Background: Syphilis in men who have sex with men (MSM) has increased dramatically, but a recent increase has also occurred in female Philadelphians, raising the question of sexual networks among MSM and heterosexual women. To explore this, we describe 1) MSM from the STD clinic who ever reported sex with women (MSMW), and 2) MSMW given partner services (PS) and their named female partners.
Methods: Clinic data for MSM/MSMW and PS interview data on MSMW with HIV or any stage of syphilis were examined. PS data were linked to field records of named female partners and risk profiles assessed.
Results: From 2010-14, 24,370 men visited clinic, 4,610 (16%) of whom ever identified as MSM; of these, 1,344 (29%) were MSMW. Compared to MSM, MSMW were likelier to be black or Hispanic. Among MSMW, sex with a female in the past year was reported as anal (89, 7.1%) or vaginal (896, 66.7%). MSMW were significantly less likely than MSM to report anal receptive (56% vs 73%), anal insertive (39% vs 77%), oral insertive (19% vs 32%), or oral receptive sex (76% vs 87%) with males in the past year. However, during 2010–2014, both MSMW and MSM were similarly likely to be diagnosed with syphilis (16.7% vs 17.3%; OR 1.0, CI 0.8-1.1) or HIV (22.0% vs 27.0%; OR 0.8, CI 0.7-0.9). Among those given PS, MSMW were likelier than MSM to report sex while drunk/high (OR 2.5, CI 1.4-4.3) and transactional sex (OR 2.5, CI 1.4-4.3); a majority (90%) of female partners reported heterosexual orientation.
Conclusions: MSMW comprise a substantial proportion of MSM in clinic, report less sexual activity than MSM, but have similar syphilis/HIV rates. Most report recent sex with females, suggesting that local syphilis epidemics in MSM and females may be related.