Other STDs. MSM are at high risk for STDs. Primary care clinicians should ask patients about symptoms of STDs in the rectum, urethra, and pharynx, and order appropriate diagnostic tests. It is important to ask the patient about rectal pain and anal discharge, which occur in proctitis. The presence of these symptoms should prompt testing for syphilis, Neisseria gonorrhoeae, and Chlamydia trachomatis, which requires a rectal swab for nucleic acid amplification testing.30 Certain strains of Chlamydia can cause lymphogranuloma venereum (LGV), which causes bloody discharge and ulcerative anal lesions. LGV is strongly associated with HIV infection. Antibiotic treatment is necessary.51
Even in the absence of symptoms, screening for STDs—including serologic testing for HIV and syphilis, and oral, rectal, and urinary testing for N gonorrhoeae and C trachomatis—is recommended for MSM once a year or, for those at high risk, twice a year. Unlike urethral infection, rectal gonorrhea and chlamydial infections are often asymptomatic.52
Shigella infection. MSM are at high risk for Shigella infection, also known as shigellosis or gay bowel syndrome.53 Shigella is transmitted via the fecal-oral route or from contaminated food or water. One to 2 days after exposure, Shigella infection causes fever, diarrhea, abdominal pain, and tenesmus. Immunosuppression increases risk of Shigella, and there is a high prevalence in HIV-positive MSM.54 Shigella infection can resolve after 5 to 7 days; severe cases may require antibiotic treatment. Some strains of Shigella are resistant to antibiotics.55,56
Meningococcal meningitis. Outbreaks of meningococcal meningitis have been reported among MSM. This population is reported to have an increased prevalence of oropharyngeal colonization with N meningitides as compared with the general population.57,58 Current guidelines from the Advisory Committee on Immunization Practices (ACIP) do not include MSM as a group that is at high risk for meningococcal meningitis and do not recommend routine vaccination.43 However, outbreaks of meningococcal meningitis are increasingly being reported. It is prudent for MSM, who are living in areas of outbreaks, to obtain meningitis vaccine.59
Mental health disorders and violence. According to a study by Bostwick and colleagues,60 approximately 42% of men who identified as gay or bisexual, or who were unsure of their sexual identity, had higher rates of mood and anxiety disorders. MSM report a higher prevalence of major depression, dysthymia, panic disorder, and general anxiety disorder.
Also, intimate partner violence is more prevalent among MSM. According to Stults and colleagues,61 44% of MSM report lifetime intimate partner violence; 39% report victimization and 30 % report perpetration. Those who experience intimate partner violence also report increased substance use, compared with heterosexual men. Substances include alcohol, marijuana, and stimulants. There is also a more prevalent use of inhaled nitrites among MSM.62 According to Buller and colleagues,63 MSM who are victims of intimate partner violence are more likely to engage in substance use, suffer from depressive symptoms, test positive for HIV, and engage in unprotected anal sex.