Gay & Bisexual Men Deserve the Best Health Possible

Syphilis Strikes Back

Gay and Bisexual Men Remain Hardest-Hit by Syphilis

Gay and bisexual men are experiencing rates of syphilis not seen since before the HIV epidemic. In recent years, gay, bisexual, and other men who have sex with men made up half of primary and secondary (P&S) syphilis cases, and data suggest that almost half of gay and bisexual men who have syphilis also are infected with HIV. Previous research also finds that gay and bisexual men of color are particularly affected.

What Gay and Bisexual Men Can Do to Prevent Syphilis

Knowledge is key! Know what puts you at risk and how to avoid and/or lower those risks.

If you are sexually active, here are some ways to lower your chances of getting syphilis:

  • Be in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results.
  • Reduce your number of sex partners; however, it’s still important that you and your partner get tested and that you share your test results with one another.
  • Use latex condoms the right way for every act of vaginal, anal, and oral sex throughout the entire sex act (from start to finish). Condoms prevent the spread of syphilis by preventing contact with a syphilis sore. Sometimes sores can occur in areas not covered by a condom, so you could still get syphilis from contact with these sores, even if you are wearing a condom.
  • Get tested – it’s the only way to know if you have syphilis. CDC recommends all sexually active gay and bisexual men be tested for specific STDs, including syphilis, at least once a year, and more frequently for those who have multiple or anonymous partners (i.e., at 3- to 6-month intervals). Visit CDC’s STD testing recommendations page to learn more.
  • The most reliable way to avoid getting syphilis or other STDs is to not have anal, vaginal, or oral sex.
  • Talk about it! Silence helps to fuel the spread of STDs.
    • Have an honest and open talk with your health care provider about your sexual history and ask whether you should be tested for syphilis or other STDs. There also are resources available for finding an LGBT-friendly health care provider.
    • Talk with your partner about sex and STDs BEFORE you have sex.

If you test positive, syphilis can be cured with the right medicine from your health care provider. It’s also important that your sex partner receives treatment. Even after you’ve been successfully treated, you can get syphilis again. That means you should continue to take actions that will lower your risk of getting infected again.

What Health Care Providers Can Do to Protect Their Patients

You play a PIVOTAL role in preventing syphilis by keeping your patients safe and by stopping further transmission of syphilis within the community.

For sexually active patients:

  • Take routine sexual historiespdf icon, including regularly asking gay and bisexual men about symptoms consistent with common STDs.
  • Talk with them about prevention methods.
  • Follow CDC’s recommendations to test gay and bisexual men for syphilis at least once a year, and every 3-6 months for those at increased risk. This includes men with a history of syphilis infection, incarceration, drug use, or multiple/concurrent partners, and those who live in areas with high rates of syphilis.
Syphilis Diagnosis and Treatment

Diagnosing and treating syphilis can be complicated. If you have questions, follow-up with your state or local health department or a local infectious disease doctor. We also have several other resources that can help.

If your patient is diagnosed with syphilis, take immediate action. Men diagnosed with syphilis should be treated with benzathine penicillin immediately. All cases of syphilis also should be reported to your state or local health department right away. CDC recommends reporting within 24 hours.

  • Consider follow-up serologic testing for gay and bisexual men (based on CDC’s STI treatment guidelines) due to data indicating they may be at risk for repeat infection.
  • Advise your patient to tell their sex partner(s) about the infection and encourage them to get tested and treated to avoid reinfection.

Don’t forget this special consideration when serving your patients:

Early syphilis increases the likelihood of a patient acquiring HIV, so patients diagnosed with P&S syphilis should also be tested for HIV. If you are serving patients in a geographic area where the HIV prevalence is high, retest for acute HIV in three months if the first test was negative.