Understanding recent increases in the incidence of sexually transmitted infections in men having sex with men: changes in risk behavior from risk avoidance to risk reduction

Sex Transm Dis. 2006 Jan;33(1):11-7. doi: 10.1097/01.olq.0000187224.10428.31.


Objective: The objective of this study was to explore risk behavior and routes of transmission in men having sex with men (MSM) with newly diagnosed sexually transmitted infections (STIs).

Methods: A questionnaire on clinical diagnosis and manifestation site for acute STIs was completed by physicians participating in a sentinel study. Patients contributed information on sexual risk behavior and the likely route of STI transmission.

Results: Three hundred fifty-six diagnosis forms and 169 matching patient questionnaires could be analyzed. The most frequent diagnosis was syphilis (n = 147; 33% primary syphilis with ulcer localization 71% genital, 22% anorectal, and 8% oral; 67% secondary syphilis), followed by gonorrhea (n = 136; 59% genital, 34% rectal, 7% pharyngeal) and Chlamydia trachomatis infection (n = 51; 48% genital, 48% rectal, 4% pharyngeal). In 12 patients, more than one infection was diagnosed, and 2 or 3 sites were affected in 11 patients. Approximately 60% of infections were acquired by genital-oral and oral-anal practices. Unprotected anal intercourse (UAI) was reported more often by HIV-positive men (mostly receptive) and men with high partner numbers.

Conclusion: High partner numbers, an important role of genital-oral sexual practices for the transmission of STIs, and relatively high frequencies of mostly receptive UAI in HIV-positive men are all contributing to increasing STI incidences among MSM.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Germany / epidemiology
  • Homosexuality, Male*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Risk Reduction Behavior*
  • Risk-Taking*
  • Safe Sex
  • Sentinel Surveillance
  • Sexual Behavior*
  • Sexually Transmitted Diseases, Bacterial / epidemiology*
  • Sexually Transmitted Diseases, Bacterial / prevention & control
  • Sexually Transmitted Diseases, Bacterial / transmission*
  • Surveys and Questionnaires