STDs among Men who Have Sex with Men (MSM), San Francisco 27 212 Applied Research, Community Health Epidemiology, and Surveillance (ARCHES) Population Health Division San Francisco Department of Public Health
Executive Summary 212 Morbidity Rates among MSM* (per 1,) Early Syphilis 1,23. Gonorrhea 2,95. Chlamydia 2,741.1 212 Morbidity Rates among Heterosexual Males (per 1,) Early Syphilis 1.8 Gonorrhea 16.8 Chlamydia 317.3 * Estimate of 64,681 MSM San Francisco Residents from 211 HIV Consensus Estimate
STDs among MSM in San Francisco, 212 For MSM 1 out of 79 was infected with early syphilis 1 out of 34 was infected with gonorrhea 1 out of 36 was infected with chlamydia For Heterosexual Men 1 out of 9,285 was infected with early syphilis 1 out of 936 was infected with gonorrhea 1 out of 315 was infected with chlamydia
MSM are disproportionately burdened by STDs For San Francisco in 212, compared to heterosexual males, MSM are at significantly higher risk of early syphilis, gonorrhea, and chlamydia Risk of early syphilis is 117. times higher in MSM compared to heterosexual males Risk of gonorrhea is 8.6 times higher in MSM compared to heterosexual males Risk of chlamydia is 27.2 times higher in MSM compared to heterosexual males
City Wide MSM STD Morbidity
MSM in San Francisco U.S. Census does not collect gender of partners or sexual identity, so no solid estimate of the number of MSM in San Francisco is available SF HIV Consensus Process Modified Delphi Model that examines a variety of data points and makes an informed, best guess. Population estimates made using the Multiplier Method (UNAIDS, 23) in which a population-based study collects information on a service used by the population during a given period. Using the total number served by that service in the same period, an estimate of total population size can be calculated. Using these two data sources, the multiplier method provides a population size estimate by the formula: N = n / p, where N is the MSM population size, given by n as the number of MSM using a particular service in a specified time period and p as the proportion of MSM reporting using the particular service in the time-period collected in a population survey. 211 HIV Consensus Estimate: 64,681 MSM reside in San Francisco
Notes about Data Included in Supplement Morbidity MSM is defined as a male who identified as gay or bisexual or reported ever having had sex with a male Data across clinic visits/morbidity events are used to determine MSM status As per CA state law, all positive reactive syphilis serologic results and positive chlamydia and gonorrhea tests are reported to SFSTD from laboratories as well as mandated provider case reports Beginning in 24, SFSTD began requiring gender of sex partners be reported on all syphilis, chlamydia, and gonorrhea case reports San Francisco STD morbidity is defined as a lab or provider report of syphilis, chlamydia, or gonorrhea for a resident of San Francisco When multiple reports for the same patient and same STD are received within 3 days of a prior report, only the initial report is counted as San Francisco morbidity For syphilis, active case investigations and interviews are conducted by SFSTD field staff. Due to the high volume, chlamydia and gonorrhea morbidity reports are not investigated. As a result, more detailed information is available for reported syphilis cases. SFSTD recommends that sexually active MSM be screened every 3-6 months for: Syphilis Chlamydia (rectal and pharyngeal sites) Gonorrhea (rectal and pharyngeal sites)
Number of Cases 9 8 Reported Early Syphilis by Sex/Sexual Orientation, San Francisco 27-212 Female MSM Other Men TG 7 6 5 4 3 2 1 27 28 29 21 211 212
Early Syphilis Rate (per 1,) 14 12 Early Syphilis Rates (per 1, population), San Francisco 27-212 MSM Other Men Female 1 8 6 4 2 27 28 29 21 211 212
Number of Reported Early Syphilis Cases 18 Reported MSM Syphilis by Age, San Francisco 27-212 16 14 12 1 8 6 4 15-19 2-24 25-29 3-34 35-39 4-44 45-49 5-54 55-59 6-64 65+ 2 27 28 29 21 211 212
Number of Reported Early Syphilis Cases 6 5 Reported MSM Early Syphilis by Race/Ethnicity, San Francisco 27-212 African American Asian/Pacific Islander Hispanic Native American Other White 4 3 2 1 27 28 29 21 211 212
Number of Reported Early Syphilis Cases 6 Reported MSM Early Syphilis by HIV Status, San Francisco 27-212 5 Negative Positive Unknown 4 3 2 1 27 28 29 21 211 212
Early Syphilis Cases among MSM, San Francisco 212 Downtown/Tenderloin Hayes Valley/NOPA South of Market Upper Market Castro/ E Twin Peaks
Number of Chlamydia Cases 25 Reported Chlamydia by Sex/Sexual Orientation, San Francisco 27-212 Female MSM Other Men TG 2 15 1 5 27 28 29 21 211 212
Chlamydia Rates (per 1,) 3 Chlamydia Rates (per 1, population), San Francisco 27-212 MSM Other Men Female 25 2 15 1 5 27 28 29 21 211 212
Number of Reported Chlamydia Cases 35 Reported MSM Chlamydia by Age, San Francisco 27-212 3 25 2 15 1 5 15-19 2-24 25-29 3-34 35-39 4-44 45-49 5-54 55-59 6-64 65+ 27 28 29 21 211 212
Number of Reported Chlamydia Cases 12 Reported Chlamydia by Race/Ethnicity, San Francisco 27-212 African American Asian/Pacific Islander Hispanic Native American Other White 1 8 6 4 2 27 28 29 21 211 212
Chlamydia Cases among MSM, San Francisco 212 Downtown/Tenderloin Hayes Valley/NOPA Castro / E Twin Peaks
Number of Gonorrhea Cases 2 18 Reported Gonorrhea by Sex/Sexual Orientation, San Francisco 27-212 Female MSM Other Men TG 16 14 12 1 8 6 4 2 27 28 29 21 211 212
Gonorrhea Rate (per 1,) 35 Gonorrhea Rates (per 1, population), San Francisco 27-212 MSM Other Men Female 3 25 2 15 1 5 27 28 29 21 211 212
Number of Reported Gonorrhea Cases 45 Reported MSM Gonorrhea by Age, San Francisco 27-212 4 35 3 25 2 15 1 5 15-19 2-24 25-29 3-34 35-39 4-44 45-49 5-54 55-59 6-64 65+ 27 28 29 21 211 212
Number of Reported Gonorrhea Caes 14 12 Reported MSM Gonorrhea by Race/Ethnicity, San Francisco 27-212 African American Asian/Pacific Islander Hispanic Native American Other White 1 8 6 4 2 27 28 29 21 211 212
Gonorrhea Cases among MSM, San Francisco 212 Downtown/Tenderloin Hayes Valley/NOPA South of Market Castro/ E. Twin Peaks Upper Market
Number of Reported Cases 12 Reported Rectal and Pharyngeal Chlamydia and Gonorrhea among MSM, San Francisco 27-212 Rectal CT Pharyngeal CT Rectal GC Pharyngeal GC 1 8 6 4 2 27 28 29 21 211 212
San Francisco City Clinic
Data from San Francisco City Clinic San Francisco City Clinic (SFCC) provides low cost STD, HIV, and reproductive health services 5 days per week SFCC began using a fully electronic medical record system in June 21 All patients at SFCC are seen by a clinician for evaluation and risk assessment Demographic information is collected from patients at registration. Sexual and drug using behaviors are collected from clinicians during exam All patients have a new behavioral assessment conducted if it has been more than 2 weeks since their last visit At SFCC, all MSM are screened for chlamydia and gonorrhea at the urogenital, pharyngeal, and rectal sites (based on reported exposure), syphilis, and offered testing for HIV
Notes about Data Included in Supplement City Clinic MSM is defined as a male who self-identified as gay or bisexual or ever reported having had sex with a male Data across clinic visits/morbidity events are used to determine MSM status HIV status is based on self-reported status as well as HIV testing conducted at SFCC A symptomatic patient visit is defined as a clinical encounter where the patient reports urogenital, anorectal, pharyngeal, or dermatalogic symptoms
Number of Patient Visits 12 Number of Patient Visits, San Francisco City Clinic 27-212 Female MSM Other Men TG 1 8 6 4 2 27 28 29 21 211 212
Number of Patient Visits 25 Age Distribution of MSM Visits, San Francisco City Clinic 27-212 2 15 1 5 15-19 2-24 25-29 3-34 35-39 4-44 45-49 5-54 55-59 6-64 65+ 27 28 29 21 211 212
Number of Patient Visits 7 Racial/Ethnic Distribution of MSM Patient Visits, San Francisco City Clinic 27-212 African American Asian/Pacific Islander Hispanic Native American Other White 6 5 4 3 2 1 27 28 29 21 211 212
Number of Patient Visits 9 8 HIV Status of MSM Patient Visits, San Francisco City Clinic 27-212 Negative Positive Unknown 7 6 5 4 3 2 1 27 28 29 21 211 212
Proportion of Visits 1 Proportion of Symptomatic MSM Patient Visits, San Francisco City Clinic 27-212 8 6 7.2 72.4 73.8 78.8 81. 83.5 4 2 27 28 29 21 211 212
Proprtion of Patient Visits 1 Proportion of MSM Reporting Any Female Partners in Prior 3 Months, San Francisco City Clinic 27-212 8 6 4 2 12.5 12.6 15.1 18.7 15.4 15.8 27 28 29 21 211 212
Number of Male Partners 6 5 Mean and Median Number of Male Sex Partners in Prior 3 Months Among MSM Patient Visits, San Francisco City Clinic 27-212 4.96 4.92 Mean Median 4.96 5.64 4 4.43 4.55 3 3 3 2 2 2 2 2 1 27 28 29 21 211 212
Proprtion Reporting Meth Use (%) 1 Proportion of MSM Visits Reporting Methamphetamine Use in Prior 12 Months, San Francisco City Clinic 27-212 8 6 4 2 14.6 9.9 1. 9.7 11.1 28 29 21 211 212
Proprtion of Patient Visits 1 Proportion of MSM Visits Reporting Any Lifetime Injection Drug Use, San Francisco City Clinic 27-212 8 6 4 2 6.4 6.3 4.9 6.1 6.4 6.4 27 28 29 21 211 212
Positivity (%) 1 Rectal Gonorrhea Positivity among MSM, San Francisco City Clinic 27-212 8 6 4 2 8. 6.5 6.5 6.5 6.9 8.1 27 28 29 21 211 212
Positivity (%) 1 Rectal Chlamydia Positivity among MSM, San Francisco City Clinic 27-212 8 6 4 2 9.3 9.1 9.6 11.2 9.1 9.3 27 28 29 21 211 212
Positivity (%) 1 Pharyngeal Gonorrhea Positivity among MSM, San Francisco City Clinic 27-212 8 6 4 2 7. 7. 7.5 7. 7.6 7. 27 28 29 21 211 212
Positivity (%) 1 Pharyngeal Chlamydia Positivity among MSM, San Francisco City Clinic 27-212 8 6 4 2 1.7 2. 1.6 2.3 1.9 1.6 27 28 29 21 211 212
Number of Early Syphilis Diagnoses 3 Early Syphilis Diagnoses among MSM, San Francisco City Clinic 27-212 25 275 2 15 23 19 196 228 139 1 5 27 28 29 21 211 212
Number of Herpes Diagnoses 16 145 Genital Herpes Diagnoses among MSM, San Francisco City Clinic 27-212 14 12 121 123 12 12 1 99 8 6 4 2 27 28 29 21 211 212
Positivity (%) 1 HIV Positivity Among MSM, San Francisco City Clinic 27-212 9 8 7 6 5 4 3 2 1 3.6 27 (n=372) 2. 2.6 2.3 1.9 2.4 28 (n=34) 29 (n=3221) 21 (n=3393) 211 (n=3553) 212 (n=392)
Number of HIV RNA Positive Specimens 25 Number of Pooled HIV RNA Positive Specimens among MSM, San Francisco City Clinic 27-212 2 15 1 5 27 28 29 21 211 212
For questions or comments Copyright Information All material contained in this report is in the public domain and may be used and reprinted without special permission; citation to source, however, is appreciated. Inquiries and comments should be addressed to: Kyle T Bernstein, PhD, ScM Sexually Transmitted Disease Prevention and Control Services 136 Mission Street, Suite 41 San Francisco, CA 9413 (415) 355-21 Suggested Citation STD Control Section. San Francisco Sexually Transmitted Disease MSM Surveillance Supplement 212. San Francisco Department of Public Health, San Francisco, California. October 213. Note on totals for previous years Numbers in this document listed for past years may not match totals in previous reports. Totals may increase due to late reports, and may decrease when duplicate reports are eliminated or cases are subsequently identified as out of our jurisdiction.