The number of syphilis and gonorrhea cases reported in Hawai'i in 2002 is the highest in at least 10 years. The actual case numbers are small when compared with the state's population of 1.2 million, but the increase in the past two years has been dramatic.

State and federal public health officials say one reason for the rise in these STDs is a loosening of attitudes about safe-sex practices.

With effective treatments now available, AIDS is no longer the death sentence it was in the first years of the epidemic, and fear of the disease has lessened, according to Peter Whiticar, chief of the state Department of Health's STD/AIDS Prevention Branch.

"Since the advent of protease inhibitors, fewer people are dying of the disease, so you don't see so many people in the community suffering from HIV/AIDS," he said. "Younger people don't relate to HIV and AIDS as being as deadly as it was earlier and there's been an increase in risky behavior."

Genital sores caused by syphilis make it easier to transmit and acquire the human immunodeficiency virus that causes AIDS. Condom use is not an adequate barrier against syphilis because the sores can sometimes be on areas not covered by a condom or not visible at all.

People with gonorrhea also can more easily contract HIV. Someone with HIV infection and gonorrhea is more likely than someone with just HIV infection to transmit HIV to others, according to the Centers for Disease Control and Prevention.

"With the increase in STDs and evidence of more risky behavior, it's likely going to play out in more HIV infections," Whiticar said.

The Health Department reports there were 484 new cases of gonorrhea reported in 2000, 603 in 2001 and 744 in 2002. The cases are almost evenly split between men and women. The pace has increased in 2003, with 252 gonorrhea cases reported from January through March.

Syphilis cases rose from 14 in 2000 to 38 in 2001 and 64 in 2002, and overwhelmingly involve men. Complete statistics for 2003 were not available.

Whiticar said what's different about most of the recent cases of syphilis is that they were acquired through man-to-man sexual contact and originated within Hawai'i. Previously, syphilis was typically spread by heterosexual relations and was contracted out of state, he said.

Jason Mossholder-Brom, director of HIV preventive services at the Life Foundation, said many gay men may not be aware of the recent upswing in STDs. The Life Foundation provides counseling, support, testing, outreach and prevention services.

Mossholder-Brom also heads the foundation's Island Kane Ohana Network, or IKON, for young gay men ages 15 to 29. He said preventing STDs is not a question of awareness, since the gay community has been "HIV-education saturated." It's a much more difficult problem of getting people to adopt safer habits, which is tough in any case.

"Young men struggled to modify their behavior to prevent HIV infection. This type of infection (syphilis) is easier to contract," he said. "Now we're asking young men to not only use a condom every time but to be extra cautious about their behaviors."

In other words, "what you're doing may not be enough."

After federal recommendations were released last year, the Health Department and Mossholder-Brom's group have been stressing screening and prevention of all STDs as well as the need for hepatitis vaccinations. The CDC guidelines recommend annual screenings for HIV, chlamydia, syphilis and gonorrhea and vaccination against hepatitis A and B for all gay and bisexual men.

"Some STDs may be asymptomatic," Whiticar said. "It's not a question of waiting until you feel you have a medical problem. You may never feel you have a problem and the damage may be done and you may not know it."

Hawai'i also has seen a significant rise in chlamydia, the most frequently reported infectious disease in the United States. Cases have increased from 2,604 five years ago to 4,530 last year, according to the Health Department.

In the first quarter of 2003, there have been 1,306 chlamydia cases — 988 involving women.

The CDC reports that teenage girls have the highest rates of chlamydial infection. Most people who have chlamydia are not aware they are infected. It is easily cured with antibiotics, but left untreated, it can cause pelvic inflammatory disease, which can result in infertility and other serious reproductive problems.