Promoting Syphilis Ulcer Recognition among Men who have Sex with Men (MSM); Focus Groups to Explore Feasibility

Background:
High rates of syphilis among men who have sex with men (MSM) continue to persist 7 years after initial rise despite widespread outreach and screening. New interventions are needed.

Objective:
To explore the possibility of a campaign to encourage MSM to check themselves and their partners for syphilis ulcers.

Method:
Focus groups and individual interviews with MSM in Chicago, San Diego, and Washington DC.

Result:
Of 43 men in 6 focus groups, plus six in-depth individual interviews, less than half said syphilis was a major sexual health concern. About half had heard that rates were high. Most got tested at least once per year for syphilis. Many practice “safe sex” to prevent HIV transmission and think oral sex is safe. Most thought syphilis is transmitted just like HIV. Many confused symptoms of syphilis and gonorrhea. Almost none knew syphilis ulcers were often painless or could be in the mouth. Many check themselves when they shower but “that doesn't mean I know what I am looking for.” Nearly all would seek medical attention if they found something, especially if they had a “gay-friendly” provider. Most only opportunistically “checked” their partners though some keep the lights on so they can see. One said “if he doesn't want me to look then he must be trying to hide something.” Most said they definitely would not have sex if a partner had a sore and many would ask their partner about it. Most thought it would be a good idea to have a campaign to educate MSM about ulcers, and thought it might be successful. Many creative ideas were suggested.

Conclusion:
Most said they “check” their bodies. However, without knowing syphilis is often painless and in the mouth or on the anus, they may not see it.

Implications:
An ulcer recognition campaign is acceptable and might decrease syphilis transmission.