All men, whether they are gay, bisexual or heterosexual can potentially acquire sexually transmitted infections if they engage in risky sexual behavior. If you want your health care provider to do what they can to prevent such infections, it is important to have a frank an open conversation with him or her so they understand behaviors in which you have engaged which may put you at risk for certain infections. Asking about sexual behavior is not the strong suit of many clinicians, so a well informed patient can help the process along. Clearly a clinician should find out if patients are sexually active, if they have sex with men, woman or both, and the nature of their sexual activity.
For men who are sexually active it is important to understand, that, practicing safe sex to prevent HIV, does not always prevent other STDs. For example, while the risk of HIV infection from oral sex may be exceedingly low or non existent, oral-penile sexual contact can lead to gonorrhea or Chlamydia infections. While these can be treated with antibiotics, many patients are surprised to find out they get these infections when they feel they have been practicing "safer sex."
The first thing your provider should do after finding out that you engaged in behavior that puts you at risk for STDs, even if you have no symptoms, is to go over the fact that STDs are commonly transmitted through oral sex, and in the case of Hepatitis A this would also include oral fecal contact. Hepatitis B is contracted generally through exposure to blood in body fluids of infected individuals as well as through sharing needles when doing inject able drugs.
At this point Hepatitis A and B viruses (HAV and HBV) are preventable by vaccines. Vaccinating children for these diseases is now routine, however, people coming into adulthood may not have been vaccinated. Hepatitis A and B vaccines are recommended for all gay men and others who might have risks of exposure, and that is almost everyone.
There is some controversy about screening sexually active people with no symptoms for gonorrhea and Chlamydia. These infections can be present and not cause symptoms so screening and treatment can find infection early and prevent symptoms for the patient as well as spread to others. It is for this reason that the Centers for Disease Control (CDC) recommends screening asymptomatic sexually active gay men for gonorrhea and Chlamydia, as well as for exposure to syphilis which can live silently in one's body.
When appropriate, screening for these is done routinely at Fenway Health. Nevertheless, some clinicians do not believe in routine screening for gonorrhea and Chlamydia as it has not been shown to be definitively effective in large population studies of people without symptoms. The United States Preventive Health Task Force (USPHTF), for example, does not recommend routine screening for gonorrhea and Chlamydia, while the US Centers for Disease Control and Prevention (CDC) does. The reason for the different recommendations from different branches of the Department of Health and Human Services is that the CDC is concerned with public health, and the USPHTF is more focused on screening individuals and will only make a recommendation when large scale studies have been done to demonstrate the effectiveness of screening and treatment. The USPHTF does recommend routine screening for Syphilis.
Our feeling is that screening for gonorrhea and Chlamydia for at-risk individuals who have no symptoms carries little risk of harm or side effects, and can prevent the spread of these diseases.
For information on what procedures are recommended for gay/bisexual and other men who have sex with men, please see the fact sheet STDs and MSM on this website.
Good health to you,
Harvey Makadon, MD
More information from Fenway Health on major STDs and safer sex
More information from the CDC on major STDs
More information from Fenway Health about HIV
For more information on HPV, please see my recent entry on "PAP Smears in Men"
Download a fact sheet about STDs
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REFERENCES
Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002; 51:1.
US Preventive Services Task Force. Infectious Diseases. Guide to Clinical Preventive Services. Available at:
www.ahrq.gov/clinic/cps3dix.htm#infectious (Accessed February 6, 2006).
Clover, RD, Zimmerman, RK. The 2003 Recommended Adult Immunization Schedule. Advisory Committee on Immunization Practices. American Academy of Family Physicians. American College of Obstetricians and Gynecologists. American College of Physicians. American Society of Internal Medicine. Centers for Disease Control and Prevention. Am Fam Physician 2002; 66:2329.
