Risk Factors for Early Syphilis Among Gay and Bisexual Men

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) (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.