Background:
Despite ongoing prevention efforts, Men who have Sex with Men (MSM) continue experiencing disproportionately high syphilis rates. Regular testing could dramatically reduce infection rates. In spite of this many MSM do not test regularly.

Objective:
To better understand how MSM conceptualize and manage their risk or contracting syphilis to improve the development of testing programs.

Method:
To inform a syphilis prevention social marketing campaign, 27 ethnically diverse Los Angeles MSM were recruited into three focus groups in March-April 2007. Groups were divided by age and HIV serostatus. Each group had a professional moderator and a discussion guide designed by researchers and community advisors. Researchers watched the groups in person and analyzed video recordings using emergent codes and theory.

Result:
Syphilis was generally not on the minds of participants and was rarely discussed with sex partners. Nonetheless, it was considered a serious and even shameful disease, particularly by HIV-positive participants. These beliefs, however, were not enough to result in syphilis risk reduction strategies such as condom use. For instance, there was consensus that condoms are not used for oral sex. In fact, the possibility of contracting syphilis was considered an acceptable risk by all groups. Finally, all groups shared erroneous knowledge about syphilis testing, such as any STD or blood test screens for syphilis.

Conclusion:
Significant barriers to syphilis prevention exist in MSM of all HIV serostatuses because of beliefs about risk and misconceptions about testing. The reluctance to reduce risk may indicate that testing programs hold more promise for reducing syphilis rates among MSM than risk reduction programs.

Implications:
Efforts aimed at increasing syphilis testing among MSM must take into account their beliefs about the acceptability of syphilis risk and misconceptions regarding testing if they are to be effective.