Risk factors for early syphilis among gay and bisexual men seen in an STD clinic: San Francisco, 2002-2003

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 (R)) (OR = 6.2 [2.614.91), using methamphetamine without sildenafill (OR = 3.2 [1.3-7.61), using sildenafil without methamphetamines (OR = 0.9 [0.3-2.9]), stronger gay community affiliation (OR = 2.3 [1.2-4.61), 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.