Self-reported Syphilis and Gonorrhea Testing among Men who have Sex with Men (MSM) in the United States, National HIV Behavioral Surveillance System, 2003-2005

Background:
The Centers for Disease Control and Prevention first provided guidance on STD testing specifically for MSM in the 2002 STD Treatment Guidelines as part of a strategy to address increasing rates of gonorrhea and syphilis among MSM in the United States. These guidelines recommended at least annual syphilis, gonorrhea, and chlamydia testing for sexually active MSM.

Objective:
To evaluate the implementation of the 2002 CDC STD Treatment Guidelines.

Method:
We used data collected during 2003-2005 from the MSM cycle of the National HIV Behavioral Surveillance System. We determined the proportion of sexually active MSM respondents who reported having been tested for syphilis and gonorrhea during the previous year and used multivariate logistic regression to identify factors associated with testing.

Result:
Of 10,030 MSM, 3,938 (39%) reported having been tested for syphilis and 3,629 (36%) reported having been tested for gonorrhea in the previous year. Six factors were associated with syphilis and gonorrhea testing, respectively: age 18-24 versus 45 years or greater (OR=2.2, CI: 1.8-2.5; OR=2.6, CI: 2.2-3.1), black versus white race (OR=1.3, CI: 1.1-1.4; OR=1.3, CI: 1.2-1.5), receipt of HIV/STD prevention services in the past year (OR=1.5, CI: 1.4-1.7; OR=1.6, CI: 1.4-1.8), disclosure of male-male sexual activity to a health care provider (OR=2.2, CI: 1.9-2.4; OR=2.0, CI: 1.8-2.3), having multiple casual sex partners or using illegal drugs with sex (OR=1.8, CI: 1.6-2.1; OR=1.8, CI: 1.5-2.0), and having private versus no health insurance (OR=1.3, CI: 1.1-1.4; OR=1.3, CI: 1.2-1.4).

Conclusion:
Syphilis and gonorrhea testing among MSM remained low, despite specific testing recommendations in the STD Treatment Guidelines.

Implications:
To increase STD testing among MSM, programs should focus on linkage with HIV/STD prevention services and health care providers should assess the risks of STDs for male patients through routine inquiries about sexual activity.