STDs & Men Having Sex with Men

A term that focuses on behavior rather than labels and is inclusive of all MSM, whether they self-identify as gay/homosexual, bisexual, or heterosexual. This community is at high-risk for HIV and STD infections; this is because MSM may practice anal sex, and the rectal mucosa is uniquely susceptible to certain STD pathogens.

Health care providers should routinely acquire sexual histories from their patients to facilitate risk assessment and risk reduction counseling for preventative sexual health services.  A sexual history should be taken during any new or routine patient visit, and especially if the patient presents with signs or symptoms of STDs.  To obtain the most pertinent information effectively, the use of open-ended questions in a non-judgmental/normalizing way is recommended.   

Questions to ask after a discussion about confidentiality:

• In the past year, how many persons have you had sex with?
• Do you have sex with men, women, or both?
• Do you have oral sex? Anal sex? Other types of sex?
• Do you have receptive sex (the bottom partner), insertive sex (the top partner), or both?
• Do you have sex after using drugs or alcohol?
• Do you ever have sex with strangers or people you do not know well?
• Have you had any sexually transmitted infections in the past?
• Tell me about your use of condoms. Are there times you do not use condoms? If so, why not?
• Tell me about your support system. With whom do you live? Are you in a committed, monogamous relationship?
• Do you have family support? Close friends?
• Have you experienced domestic abuse, rape, or other physically dangerous situations?
• Are you currently involved in a relationship that is abusive or that you have other concerns about?
• Do you have any concerns about your sexual practices that I have not asked about?

Providers should routinely ask sexually active MSM about symptoms consistent with common STDs in addition to STD related risks and sexual behaviors.

The following screening tests should be performed, regardless of condom use during exposure, for sexually active MSM, including those with HIV infection:

• HIV Serology at least annually if HIV status is unknown or negative and the patient (or the patient’s partner) has had more than one sex partner since the most recent HIV test.
• Syphilis Serology at least annually
• Multi-site testing for Gonorrhea and Chlamydia: Urine, Anus, Throat
  • A test for urethral infection at least annually with Gonorrhea and Chlamydia for MSM who have insertive intercourse during the last year.
  • A test for rectal infection at least annually with Gonorrhea and Chlamydia in MSM who have had receptive intercourse in the last year.
  • A test for pharyngeal infection at least annually with Gonorrhoeae in MSM who have had receptive oral intercourse during the last year.
• HBsAG to detect chronic HBV infection. HCV and HBV testing among past or current drug users.
• HCV Serology, especially among MSM with HIV infection. Screening should be performed using HCV antibody assays followed by HCV RNA testing for those with a positive antibody result.

• HPV vaccine for MSM through age 26
  • HPV infection and HPV-associated conditions are highly prevalent among MSM
• Hepatitis A and B vaccination for all MSM
• Meningococcal Vaccine for MSM with at least one other risk factor (medical, occupational, lifestyle, etc.)

PrEP is a preventative option for MSM who are at very high risk of HIV and less likely to follow safer sex practices. These include men who use recreational drugs or alcohol during sex, inject drugs, exchange sex for money or services, use condoms inconsistently, or have sex with HIV-infected partners, in addition to men who have multiple or anonymous partners.

Although PrEP can provide significant protection from HIV infection, it is not a substitute for safer sex practices. For more information or if you want to help get your patient on PrEP, please contact our PrEP Coordinator at 509-324-1438