Emerging Issues

A number of new issues have emerged in the STD field. Several health issues among MSM have emerged that affect the overall health of the Nation. Much of the rise in syphilis rates since the launch of Healthy People 2010 is attributable to an increase in primary and secondary syphilis among MSM.²⁵

Increases also have occurred in gonorrhea and in a previously rare form of chlamydia, lymphogranuloma venereum.²⁶ Some of these increases may be attributable to an overall rise in the use of methamphetamines (crystal meth) among MSM, which has a documented association with increased risky sexual behavior.^{27, 28} The Internet also has become a major venue for men to connect with other men to arrange sexual encounters.^{29, 30} These phenomena present substantial challenges for STD/HIV prevention programs.¹⁹

Current chlamydia screening programs for males are limited. CDC recommends screening all sexually active females 25 years of age and under for chlamydia on an annual basis.³¹ In 1999, CDC initiated a research project on male screening to determine the proportion of males with cases of asymptomatic chlamydial infections, the feasibility of screening asymptomatic males for chlamydia in multiple venues, and the risk factors for infection. This research project comprises a screening demonstration, a longitudinal study, and a cost-effectiveness analysis.^{32, 33} Recommendations about screening men in settings with a high proportion of chlamydial infections are under development.

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