The letter, which urged doctors to reinforce safe-sex education and consider routine sexually transmitted disease testing, also noted that gay and bisexual men make up a growing share of early-stage HIV infections in the state, jumping from 41 percent in 2008 to 51 percent in 2010.

Indeed, Flanigan says he is concerned that the surging syphilis rates, particularly acute among younger men, "could be a harbinger of an increased HIV epidemic in the gay and bisexual community."

Getting a full handle on the situation may take some outside expertise. And in late December, the state asked the Centers for Disease Control and Prevention to recommend better interventions with gay, bisexual, and transgendered men.

The federal agency, to start, is working on two sets of surveys: one targeted at men having sex with men and another at medical providers. They should be in the field by May. They can't come soon enough.

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