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

Download the complete MSM Toolkit.

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.

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

Asymptomatic Screening – Chapter 1

RESOURCES

• CDPH Dear Colleague Letter - Extragenital Screening (PDF)
  
• Use of Treponemal Immunoassays for Screening and Diagnosis of Syphilis - CDPH (PDF)
• HIV Testing in Clinical Settings – CDC

• Delivery of the Positive HIV Test Result
  

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

• California STD Treatment Guidelines Table for Adults & Adolescents 2015 - CDPH (PDF)
• Sexually Transmitted Disease Treatment Guidelines - CDC
  
• Verification Protocol for Chlamydia and Gonorrhea NAAT of Rectal Swabs (PDF)
• Verification Protocol for Chlamydia and Gonorrhea NAAT of Pharyngeal Swabs (PDF)
• CDPH Dear Colleague Letter - Extragenital Screening (PDF)
  
• California Gonorrhea Treatment Guidelines – Suspected Gonorrhea Treatment Failure - CDPH (PDF)
  
• Reverse Sequence Syphilis Screening - Frequently Asked Questions (PDF)
  
  

​​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

• Summary of Regulations Related to STD Prevention and Control Efforts in California – CDPH (PDF)

• CalREDIE Help – CDPH

Resources and Selected References – Chapter 10

This chapter provides a categorical list of selected resources discussed in the individual toolkit chapters.

Other Resources

California Department of Public Health STD Control Branch

Clinical Guidelines and Job Aids

Public Health Reporting

California Prevention Training Center

MSM Sexual Health Standards of Care - NCSD

AIDS Education Training Centers National Resource Center

Hepatitis C Online

Gay and Lesbian Medical Association

Center of Excellence for Transgender Health

American Academy of HIV Medicine

National HIV/AIDS Clinical Consultation Center