Hep C, syphilis, gonorrhea, oh my!

So it has been quite a while since my last post.  I must admit med school is kicking my ass, but I must find time to write since HIV prevention among MSM is my passion.

So in the HIV community we tend to solely focus only on HIV prevention and fail to realize that other nasty bugs are transmitted between MSM.  Many of these, co-occur in individuals with who already have HIV and may place further stress on an already damaged immune system.

As I live in a large urban city, I have come across several individuals that are infected with Hepatitis C and currently undergoing treatment.  While I have understood that Hep C is sexually transmitted, physicians and other individuals have engrained into my head that Hep C is mostly prevalent among drug users and transmitted by intravenous drug use, with occasional sexual transmission.    Perhaps individuals will mention that Hep C can be transmitted sexually, but then go on to quantify the statement saying it’s not likely.  A new study has found that in a cohort of HIV positive individuals followed, 75 percent of new Hep C infections occurred in individuals with no history of injection drug use.  Thus, the infections in this group must have been acquired sexually.  Hep C leads to liver damage, and potential liver disease, and if left untreated can be lethal.

Hep C is not the only thing that those who bareback (have sex without a condom) should be concerned about.  syphilis is on the upswing.  Over the past several years there has been a huge surge in syphilis cases among men who have sex with men in several urban centers. Primary stages of syphilis may cause painful sores and chancres, and such sores if left untreated can increase the probability of acquiring HIV.  MSM are also at increased risk for acquiring chlamydia and herpes.

But not all providers will test individuals for STIs aside from HIV, and will not test already positive HIV individuals for STDs.  I think many HIV testing centers due to resource constraint will not screen for STIs unless a specific request is made.  I came across a great article from the NY times (although it’s from 3 years ago).  Only about a third of gay men surveyed in urban cities reported being tested for syphilis and gonorrhea. Providers do not test these populations as frequently as they should, or follow national guidelines set out regarding testing for STI.

Bottom (no pun intended) line: Educate MSM to engage in safer sex.  Not only will this prevent HIV but it will help to decrease rates of Hep C, gonorrhea, syphilis and a range of other STIs.  HIV is not the only enemy.  But we can protect ourselves from other STIs in the same way that we do HIV.  HIV prevention programs should educate MSM about HIV in addition to other STIs and how to overall protect themselves and remain sexually healthy.

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