Gonococcal, Chlamydia and Syphilis Infection Positivity Among MSM Attending a Large Primary Care Clinic, Boston, 2003-2004

Increases in syphilis and rectal gonorrhea have been reported in the past decade among US men who have sex with men (MSM), the authors noted; "however, limited [STD] positivity data are available on MSM who receive their health care from primary care or general medical clinics." In the current study, the researchers set out "to elucidate STD positivity in asymptomatic MSM seen at the largest primary care clinic for MSM in New England and to describe STD test positivity by reason for STD testing."

As part of CDC's MSM Prevalence Monitoring Project, all 21,927 medical visits by MSM to Fenway Community Health in Boston between 2003 and 2004 were reviewed. Prevalence of positive STD tests -- for chlamydia, gonorrhea, and syphilis reactivity -- was determined and analyzed by demographic characteristics, HIV status, symptoms, and reasons for testing.

During the observation period, 23.4 percent of MSM visits included STD testing. The patients' mean age was 39 (range: 18-65); 84 percent were white; 5 percent were black; and 5 percent were Hispanic. In all, 65 percent of MSM tested were asymptomatic; 7 percent of asymptomatic men tested positive for at least one STD. At least one STD was diagnosed among 4.4 percent of men routinely screened; among 6.9 percent of MSM who reported high-risk sex in the preceding three months; and among 17 percent of men reporting exposure to an STD. Overall, among asymptomatic MSM screening, 1.0 percent had urethral gonorrhea; 1.7 percent had pharyngeal gonorrhea; 5.6 percent had rectal gonorrhea; 2.2 percent had urethral chlamydia; and 4.3 percent were seroreactive for syphilis.

"Rectal gonorrhea and syphilis seropositivity were frequently diagnosed in asymptomatic MSM; STD prevalence was highest in MSM tested due to an STD exposure or reporting high-risk sex, underscoring the need to promote routine screening in high-risk MSM populations," the authors concluded.