FAQ: Gay Men’s Health

Dear Dr. Know,
What (if any) special concerns should I have if I am a gay man?

Patient in PA

Dear Patient,
Yes, gay straight and bi men who have sex with men should observe the following health care screening:

HEALTH CARE SCREENING FOR MEN WHO HAVE SEX WITH MEN

  • Physical exam: every 3 to 5 years
  • Family history.  This should be reviewed/updated at every physical exam.
  • Lab screening: fasting glucose, cholesterol particularly
  • Be honest about your sexual practices:  are you top, bottom, versatile?  Are you monogamous in your relationship? In what sexual practices do you engage?  If your physician is uncomfortable with these issues, find another physician.
  • HIV test every 3 to 6 months depending on your sexual practices.  Do you practice safe sex? If not, get screened more often.
  • Syphilis test every 3 to 6 months.  Syphilis is rampant in this community, and condoms may not protect you.  This goes for herpes and venereal warts.
  • Venereal wart immunization.  Unfortunately, this immunization is approved only for men up to the age of 26, and it is very expensive:  $200 a shot for 3 shots.  60 to 75 % of men who have sex with men have venereal warts, and they can be anal, so you don’t necessarily know that you have them.
  • Anal pap smear if you have ever bottomed, no matter how remotely.  Anal cancer is more common in men who have sex with men than cervical cancer is in women.
  • Venereal wart anal screening for exposure to the strains of the venereal wart virus that are known to cause cancer.
  • Gonorrhea and Chlamydia screening:  as needed based on symptoms and sexual practices
  • Hepatitis A and B immunizations.  Get screened first.  Screening should also include hepatitis C.  Many of my patients have had hepatitis A, B and/or C and never knew it.  You don’t neeed the immunizations if you have already had the infection.  If you are HIV positive, you should receive a double dose of hepatitis B vaccine.  Ten percent of people infected with hepatitis B become chronic carriers, and can infect their partners; and a small percentage of the chronic carriers will develop liver cancer.
  • Herpes 2 screening.  Are you positive for exposure?  A simple blood test will answer the question.
  • Evaluation of nicotine use
  • Evaluation of drug and/or alcohol use
  • Screening for depression

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