October 20, 2005

Dear colleague,

I am writing to update you concerning the ongoing epidemic of sexually transmitted diseases (STD) in men who have sex with men (MSM), and to make you aware of Public Health – Seattle & King County ’s revised HIV/STD screening recommendations.

Between 2003 and 2004, the number of cases of early syphilis occurring among MSM in King County increased from 77 to 140, an 87% increase.  As of the end of September, there have been 128 early syphilis cases among MSM in 2005.  The number of cases of urethral gonorrhea seen among MSM in the Public Health STD clinic has been stable for the last 3 years, but is more than twice as high as in 2000.  Clearly, the ongoing epidemic of STD among MSM shows no signs of abating.

In response to this epidemic, Public Health has increased publicly funded syphilis testing among MSM more than 100%, to almost 4,000 tests per year.  We have funded annual public awareness campaigns, increased the provision of clinical care to MSM in our STD clinic and at Gay City ’s Wellness Center , and increased efforts related to partner notification.  In 2001, we issued the nation’s first STD screening guidelines directed toward MSM.  We are now revising those guidelines to more explicitly define how often MSM should be tested for STDs, including syphilis and HIV.  A copy of the guidelines is attached.

As always, we appreciate your ongoing efforts to treat and prevent STD and HIV in our community.

Sincerely,

HIV testing and STD screening should be performed on all sexually active MSM annually except those in long-term (> 1 year), mutually monogamous relationships. Sexually active MSM include all MSM engaging in any anal, or oral sex. Screening should include the following tests:
HIV (if not previously known to be HIV infected)
RPR
Rectal cultures for gonorrhea and chlamydial infection (men who report receptive anal sex only)+
Pharyngeal culture for gonorrhea


Repeat HIV and STD testing (as above) should be performed at 3-6 months follow-up for the following persons:

All persons, regardless of sexual orientation, diagnosed with gonorrhea, chlamydial infection or early syphilis**.
MSM with any one or more of the following risk factors:

Unprotected anal intercourse with a partner of unknown or discordant HIV status in the last year
Bacterial STD diagnosis
Methamphetamine use in the last year

Persons rescreening following an episode of urethral gonorrhea or chlamydial infection should be retested for urethral gonorrhea and chlamydia.
When to screen within the 3-6 month timeframe should be decided with the patient.