STDs in Men Who Have Sex with Men
Public Health Impact
Notifiable disease surveillance data on syphilis and data from GISP suggest that some STDs in MSM, including men who have sex with both women and men, are increasing.1–4 Because STDs and the behaviors associated with acquiring them increase the likelihood of acquiring and transmitting HIV infection,5 the rise in STDs among MSM may be associated with an increase in HIV diagnoses among MSM.6
With the exception of reported syphilis cases, most nationally notifiable STD surveillance data do not include information on sexual behaviors; therefore, data on national trends in STDs among MSM in the United States are not currently available. Furthermore, testing strategies are often suboptimal for detecting STDs in MSM. Testing for gonorrhea and chlamydia in MSM largely focuses on detecting urethral infections, which are more likely to be symptomatic than pharyngeal or rectal infections.7 Data from enhanced surveillance projects are presented in this section to provide information on STDs in MSM.
STD Surveillance Network—Monitoring Trends in Prevalence of STDs Among MSM Who Visit STD Clinics, 2009
In 2005, SSuN was established to improve the capacity of national, state, and local STD programs to detect, monitor, and respond rapidly to trends in STDs through enhanced collection, reporting, analysis, visualization, and interpretation of disease information.8 SSuN currently includes 12 collaborating local and state health departments. In 2009, a total of 42 STD clinics at these 12 sites collected enhanced behavioral and demographic information on patients who presented for care to these clinics. During 1999–2008, similar enhanced surveillance data were collected in eight STD clinics, including three community-based gay men’s health clinics, through the MSM Prevalence Monitoring Project.9
For data reported in this section, MSM were defined as men who either reported having sex with another man in the 3 months before STD testing or who self-reported as gay/homosexual or bisexual. MSW were defined as men who reported having sex with women only within the 3 months before STD testing or who did not report the sex of their sex partner, but reported that they considered themselves straight/heterosexual. More detailed information about SSuN methodology can be found in the STD Surveillance Network section of the Appendix, Interpreting STD Surveillance Data.
Gonorrhea and Chlamydial Infection
In 2009, the proportion of MSM who tested positive for gonorrhea and chlamydia at SSuN STD clinics varied by city (Figure W). A larger proportion of MSM who visited SSuN STD clinics tested positive for gonorrhea than tested positive for chlamydia in all cities except New Orleans (where the proportions were equal) and Birmingham (where the proportion for chlamydia was higher).
Across the participating sites, about the same number of MSM were tested for gonorrhea (17,007) and chlamydia (16,615). The median site-specific gonorrhea prevalence was 14.9% (range by site: 6.5%–27.9%). The median site-specific chlamydia prevalence was 11.2% (range by site: 4.5%–18.5%). For this report, a person who tested positive for gonorrhea or chlamydia more than one time was counted only once.
Co-infection with P&S Syphilis and HIV
In 2009, the proportion of MSM who presented to SSuN clinics with P&S syphilis infection who also were infected with HIV ranged from 30% in Birmingham to 74% in Baltimore (Figure X). The median site-specific proportion was 44.4%. P&S syphilis was identified by provider diagnosis and HIV was identified by laboratory report, self-report, or provider diagnosis.
Nationally Notifiable Syphilis Surveillance Data
P&S syphilis increased in the United States during 2005–2009, with a 59.3% increase in the number of P&S syphilis cases among men and a 66.7% increase among women (Tables 26 and 27). In 2009, the rate of reported P&S syphilis among men (7.8 cases per 100,000 males) was 5.6 times higher than the rate among women (1.4 cases per 100,000 females) (Tables 26 and 27). Higher rates were observed in men than in women for all racial and ethnic groups.
In 2009, MSM accounted for 62% of all P&S syphilis cases in the United States. MSM accounted for more cases than MSW or women in all racial and ethnic groups (Figure 43). More information about syphilis can be found in the Syphilis section of the National Profile.
Gonococcal Isolate Surveillance Project
GISP is a national sentinel surveillance system designed to monitor trends in antimicrobial susceptibilities of strains of N. gonorrhoeae in the United States.4,10 GISP also reports the percentage of N. gonorrhoeae isolates obtained from MSM. Overall, the proportion of isolates from MSM in selected STD clinics from GISP sentinel sites has increased steadily, from 4.6% in 1990 to 25.3% in 2009 (Figure Y). The proportion of isolates from MSM varies geographically, with the largest proportion reported from the West Coast (Figure Z).
2 Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex with men — New York City, 2001. MMWR Morb Mortal Wkly Rep. 2002;51: 853-6.
3 Helms DJ, Weinstock HS, Asbel LE, Ciesielski C, Cherneskie T, Furness BW, et al. Increases in syphilis among men who have sex with men attending STD clinics, 2000–2005. In: Program and abstracts of the 17th Biennial Meeting of the ISSTDR; 2007 Jul 29-Aug 1; Seattle, WA. Abstract No. P-608.
4 Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2007 supplement: Gonococcal Isolate Surveillance Project (GISP) annual report 2007. Atlanta: U.S. Department of Health and Human Services; 2009.
5 Fleming 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;75:3-17.
7 Mahle KC, Helms DJ, Golden MR, Asbel LE, Cherneskie T, Gratzer B, et al. Missed gonorrhea infections by anatomic site among asymptomatic men who have sex with men (MSM) attending U.S. STD clinics, 2002–2006. In: Program and abstracts of the 2008 National STD Prevention Conference; 2008 March 10-13; Chicago, IL. Abstract No. A1d.
8 Rietmeijer K, Donnelly J, Bernstein K, Bissette J, Martins S, Pathela P, et al. Here comes the SSuN—early experiences with the STD Surveillance Network. Public Health Reports. 2009;124(Suppl 2):72–77.
9 Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2008. Atlanta: U.S. Department of Health and Human Services; 2009.