Yes, as a gay man you are considered a high-prevalence population for certain sexually transmitted infections, particularly HIV and other bacterial STIs.
Gay and bisexual men are at increased risk for sexually transmitted infections and account for more than half of all persons living with HIV or AIDS in the United States. 1
Understanding Your Risk Status
HIV and STI Prevalence
- Men who have sex with men (MSM) account for approximately 60% of HIV-positive persons in the United States 1
- Among men with HIV infection diagnosed at 13 years or older, 68% of infections are attributed to male-to-male sexual contact 1
- The CDC considers men who have sex with men to be at very high risk of new HIV infection 1
- Gay men have significantly higher rates of gonorrhea (up to 16% prevalence in STD clinic settings), chlamydia (approximately 12%), and syphilis compared to the general population 2
What "High-Prevalence" Means Clinically
According to the CDC, a high-prevalence setting is defined as a geographic location or community with an HIV seroprevalence of at least 1% 1. However, your individual risk is determined by specific behavioral factors rather than identity alone:
Behavioral risk factors that increase your actual risk include: 1
- Having unprotected vaginal or anal intercourse
- Having multiple sex partners
- Having sex partners who are HIV-infected, bisexual, or injection drug users
- Exchanging sex for drugs or money
- Having acquired or requesting testing for other STIs
Recommended Screening Schedule
The CDC recommends annual screening for all sexually active MSM, with more frequent screening (every 3-6 months) if you have: 2
- Multiple or anonymous partners
- Use drugs during sex
- Have partners who engage in these activities
Comprehensive Screening Should Include:
- Testing for gonorrhea and chlamydia at all potential exposure sites (pharynx, rectum, urethra) 2
- Serologic testing for syphilis 2
- HIV testing 2
- Hepatitis B vaccination if not already immune 1
Prevention Strategies Available to You
Vaccination
You should receive hepatitis B vaccine as sexually active homosexual and bisexual men are specifically identified as a priority vaccination group 1. The prevalence of previous hepatitis B infection among sexually active homosexual men is high, so prevaccination testing may be cost-effective 1.
Post-Exposure Prophylaxis
Doxycycline post-exposure prophylaxis (doxy PEP) is now recommended by the CDC for MSM who have had a bacterial STI diagnosed in the past 12 months 2. This represents a new prevention tool that can reduce your risk of acquiring bacterial STIs.
Pre-Exposure Prophylaxis (PrEP)
If you have recurrent bacterial STIs or engage in condomless anal intercourse, the CDC recommends offering PrEP immediately 2. This is particularly important because the presence of bacterial STIs increases HIV acquisition risk through mucosal inflammation and disruption 2.
Important Clinical Considerations
Co-Infection Risks
Research demonstrates that HIV-positive gay men have significantly higher rates of other STIs compared to HIV-negative men, including higher prevalence of hepatitis B infection, syphilis, and anal gonorrhea 3. The presence of other STIs increases the risk of HIV acquisition and transmission 2.
Mental Health Disparities
Beyond STI risk, lesbian, gay, and bisexual persons are approximately 2.5 times more likely to have a mental health disorder than heterosexual men and women 1. LGBT populations also have the highest rates of tobacco, alcohol, and other drug use 1. These factors can compound health risks and should be addressed as part of comprehensive care.
Common Pitfalls to Avoid
Do not rely on subjective risk assessment alone. The CDC emphasizes that behavioral screening must identify actual risk behaviors (such as recurrent STIs or receptive anal intercourse) rather than accepting your subjective risk assessment 2. Many individuals are not aware of their sex partners' risk factors for HIV infection 1.
Do not assume monogamy eliminates risk. Individuals not at increased risk include only those who are sexually active in exclusive monogamous relationships with uninfected partners 1. This requires knowledge of your partner's status and behaviors.
Do not delay screening if asymptomatic. Many STIs, including HIV, can be asymptomatic for extended periods. Regular screening based on the recommended intervals is essential regardless of symptoms 2.