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Background: Syphilis is transmitted from ulcers. Ulcers may go undetected in men when located in the mouth or rectal area. Self-examination by men may result in earlier presentation for care, diagnosis, treatment, and partner referral.
Objectives: To increase patient self-examination of mouth and rectal areas for syphilis lesions in HIV-infected men.
Methods: All male HIV-infected patients in two HIV clinics were given information and photos of syphilis ulcers at each visit to review while waiting for the medical provider in the examination room. At the initial, and each subsequent visit, providers collected the number of unprotected oral and anal sex encounters in the prior 3 months with steady, casual, and anonymous partners. Providers also recorded whether the patients had examined their oral or rectal areas in the prior 3 months.
Results: From February 2, 2008 through January 31, 2009, 689 HIV-infected male patients received sexual risk assessment and self examination questions at one or more visits by their medical provider. Self examination behaviors increased from 46% (Baseline) to 72% (p = <0.001) among all patients with data from three patient encounters (N = 224). Among the men in the study, there was no change in number of unprotected sex acts with steady (p = 0.2), anonymous (p = 0.7), or casual partners (p = 1.0) over time, but among those who reported having sex (N = 113), there was an increase in self-examination of the oral/rectal areas from 58% to 83% between the first and third visits (p = <0.001)
Conclusions: After seeing pictures of ulcers and talking with their HIV-providers about syphilis, more men reported checking their mouths and rectal areas for syphilis ulcers.
Implications for Programs, Policy, and/or Research: Clinic- and provider-delivered education to MSM regarding syphilis should include recommendations for self-examination to identify syphilis lesions.