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STDs
Among Men Who Have Sex with Men
Public Health Impact
In the early 1980s, rates of reportable STDs among men who have
sex with men (MSM) declined as they did for the rest of the U.S.
population. Reports from several U.S. cities and the Gonococcal
Isolate Surveillance Project (GISP) indicate that since 1993, an
increasing number of MSM are acquiring STDs.1-4 These reports
are consistent with analyses of available behavioral data that
indicate an increase in the number of MSM participating in sexual
behavior that places them at risk for STDs and HIV infection.5 Several factors
may have contributed to this change, including the availability
of highly active antiretroviral therapy (HAART).6 Because STDs and
the behaviors associated with them increase the likelihood of acquiring
and transmitting HIV infection,7 the rise in STDs
among MSM may signal an increase in the incidence of HIV infection
among MSM.
Observations
- In 2000, six STD
clinics in five U.S. cities (Seattle, Philadelphia, the District
of Columbia, Long Beach, and Chicago) submitted chlamydia, gonorrhea,
syphilis, and HIV data to CDC as part of the Monitoring Trends
in Prevalence of STDs, Tuberculosis, and HIV Risk Behaviors Among
Men Who Have Sex with Men Project (MSM Project). The MSM Project
includes data collected as a part of routine care at participating
clinic sites.
- Median STD clinic
test positivity among MSM was 14% (range: 8-20%) for urethral gonorrhea;
7% (range: 5-13%) for rectal gonorrhea; 5% (range: 2-12%) for urethral
chlamydia and 4% (0-12%) for HIV (Figure BB).
- Among MSM attending
these STD clinics, the median STD clinic prevalence of syphilis
was 2% (range: 0-4%) (Figure BB).
- STD and HIV positivity
varied by race/ethnicity, but tended to be highest among African-American
MSM (Figure
BB).
- Positivity for
urethral gonorrhea was higher for HIV-positive than HIV-negative
MSM. Among HIV-positive MSM, median STD clinic positivity for urethral
gonorrhea was 21% compared with 12% among HIV-negative MSM. Rectal
and pharyngeal gonorrhea positivity was the same for HIV-positive
and HIV-negative MSM. Positivity for urethral chlamydia was 6%
for HIV-negative and 2% for HIV-positive MSM (Figure CC).
- The prevalence
of syphilis was higher for HIV-positive than HIV-negative MSM.
Among HIV-positive MSM, 6% had syphilis, compared with 1% of HIV-negative
MSM (Figure
CC).
- GISP also reports
the percentage of Neisseria gonorrhoeae isolates obtained
from MSM.8 Overall, the
proportion of isolates coming from MSM increased from 4% in 1988
to 14% in 2000 in GISP clinics, with most of the increase occurring
after1993. The number of GISP clinics having >5% of GISP isolates
from MSM rose from seven clinics in 1990 to 14 clinics in 2000.
Among the 14 GISP clinics with >5% of isolates coming from MSM
in 2000, the percentage of patients who were MSM ranged from 7%
to 70%, with a median of 19% (Figure
DD). Additional information on GISP may be found in the Gonorrhea
section.
1Centers for Disease Control and Prevention. Resurgent bacterial sexually transmitted disease
among men who have sex with men – King County, Washington, 1997-1999. MMWR 1999;48:773-7.
2Centers for
Disease Control and Prevention. Outbreak of syphilis among men who have sex with
men –Southern California, 2000. MMWR;50:117-20.
3Centers for
Disease Control and Prevention. Gonorrhea among men who have sex with men – Selected
sexually transmitted disease clinics, 1993-1996. MMWR 1997;46:889-92.
4Fox KK, del
Rio C, Holmes K, et. al. Gonorrhea in the HIV era: A reversal in
trends among men who have sex with men. Am
J Public Health. 2001;91:959-964.
5Stall R, Hays
R, Waldo C, Ekstrand M, McFarland W. The gay ‘90s: a review of research
in the 1990s on sexual behavior and HIV risk among men who have sex
with men. AIDS 2000;14:S1-S14.
6Scheer S, Chu
PL, Klausner JD, Katz MH, Schwarcz SK. Effect of highly active antiretroviral
therapy on diagnoses of sexually transmitted diseases in people with
AIDS. Lancet 2001;357:432-5.
7Fleming DT,
Wasserheit JN. From epidemiologic synergy to public health policy
and practice: the contribution of other sexually transmitted diseases
to sexual transmission of HIV infection. Sex Transm Infect 1999;48:773-7.
8Centers for
Disease Control and Prevention. Sexually
Transmitted Disease Surveillance 2000 Supplement: Gonococcal Isolate
Surveillance Project (GISP) Annual Report 2000. Atlanta, GA: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, 2001 (in press).
Figure
BB. MSM Project — Median STD clinic test positivity for chlamydia,
gonorrhea, HIV and syphilis prevalence among MSM, by race/ethnicity,
2000
Figure
CC. MSM Project — Median STD clinic test positivity for chlamydia,
gonorrhea, and syphilis prevalence among MSM, by self-reported
HIV status, 2000
Figure
DD. Gonococcal Isolate Surveillance Project (GISP) — Percent
of Neisseria gonorrhoeae isolates obtained from MSM for STD clinics
in 14 cities, 1998, 1999 and 2000
Note: In 2000, these 14 clinics reported
91.7% (633/690) of GISP gonorrhea cases in men who have sex with
men (MSM). In 1998 ALB reported 0.0% MSM. Clinics include: ALB=Albuquerque,
NM; ANC=Anchorage, AK; ATL=Atlanta, GA; CHI=Chicago, IL; DEN=Denver,
CO; HON=Honolulu, HI; LBC=Long Beach, CA; MIA=Miami, FL; ORA=Orange
County, CA; PHX=Phoenix, AZ; POR=Portland, OR; SDG=San Diego, CA;
SEA=Seattle, WA; and SFO=San Francisco, CA.
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