This month in honor of Pride, we at LetsGetChecked are answering your most common questions about STDS in MSM.
As an Infectious Disease Specialist, I know that there are misconceptions out there when it comes to sexual health concerns in the LBGTQ community.
In this article, we will be addressing the questions you have about leading STDs in MSM (gay, bisexual and other men who have sex with men) including why the MSM community is viewed as high risk. The most common STDs in the MSM community, why younger people are at higher risk and the everyday precautions we can all take to lower the risk of contracting an STD.
Frequently Asked Questions
● Why Is The MSM Community Viewed As “High Risk”?
● What Is The Most Common STD In MSM?
● Are Younger MSM At Higher Risk To Contract An STD?
● How Can The MSM Community Better Protect Their Sexual Health?
Why Is The MSM Community Viewed As “High Risk”?
First things first, anyone who has sex can get an STD. The MSM community is quite diverse so individual risk of acquiring an STD is variable. We do know that the MSM community is disproportionately impacted by HIV, syphilis, viral hepatitis, and other STDs.
In other words, the MSM community is viewed as "high risk" due to the fact that there is a high incidence rate of STDs among this group.
Not using condoms all the time, having multiple partners, having anal sex and using alcohol/drugs with sex can all increase your risk of getting an STD.
Many STDs will have no signs or symptoms, especially in men, and so may go undiagnosed and untreated if routine screening isn’t done. Your partner could be infected and not be aware of their diagnosis.
We also know that typically urine testing is performed for chlamydia and gonorrhea, two of the most common STDs. Testing only urine for these infections can miss up to two thirds of gonorrhea and chlamydia infections in MSM.
Anal and throat screening leads to many other diagnoses that may otherwise be missed. Screening these sites may lead to more diagnosis, treatment, and reduce ongoing transmission amongst MSM.
Sexual risk behaviors alone don’t explain these disparities, these communities may face complex challenges related to stigma, homophobia and discrimination which impact on their ability to access quality healthcare.
What Is The Most Common STD In MSM?
HIV is the leading sexual health concern in the United States in the MSM community.
In the United States, gay and bisexual men are disproportionately affected by HIV and around 1 in 7 are unaware of their HIV positive status compared to men who have heterosexual intercourse only.
About 60% of all new HIV diagnoses in 2017 were in MSM, most of these are in Black/African American and Latino/Hispanic group.
When it comes to the treatment of HIV, in the MSM community, we now have excellent medications to control the infection.
We also have medications to prevent acquisition of HIV for people who are higher risk of getting the infection; HIV pre-exposure prophylaxis (PrEP) is very effective at preventing HIV transmission. By screening people for HIV, getting people connected to HIV care, and using HIV PrEP we can considerably reduce transmission of HIV in the United States.
Finally, there are also many on-going efforts around the world to find a cure or a vaccine for HIV. As HIV is such a complex virus this will likely take many more years before we have an effective and safe cure or vaccine. We have come a long way in a very short amount of time since HIV was first identified as the cause of AIDS in 1983, when it caused terrible disease and killed nearly all infected people within years.
Now we have multidrug combination pill, once a day regimens which are very well tolerated and highly effective. In the current era if you are diagnosed early before HIV can cause complications, stay on HIV treatment and suppress the virus in the blood you can now live nearly as long as someone without HIV.
Syphilis is another issue that has begun to affect MSM more specifically. Between 2016 and 2017, the number of reported primary and secondary (P&S) cases in the United States increased by 10.5%.
Overall, syphilis rates have been rising in the US over the past 20 years; most of these cases are among MSM. We also know that the genital ulcers caused by syphilis increases the risk of getting HIV, which is another serious health concern in the MSM community.
Syphilis can reactivate months to years later and can cause many issues including skin rash, fevers, hair loss, liver problems, meningitis, eye problems, spinal cord problems, or serious heart diseases. Testing for syphilis requires a simple blood test and there are good treatments for syphilis, it is important to get treated as early as possible to prevent these later complications.
Speaking openly with your sexual partners and healthcare providers about STDs and testing is important.
Using condoms can reduce your chances of getting syphilis from anal intercourse. Syphilis can also be spread if there are open ulcers that come in contact with any area, so it can be transmitted through touching or kissing a person with ulcers from syphilis.
After the initial infection syphilis can become latent, which means the infected person may no longer have visible ulcers but still has the infection.
Are Younger MSM At Higher Risk?
STDs are generally more common in younger people.
Overall STDs are very common in the U.S., 50% of all sexually active people will have an STD by the age of 25.
The risk of acquiring an STD is related to the level of sexual activity, number of partners, and unprotected sex.
That STDs are more common in this group also means young people are more likely to come into contact with an infected partner, further increasing their risk of getting an STD.
Younger people may also be less aware or less able to access sexual health services for prevention, diagnosis and treatment of STDs.
Overall, syphilis rates have been rising in the US over the past 20 years; most of these cases are among MSM. We also know that the genital ulcers caused by syphilis increase the risk of getting HIV, which is another serious health concern in the MSM community.
How Can The MSM Community Better Protect Their Sexual Health?
Using condoms consistently is the best way to protect yourself from STDs.
However STDs can be transmitted through oral sex as well, devices such as dental dams and other barrier protection for oral intercourse are available.
If you are sexually active and don’t use condoms every time and especially if you have multiple partners it is best to get screened every 3-6 months for STDs.
This can include screening for HIV, syphilis, hepatitis C, gonorrhea, chlamydia, and sometimes herpes viruses. For complete chlamydia and gonorrhea screening a urine specimen, an anal swab, and a throat swab should all be sent. Just sending the urine specimen may miss a lot of STDs in MSM.
There are some STDs that you can protect yourself against, for instance MSM are at higher risk of being exposed to hepatitis A and B, both of these infections have very effective immunizations available which prevent getting these infections.
There is also an effective vaccine available for human papillomavirus or HPV, which can prevent getting HPV viruses that may leave patients open to oral and anal cancers.
Regular screening is recommended to detect STDs early so they can be treated before complications or transmission to others can occur. For all sexually active MSM, annual STD screening is recommended. For people at higher risk (having multiple sexual partners, unprotected sex, exchanging sex for money) more frequent STD screening every 3-6 months is recommended.
Worried You Have An STD?
If you suspect that you have an STD, we know that this can be a very stressful time.
The most important thing to remember is that you are taking steps in the right direction to better protecting your sexual health in the future through equipping yourself with knowledge today.
Want to learn more about STD symptoms in men? Click here for your full guide.
If you want to find out how long it takes for an STD to become reactive following the time frame at which you contracted the STD, click here.
If you want to learn more about at home STD testing, with some added support and guidance from the LetsGetChecked medical team, you can get in contact directly via live chat or schedule a call with a member of our nursing team.
Written by Maryam Mahmood, Edited by Hannah Kingston