II. Epidemiology
- Incidence: 4% of men in the United States
III. History: Sexual
- Number of sexual partners in the last year
- Sex with men, women or both?
- Sex after using Alcohol or drugs?
- Sex with strangers or acquaintances?
- Do you use Condoms always?
- How often do you not use Condoms?
- How many Sexually Transmitted Infections have you had in the past?
- Types of sex (oral, vaginal, anal)?
- Insertive anal sex (top partner)
- Higher risk than oral sex for Sexually Transmitted Infection
- Receptive anal sex (bottom partner)
- Highest risk for Sexually Transmitted Infection
- Insertive anal sex (top partner)
IV. History: Social
-
Domestic Abuse or rape?
- Current abusive relationship?
- Support system
- Who are the other people in your home?
- Monogamous relationship?
- Family support (spouse, parents, siblings, children)?
- Close friends?
V. Labs
- Gonorrhea PCR (Nucleic Acid amplification test or NAAT)
-
Chlamydia PCR (Nucleic Acid amplification test or NAAT)
- Anal Chlamydia PCR if anal insertive or receptive intercourse in past year
- Urine Chlamydia PCR if anal insertive intercourse in past year
-
HIV Test
- Test at least annually in high risk patients (offer for all annually)
-
Hepatitis A Serology
- Hepatitis A Vaccine if not immune
-
Hepatitis B Serology (e.g. HBsAg)
- Test at least annually in high risk patients (offer for all annually)
- Hepatitis B Vaccine if not immune
-
Hepatitis C
- Screen at least annually in high risk patients
- High risks include IVDA history, HIV Infection, multiple sex partners, unprotected sex
-
Herpes Simplex Virus Testing
- Consider sceening for Genital HerpesSerology if status unknown (per CDC)
-
Syphilis Screening (e.g. RPR, VDRL)
- Screen annually (esp. in high risk groups)
VI. Evaluation: STD Screening in low risk groups
- Criteria
- Monogamous relationship OR
- Consistent Condom use
- Testing is optional
- Annual HIV Test
- Other Sexually Transmitted Infections (see above)
VII. Evaluation: STD Screening in high risk groups
- Criteria
- Multiple sexual partners OR
- Inconsistent Condom use
- Evaluate every 3 to 6 months evaluate STI risks
- See Immunizations below
- Obtain HIV Test and Hepatitis B testing at least annually
- Consider annual testing of Hepatitis C
- Gonorrhea and Chlamydia testing as described above
- Reinforce prevention practices below (includes Immunizations and HIV prevention)
- Consider additional tests as above
VIII. Prevention
- See Health Maintenance in Men
-
General measures
- Always use Condoms
- Exception: Longterm monogamous couples without STI
- Stay aware of partner's Sexually Transmitted Infection (STI) status
- Avoid high risk behavior (e.g. sex while intoxicated, multiple sexual partners)
- Always use Condoms
-
Immunizations
- Hepatitis A Vaccine (per CDC)
- Hepatitis B Vaccine (per CDC, USPTF)
- HPV Vaccine
- Indicated in all males age 26 years and younger
- Meningococcal Vaccine
- Indicated in Men who have Sex with Men AND one other risk factor (e.g. healthcare career)
- HIV Prevention
- Anal Cancer (due to HPV Infection)
- Baseline and annual anal pap test indicated in HIV Infection (per NY Dept Health)
IX. Complications: Sexually Transmitted Infections in Men who have Sex with Men (MSM)
-
Chlamydia
- As with Gonorrhea, rectal and anal infections are often missed
-
Gonorrhea
- As with Chlamydia, rectal and anal infections are often missed
- Higher risk with HIV Infection, recreational drug use
-
Hepatitis A
- Men who have Sex with Men (MSM) represent 10% of new cases
-
Hepatitis B
- Men who have Sex with Men (MSM) represent 20% of new cases
-
Hepatitis C
- Higher risk with HIV Infection, receptive intercourse, multiple partners
-
Genital Herpes
- Higher risk of acquiring HIV Infection
-
HIV Infection or AIDS (Relative Risk: 44)
- Men who have Sex with Men (MSM) account for >50% of those with HIV, and >60% of those newly diagnosed
- Highest risk group is, black MSM 13 to 24 years old
-
Human Papillomavirus (HPV) and Anal Cancer (Relative Risk: 17)
- Higher risk with HIV Infection
-
Proctocolitis (infectious Proctitis, enteritis)
- Gonorrhea, Chlamydia, HSV, Syphilis and Lymphogranuloma venereum transmitted via receptive anal intercourse
-
Syphilis
- Increasing risk among Men who have Sex with Men (MSM), especially among minority groups