STDs among gay and bisexual men

From the early 1980s until recently, rates of HIV and STDs among gay and bisexual men declined and then held steady. The scale of behavior change among gay and bisexual men during this time was unprecedented. But even these lower rates of HIV and STD transmission achieved in the late 1980s remained several times higher than that of the general population.

Recently, cases of gonorrhea among gay and bisexual men in King County more than doubled from 1997 through 2000, and chlamydia cases increased by at least 50 percent. The rate of gonorrhea in gay and bisexual men in King County now is at least 10 times higher than in heterosexuals.

Even more dramatically, the rate of syphilis infection in the gay population has skyrocketed, from virtually no cases in 1995 and 1996 to 80 or more cases per year at present. The rate of syphilis in gay and bisexual men in King County now is 150 times greater than for the heterosexual population.

Increases in gonorrhea and other STDs among gay and bisexual men have been reported in San Francisco, Cleveland, Los Angeles, and other cities in the last year.

Compared to HIV, other STDs may seem relatively harmless, but they take a heavy toll. Approximately 15 million STDs occur annually in the U.S. at a cost of over $10 billion.

Health consequences of STDs in men range from mild acute illness, like burning and itching of the urethra (the opening of the penis), to serious long-term complications such as anal and liver cancer and, in the case of syphilis, stroke and blindness. Some STDs, like gonorrhea, chlamydia, and syphilis, are easily curable with antibiotics; if treated promptly, they rarely have long-term consequences.

Other STDs, like hepatitis B, can lead to weeks or months of painful and debilitating illness. Both genital herpes and genital human papillomavirus (HPV--the virus that causes genital warts and is associated with penile and anal cancer in men) cause lifelong infections.

Almost all STDs greatly increase the chances of catching HIV and of spreading it to others.

Consider this: If you are HIV-positive and have an outbreak of open sores from herpes or syphilis, or if you have inflammation due to gonorrhea or chlamydia, those sores and inflamed tissues contain highly concentrated amounts of the virus. If you're HIV positive, infections like gonorrhea and chlamydia in your penis can make you shed 8-10 times more HIV in your semen.

If you are HIV negative but have herpes, gonorrhea or chlamydia, disease-fighting cells of your immune system are attracted to the STD-infected tissues. Such "activated" immune cells are especially susceptible to HIV if your partner is carrying the virus, making you much more likely to catch HIV through unprotected sex.

It's very important that you find a health care provider with whom you feel comfortable enough to talk explicitly about your sex life - someone who incorporates your status as a sexually active gay or bisexual man into your overall health picture.

STD testing for gay and bisexual men should take into account actual exposures. A urine test or penile swab will not detect all infections. If you have oral sex you may need a throat swab and if you have receptive anal intercourse you may need an anal swab to accurately test for infection. Indeed, the rectum is the most common site for testing when symptoms aren't present, because rectal infections are especially likely to be asymptomatic. Some research suggests that anal pap smears may be helpful in detecting pre-cancerous lesions of the anus, but anal paps are not yet routinely provided by most clinics.

If you have sex with more than one partner, or if your main partner might be having sex with others, it's a good idea to get tested regularly. The exact frequency depends on your particular risks, but for most gay or bisexual men it is a good idea to be tested every 3-6 months. This is especially important since most STDs don't show symptoms.

If you think you may have an STD, see your health care provider and get tested right away.

• The Public Health-Seattle & King County STD Clinic, located at Harborview Medical Center, offers comprehensive, services provided by gay-friendly staff. Services are available on a walk-in basis and are offered without regard to your ability to pay. 206-744-3590.
• Learn more about STDS including HIV, gonorrhea, herpes, and others.