Risk Factors for Early Syphilis Among Gay and Bisexual Men Seen in an STD Clinic: San Francisco, 2002–2003

In Brief 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. Among gay and bisexual men attending an STD clinic, nonwhite race, positive HIV status, methamphetamine use especially with sildenafil (Viagra), meeting partners on the Internet, and a high gay community affiliation index were associated with early syphilis infection.