C4c Increased Detection and Geographic Spread of Gonorrhea, Chlamydia and Syphilis in Boston Area Men Who Have Sex with Men, 1997-2008

Wednesday, March 10, 2010: 11:00 AM
International Ballroom E/F (M2) (Omni Hotel)
Kenneth Mayer, MD, The Fenway Institute, Fenway Health, Boston, MA, Matthew Mimiaga, ScD, MPH, and The Fenway Institute, Harvard Medical School, Boston, MA and Chris Grasso, MPH, The Fenway Institue, Fenway Health, Boston, MA

Background: Fenway Health (FH) is the largest ambulatory facility caring for men who have sex with men (MSM) in New England; of ~6,000 MSM clients, 1,200 are HIV-infected.

Objectives: To describe changes in STD prevalence among MSM at FH, 1997-2008.

Methods:  Electronic medical records over the last 12 years were reviewed; statistical analyses, including Chi-square tests, and tests for trend, were performed, comparing infection rates over time and by demographics.

Results:  In 2008, 3,493 MSM at FH were screened for one or more STD. They had a mean age of 39 years (SD=11), the majority were Caucasian (73%), 30% were HIV-infected, and 62% had private insurance. In 1997, only 38 cases of gonorrhea and 2 of syphilis were diagnosed at FH, but by 2008, 75 cases of gonorrhea (45 urethral, 30 rectal) and 156 new syphilis infections were detected (p<.0001). In 2004, 51 chlamydia infections were diagnosed, compared to 80 cases in 2008 (p<.0001).  Men with STDs tended to be Caucasian (74%; p<.0001) and HIV-infected (53%; p<.0001), but had wide age distribution, with 26% <30 y.o. and 49% >40 y.o.  In 1997, 67% of MSM with a new STD lived within the 3 zip codes adjacent to FH, but by 2008, 82% of the men came from noncontiguous areas (p<.0001). Since 2000, half of the men diagnosed with syphilis were HIV-infected, and in 2008, 71% were HIV-infected (p<.001).

Conclusions:  STDs have been increasingly detected in MSM seen at FH with wider geographic representation, consistent with regional spread. Syphilis rates have increased considerably, particularly among HIV-infected MSM, but rises have also been seen with other bacterial STDs. Intensified screening, community education and prevention programs are warranted.

Implications for Programs, Policy, and/or Research:  The increase in STD, namely syphilis, among HIV-infected MSM underscores the need for focused prevention interventions for patients in care settings.