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Knowledge, Attitudes, and Practices Regarding Syphilis Screening Among Men Who Have Sex With Men in San Francisco

Katz, Kenneth A. MD, MSc, MSCE*†; Raymond, Henry Fisher DrPH, MPH; Bernstein, Kyle T. PhD, ScM; Klausner, Jeffrey D. MD, MPH†§

Sexually Transmitted Diseases: April 2013 - Volume 40 - Issue 4 - p 318–322
doi: 10.1097/OLQ.0b013e3182809760
Original Study

Background Syphilis screening for men who have sex with men (MSM) in San Francisco (SF) is recommended every 3 to 6 months. We surveyed MSM in SF to determine the prevalence and factors associated with complying with that recommendation, identify screening barriers, and investigate whether identifying low perceived syphilis risk as a reason for not testing correlated with syphilis risk factors.

Methods We conducted a cross-sectional survey as part of the National HIV Behavioral Surveillance System. We used logistic regression to analyze factors associated with complying with the SF-specific screening recommendation and with identifying low perceived risk as a reason for not testing. We analyzed data on screening barriers descriptively.

Results Among 441 MSM, 37.5% (95% confidence interval [CI], 31.5%–43.6%) complied with the recommendation. Compliance was associated with human immunodeficiency virus infection (odds ratio [OR], 3.6; 95% CI, 1.7–7.8), more than 10 male sex partners (OR, 4.3; 95% CI, 1.6–12.0), having unprotected anal sex with a casual partner (OR, 4.2; 95% CI, 2.0–8.9), and knowing the recommendation (OR, 4.1; 95% CI, 2.1–8.2). Low perceived risk, time constraints, and not knowing that one should get screened were identified as reasons for not testing by 61.7%, 18.9%, and 18.8%, respectively. Identifying low perceived risk as a reason for not testing was associated with having more than 10 sex partners (OR, 0.2; 95% CI, 0.1–0.5).

Conclusions Attempts to improve compliance with the syphilis screening recommendation should include education regarding recommended screening frequency and syphilis risk factors and interventions to increase screening convenience.

Fulfilling syphilis testing recommendations was associated with knowing the recommended interval, HIV infection, number of sex partners, and unprotected anal sex. Barriers included perceived risk and available time to test.

From the *Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; †STD Prevention and Control Services, ‡HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA; and §Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine, University of California, Los Angeles, CA

Supported by the Centers for Disease Control and Prevention (1U62PS000961).

Conflict of interest disclosure: None.

Prior presentation: Poster presentation at the International Society for STD Research meeting in London, UK, 2009.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Correspondence: Jeffrey D. Klausner, MD, MPH, 9911 West Pico Boulevard, Los Angeles, CA 90035. E-mail:

Received for publication July 9, 2012, and accepted November 29, 2012.

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© Copyright 2013 American Sexually Transmitted Diseases Association