, that the MSM term makes total sense. My point was, that unless someone reads the link (and of course not everyone reads every link in every article since that would typically involve reading all of Wikipedia), the term MSM comes across (IMO) as a dumb term until you understand that it is a clinical term which one might argue is meant to be dumb, in that it is not, unlike most words in the English language, intended to provide additional information beyond those selectively chosen words. I'm just saying that "MSM", without indication that it's a clinical term, struck me as a very odd term, which I assumed (wrongly) was used for an incorrect reason of excessive political correctness.

And I do still think it may be prudent to add some phrasing to the end of the third paragraph to indicate that the claim is backed up below. I recognize that one isn't normally required to say in an article lead that the rest of the story follows; but I would point out that 68....'s comments were "And this page is locked so I can't even stick Citation Needed in, let alone remove it.", and without some indication that you've backup of the statement further on (which you have done), the initial response from some readers will be to take immediate offence (however unjustified that response may seem).

But regardless, you've fully backed up the statements of the article, and I hope you believe it's therefore an ever so slightly better finished product. I still think, as I have from the start, that it's an extremely well written article & I congratulate you all on a job well done; I hope & assume (with the other additions you've made) it will garner the GA it deserves. Cheers! — Who R you? (talk) 01:20, 3 August 2011 (UTC)

Thanks Who R you. Doc James (talk · contribs · email) 01:40, 3 August 2011 (UTC)

You are most welcome Doc. — Who R you? (talk) 02:48, 3 August 2011 (UTC)

I like your description of MSM as dumb, because it fits so well with the old sense of "silent" or "mute". It is one of those odd terms that is both truly medical (and quasi-medical) jargon and also correctly interpreted by the plainest of the plain old meaning of the individual words. I believe that whoever invented the phrase would be delighted to know that it has (so far, at least) maintained its silence on any point except the plain meaning. WhatamIdoing (talk) 04:46, 3 August 2011 (UTC)

Nice...  The down side is that no layman catchs that unless they read the MSM link and, I suspect, given the large number of unknown phrases and terms in a medical article like this, the non-HCP likely won't follow that particular link and therefore won't learn the particularly succinct nature of the phrase. It's unfortunate they don't (as far as I know) have stats to indicate how many readers follow which links out of an article; I'd be curious what percentage of readers (other than HCPs who already understand the term) will a)understand, or b)follow the link to learn, about the term. — Who R you? (talk) 09:32, 3 August 2011 (UTC)

I

I am struck when reading this article by the sentence mentioning syphilis being associated with an increase in promiscuity and unsafe sexual practices among MSM, as it seems both hard to believe and, frankly, unfounded, as there is no citation immediately available. For a claim such as this, I think an inline citation is very much needed, even if that means adding citations to the rest of the introduction. Not doing so undermines the reputability of the whole article.--Mhogan24 (talk) 04:49, 31 December 2011 (UTC)

If you read this article there are excellent refs to support it.Doc James (talk · contribs · email) 04:12, 1 January 2012 (UTC)

Notice please that the sentence does not claim that promiscuity has increased among MSMs. It identifies four separate causes, which are:

1. unsafe sexual practices among men who have sex with men,
2. increased promiscuity,
3. prostitution and
4. decreasing use of barrier protection.

The last three causes apply just as much to heterosexual women as to MSMs. WhatamIdoing (talk) 06:23, 1 January 2012 (UTC)

Solution to the contention

This discussion is very interesting. While research does seem to back up this assertion, I think the wording might be inflammatory and seem biased. In the interest of keeping Wikipedia unbiased, why don't we move that last sentence in the intro to the epidemiology section and tag it with citations? That way the information is there, but a reader who comes to the page doesn't suddenly become upset at the wording and move on to a different site? Obviously, from this talk page, people become upset when reading it. A citation will at least show that the assertion comes from science, and not from Doc James' own bias. I can't think of a good reason not to cite something on Wikipedia! Sdegan (talk) 16:54, 4 January 2012 (UTC)

Sure added refs to the lead to verify the content in question. While WP:LEAD states we should not be putting refs in the lead I agree that the reality is different and will begin adding refs to the lead again as these sorts of issues inevitably arrive.--Doc James (talk · contribs · email) 17:10, 4 January 2012 (UTC)

Thanks! I agree that it's odd to have citations at the beginning, which is why I suggested moving it. Either way, it is now harder for someone to misconstrue the meaning of what is being said because it is very clearly cited. Sdegan (talk) 17:15, 4 January 2012 (UTC)

Ceftriaxone is a cephalosporin, not a tetracycline group antibiotic

Ceftriaxone is a cephalosporin, not a tetracycline group antibiotic (common medical knowledge) — Preceding unsigned comment added by 65.78.129.25 (talk) 04:26, 17 September 2011 (UTC)

Y Done  Dr meetsingh  Talk  14:59, 17 September 2011 (UTC)

Genome sizes are measured in basepairs, not daltons

Under the "Bacteriology" section, it is stated that the genome of Trponema pallidum is 1.14 MDa. It should be 1.14 Mbp. — Preceding unsigned comment added by Btho86 (talk • contribs) 18:24, 28 October 2011 (UTC)

Edit request on 24 December 2011

Under 'Epidemiology', change:

"It affects between 700,000 and 1.6 million pregnacies a year"

to

"It affects between 700,000 and 1.6 million pregnancies a year"

because

'pregnacies' is probably a misspelling of the word 'pregnancies'.

Abuzadora (talk) 14:59, 24 December 2011 (UTC)

Done --Jnorton7558 (talk) 17:47, 24 December 2011 (UTC)

Edit request on 9 January 2012

This article states the columbian hypothesis for syphilis is currently the best supported by modern science. This hypothesis has been destroyed by evidence of congenital syphilis in Pompeii, however: http://www.bbc.co.uk/news/world-europe-11952322 Please fix. 76.91.45.145 (talk) 03:33, 9 January 2012 (UTC)

Please provide review articles.--Doc James (talk · contribs · email) 18:04, 9 January 2012 (UTC)

N Not done, needs a source--Jac16888 ^Talk 15:12, 21 January 2012 (UTC)