A failure to appreciate the inherent dangers of unprotected oral sex with multiple partners may lie behind a rise in syphilis among gay men in the UK. The first case-control study of behaviours associated with the recent increase—seen also elsewhere in Europe and the United States—indicates that prevention strategies would best be targeted at venues where sexual partners are picked up and within the travel industry.

Unsurprisingly, perhaps, the study's findings showed that sexual partners were mostly anonymous; they tended to be picked up in specific venues—darkrooms, cruising areas, and saunas. They also disclosed a significant relation between incidence of infection with syphilis and HIV and a strong relation between both diseases and seeking sexual partners abroad and using gamma hydroxybutyrate (GHB).

The study comprised 27 individuals out of 58 in Greater Manchester with a diagnosis of syphilis between May 1999 and August 2000 who agreed to provide information in a structured interview on their social and sexual behaviour in the 12 months leading up to diagnosis. Most were male (96%), homosexual (85%), and a quarter had existing HIV infection. The controls, 62 in total, were recruited with help from voluntary groups to reflect overall similarity to the case group and were male, homosexual, and white, and were living in the same general postcode area. Comparisons were made between cases and controls overall and among four subgroups—cases with syphilis, with syphilis and HIV, and controls with HIV only or no infection.

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