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While anyone can become infected with an STD, certain groups, including gay and bisexual men and young people, are at greatest risk. Primary and secondary syphilis are the most infectious stages of the disease, and if not adequately treated, can lead to visual impairment, data coming from CDC stroke , and in rare cases, even death. Surveillance data from several major cities throughout the country indicate that an average of 4 in 10 gay with syphilis are also infected with HIV. Given the high prevalence of HIV in the gay community, increasing syphilis infections among men who have sex with men are particularly troubling. Risk behavior alone does not explain the disproportionate levels of infection among gay and bisexual men.