Trends in STD Positivity Among MSM in Primary Care at a Large Urban LGBT Health Center, Chicago, 2002-2008

Background: MSM bear a significant burden of STDs in the US.  Increases in STDs among MSM since the late 1990s underscore the need for continuing prevention. 

Objectives: We examined trends in diagnoses of syphilis and urogenital gonorrhea (NG) and chlamydia (CT) among MSM receiving primary care at an urban LGBT health clinic.

Methods: Data were collected in accordance with routine STD surveillance procedures and analyzed using SAS version 9.1.  Statistical significance of trends over time were assessed by non-parametric trend test.

Results: 5,802 tests for syphilis, 3,003 tests for NG, and 2,998 tests for CT were performed between January 2002 and December 2008.  Testing increased annually, by an average of 13.5% for syphilis, 18.5% for NG, and 18.7% for CT. Overall, 306 (5.3%) cases of all-stage syphilis, 190 (6.3%) cases of NG, and 149 (5.0%) cases of CT were detected.  The prevalence of syphilis declined from 9.3% in 2002 to 3.9% in 2007 (p<0.001), but increased by 15% between 2007 and 2008.  NG prevalence also declined, from 9.1% in 2002 to 3.5% in 2006, but rose to 7.1% in 2007 and remained elevated in 2008.  CT prevalence declined from 8.3% in 2002 to 4.8% in 2003 but then remained stable at approximately 5% through 2008.

Conclusions: Observed declines in the prevalence of NG and syphilis may have resulted from expanded screening rather than actual declines in morbidity, since testing increased annually during this period. However, despite expanded screening, CT did not decline after 2003 and NG increased 200% from 2006 to 2007, underscoring the need to supplement continued screening with effective risk reduction messages.  

Implications for Programs, Policy, and/or Research: Research is needed to determine whether changes in risk taking are occurring among MSM, and to explore opportunities for education and risk reduction counseling during the clinical encounter.