Risk factors for early syphilis among gay and bisexual men seen in an STD clinic: San Francisco, 2002-2003.

BACKGROUND

Substantial increases in syphilis among gay and bisexual men have been reported in San Francisco.

GOAL

To identify risk factors for early syphilis infection among gay and bisexual men attending the San Francisco municipal STD clinic (City Clinic).

STUDY

Cross-sectional, self-administered, behavioral survey of gay and bisexual men attending City Clinic between November 2002 and March 2003 linked with electronic medical record data.

RESULTS

Among 1318 gay and bisexual men surveyed, 53 (4.0%) were diagnosed with early syphilis. The final multivariate model included nonwhite race (OR = 2.1 [1.1-4.4]), HIV-infection (OR = 3.9 [2.0-7.7]), using both methamphetamine and sildenafil (Viagra(R)) (OR = 6.2 [2.6-14.9]), using methamphetamine without sildenafil (OR = 3.2 [1.3-7.6]), using sildenafil without methamphetamines (OR = 0.9 [0.3-2.9]), stronger gay community affiliation (OR = 2.3 [1.2-4.6]), and having recent Internet partners (OR = 2.1 [1.0-4.3]).

CONCLUSIONS

Syphilis prevention efforts should address methamphetamine and sildenafil use among gay and bisexual men and require strong and substantive involvement with the gay community to address syphilis in San Francisco.