A Clinician's Resource for Sexually Transmitted Diseases (STDs) in Gay Men and Other Men Who Have Sex with Men (MSM) - The MSM Toolkit

A PDF version of the toolkit is available: MSM Toolkit (PDF).

Effective communication around STDs is a challenge for many healthcare providers, especially with little time to provide comprehensive health care and social support services for patients.

Why focus on MSM?

STDs in communities of MSM, particularly among those with HIV infection, are common medical problems with important public health implications.

In 2014, 85% of all reported male primary and secondary syphilis cases in California with data on sexual orientation were MSM. Of interviewed MSM with known HIV status, 45% were co-infected with HIV.

Infection with STDs such as syphilis, gonorrhea (GC), and chlamydia (CT) increase by a factor of 2 to 5 the risk of sexual HIV acquisition and transmission.

A Clinician's Resource for Sexually Transmitted Diseases (STDs) in Gay Men and Other Men Who Have Sex with Men (MSM) - The MSM Toolkit is a resource designed to improve clinicians' knowledge, skills, and comfort in effectively diagnosing and managing STDs in MSM.

Disclaimer for public health clinical guidelines: These guidelines are intended to be used as an educational aid to help clinicians make informed decisions about patient care. The ultimate judgment regarding clinical management should be made by the health care provider in consultation with their patient in light of clinical data presented by the patient and the diagnostic and treatment options available. Further, these guidelines are not intended to be regulatory and not intended to be used as the basis for any disciplinary action against the health care provider.

Acronyms used in MSM Toolkit (PDF)

The following sections provide summaries and resources for the chapters within the MSM Toolkit (PDF).

Asymptomatic Screening – Chapter 1

This chapter discusses how and when to evaluate the sexual health of MSM clients. Important considerations for the screening of chlamydia, gonorrhea, syphilis, and HIV are also included.

Resources

Sexual History Taking and Risk Assessment – Chapter 2

This chapter outlines the rationale for and methods of conducting sexual histories and risk assessments and includes some sample questions.

Physical Exam Findings – Chapter 3

This chapter describes examples of clinical signs of an STD to look for during a comprehensive physical exam and recommends related testing.

Bacterial STDs – Chapter 4

This chapter discusses patient evaluation, testing, treatment, and follow-up for chlamydia, gonorrhea, and syphilis. Special considerations for suspected gonorrhea treatment failure are included.

Resources

HIV – Chapter 5

This chapter identifies basic expectations for healthcare providers of MSM related to the prevention, screening, and diagnosis of HIV in MSM patients.

National Clinician Consultation Center for HIV (ucsf.edu)

Pre-exposure Prophylaxis for the Prevention of HIV Infection in the United States 2017 - CDC (PDF)

Pre-exposure Prophylaxis for the Prevention of HIV Infection in the United States 2017: Clinical Providers' Supplement - CDC (PDF)

Viral Hepatitis (A, B, and C) – Chapter 6

This chapter discusses recommended strategies for hepatitis testing, vaccination, and clinical management in MSM.

Resources

Viral Hepatitis - CDC

Office of Viral Hepatitis Prevention - CDPH

American Association for the Study of Liver Diseases - Practice Guidelines

American Association for the Study of Liver Diseases - HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians - CDC

Viral Hepatitis Clinical Guidelines

Enhancing the Care Setting – Chapter 7

This chapter discusses methods for creating a clinical environment that is sensitive to the needs of LGBT patients.

Resources

Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients (PDF)

Recommendations for Inclusive Data Collection of Trans People in HIV Prevention, Care & Services

Cultural Competence Webinar Series - Quality Healthcare for Lesbian, Gay, Bisexual & Transgender People

STD/HIV Partner Services – Chapter 8

This chapter defines and describes the Partner Services purpose, process, and benefits.

Resources

Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection - CDC (PDF)

Public Health Reporting – Chapter 9

This chapter provides an overview of the disease-specific reporting requirements for California. Included are links to related legislation, policies, and forms.

Resources