Sexuality Research and Social Policy

, Volume 15, Issue 2, pp 172–182 | Cite as

Sexually Transmitted Infections Among Young Men Who Have Sex with Men: Experiences with Diagnosis, Treatment, and Reinfection

  • Brian A. Feinstein
  • Trey V. Dellucci
  • Simon Graham
  • Jeffrey T. Parsons
  • Brian MustanskiEmail author


Despite high rates of sexually transmitted infections (STIs) among young men who have sex with men (YMSM), little is known about their experiences with diagnosis, treatment, and reinfection. To fill this gap, we interviewed 17 YMSM ages 18–29 who participated in an online HIV prevention trial and tested positive for STIs at both the baseline and 3-month follow-up assessments. Participants were asked about their reactions to testing positive, experiences with treatment, disclosure to partners, and changes in thinking and behavior. Reactions were diverse, the most common being surprise and concern. Most participants sought treatment, although type of provider varied (e.g., primary care physician, clinic that specialized in gay/bisexual men’s health). Providers tended to retest participants, but some did so at the incorrect anatomical site. Participants who felt comfortable talking to providers about STIs tended to use their regular provider or one who specialized in gay/bisexual men’s health. Most participants described changes in their thinking and behavior (e.g., increased condom use, fewer sex partners, questioning whether or not they could trust their partners). Most participants disclosed to at least one partner, but some did not remember or were not in contact with partners. Experiences were similar the first and second time participants tested positive for STIs during the study with a few exceptions (e.g., more self-blame and comfort talking to providers the second time). In sum, YMSM have diverse experiences with STI diagnosis and treatment. Implications for public policy and STI prevention are discussed.


Young men who have sex with men Sexually transmitted infection Diagnosis Treatment Reinfection 


Funding Information

This study was funded by grants from the National Institute on Drug Abuse and the National Institute of Mental Health (R01DA035145 and R01DA035145-02S1). Brian A. Feinstein’s time was also supported by a grant from the National Institute on Drug Abuse (F32DA042708). Simon Graham was funded by an Australian-American Fulbright postdoctoral scholarship, a McKenzie postdoctoral fellowship, and the Melbourne Poche Centre for Indigenous Health at the University of Melbourne, Australia. The content of this article is solely the responsibility of the authors and does not necessarily reflect the official views of the funding agencies. The authors thank the participants for their contributions and the CDC Division of STD Prevention Laboratory for performing the STI testing.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Bachmann, L. H., Johnson, R. E., Cheng, H., Markowitz, L., Papp, J. R., Palella Jr., F. J., & Hook III, E. W. (2010). Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and chlamydia trachomatis rectal infections. Journal of Clinical Microbiology, 48, 1827–1832. Scholar
  2. Barbee, L. A., Khosropour, C. M., Dombrowksi, J. C., & Golden, M. R. (2017). New human immunodeficiency virus diagnosis independently associated with rectal gonorrhea and chlamydia in men who have sex with men. Sexually Transmitted Diseases, 44, 385–389. Scholar
  3. Berger, R. E., Alexander, E. R., Harnisch, J. P., Paulsen, C. A., Monda, G. D., Ansell, J., & Holmes, K. K. (1979). Etiology, manifestations and therapy of acute epididymitis: Prospective study of 50 cases. The Journal of Urology, 121, 750–754.CrossRefPubMedGoogle Scholar
  4. Bernstein, K. T., Marcus, J. L., Nieri, G., Philip, S. S., & Klausner, J. D. (2010). Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. Journal of Acquired Immune Deficiency Syndrome, 53, 537–543. Scholar
  5. Blake, D. R., Spielberg, F., Levy, V., Lensing, S., Wolff, P. A., Venkatasubramanian, L., et al. (2015). Could home STI specimen collection with e-prescription be a cost-effective strategy for clinical trials and clinical care? Sexually Transmitted Diseases, 42, 13–19.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Branson, B. M., Handsfield, H. H., Lampe, M. A., Janssen, R. S., Taylor, A. W., Lyss, S. B., et al. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recommendations and Reports, 55, 1–17.PubMedGoogle Scholar
  7. Brewer, T. H., Schillinger, J., Lewis, F. M., Blank, S., Pathela, P., Jordahl, L., et al. (2011). Infectious syphilis among adolescent and young adult men: Implications for human immunodeficiency virus transmission and public health interventions. Sexually Transmitted Diseases, 38, 367–371. Scholar
  8. Carter, J. D., & Inman, R. D. (2011). Chlamydia-induced reactive arthritis: Hidden in plain sight? Best Practice & Research: Clinical Rheumatology, 25, 359–374. Scholar
  9. CDC. (2006). Expedited partner therapy in the management of sexually transmitted diseases. Atlanta: US Department of Health and Human Services.Google Scholar
  10. CDC. (2008). Trends in HIV/AIDS diagnoses among men who have sex with men—33 states, 2001-2006. Morbidity and Mortality Weekly Report, 57, 681–686.Google Scholar
  11. CDC. (2015). Sexually transmitted disease surveillance 2014. Atlanta: U.S. Department of Health and Human Services.Google Scholar
  12. CDC. (2016). Guidance on the use of expedited partner therapy in the treatment of gonorrhea. Retrieved from
  13. CDC. (2017a). STD & HIV screening recommendations. Retrieved from
  14. CDC. (2017b). HIV surveillance—Men who have sex with men (MSM). Retrieved from
  15. CDC. (2017c). Expedited partner therapy. Retrieved from
  16. CDC. (2017d). Sexually transmitted diseases (STDs): Training. Retrieved from
  17. Chow, E. P., Tomnay, J., Fehler, G., Whiley, D., Read, T. R., Denham, I., et al. (2015). Substantial increases in chlamydia and gonorrhea positivity unexplained by changes in individual-level sexual behaviors among men who have sex with men in an Australian sexual health service from 2007 to 2013. Sexually Transmitted Infections, 42, 81–87. Scholar
  18. Cosentino, L. A., Campbell, T., Jett, A., Macio, I., Zamborsky, T., Cranston, R. D., & Hillier, S. L. (2012). Use of nucleic acid amplification testing for diagnosis of anorectal sexually transmitted infections. Journal of Clinical Microbiology, 50, 2005–2008. Scholar
  19. Decker, M. R., Miller, E., McCauley, H. L., Tancredi, D. J., Levenson, R. R., Waldman, J., et al. (2011). Intimate partner violence and partner notification of sexually transmitted infections among adolescent and young adult family planning clinic patients. International Journal of STD & AIDS, 22, 345–347. Scholar
  20. Dedoose Version 7.6.17. (2017). web application for managing, analyzing, and presenting qualitative and mixed method research data. Los Angeles: SocioCultural Research Consultants, LLC Scholar
  21. Dilley, J. W., Woods, W. J., Loeb, L., Nelson, K., Sheon, N., Mullan, J., et al. (2007). Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: Results from a randomized controlled trial using paraprofessional counselors. Journal of Acquired Immune Deficiency Syndrome, 44, 569–577.CrossRefGoogle Scholar
  22. Dilley, J. W., Woods, W. J., Sabatino, J., Lihatsh, T., Adler, B., Casey, S., et al. (2002). Changing sexual behavior among gay male repeat testers for HIV: A randomized, controlled trial of a single-session intervention. Journal of Acquired Immune Deficiency Syndrome, 30, 177–186.CrossRefGoogle Scholar
  23. Fung, M., Scott, K. C., Kent, C. K., & Klausner, J. D. (2007). Chlamydial and gonococcal reinfection among men: A systematic review of data to evaluate the need for retesting. Sexually Transmitted Infections, 83, 304–309. Scholar
  24. Grov, C., Cain, D., Rendina, H. J., Ventuneac, A., & Parsons, J. T. (2016). Characteristics associated with urethral and rectal gonorrhea and chlamydia diagnoses in a US National Sample of gay and bisexual men: Results from the one thousand strong panel. Sexually Transmitted Diseases, 43, 165–171. Scholar
  25. Holmes, K. K., Counts, G. W., & Beaty, H. N. (1971). Disseminated gonococcal infection. Annals of Internal Medicine, 74, 979–993.CrossRefPubMedGoogle Scholar
  26. Hologic, Inc. (2016). Aptima combo 2 assay for pather system package insert. San Diego, CA.Google Scholar
  27. Hoover, K. W., Butler, M., Workowski, K., Carpio, F., Follansbee, S., Gratzer, B., et al. (2010). STD screening of HIV-infected MSM in HIV clinics. Sexually Transmitted Diseases, 37, 771–776. Scholar
  28. Kelley, C. F., Vaughan, A. S., Luisi, N., Sanchez, T. H., Salazar, L. F., Frew, P. M., et al. (2015). The effect of high rates of bacterial sexually transmitted infections on HIV incidence in a cohort of black and white men who have sex with men in Atlanta, Georgia. AIDS Research and Human Retroviruses, 31, 587–592. Scholar
  29. Kent, C. K., Chaw, J. K., Wong, W., Liska, S., Gibson, S., Hubbard, G., & Klausner, J. D. (2005). Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clinical Infectious Diseases, 41, 67–74.CrossRefPubMedGoogle Scholar
  30. Kirkcaldy, R. D., Zaidi, A., Hook III, E. W., Holmes, K. K., Soge, O., del Rio, C., et al. (2013). Neisseria gonorrhoeae antimicrobial resistance among men who have sex with men and men who have sex exclusively with women: The gonococcal isolate surveillance project, 2005-2010. Annals of Internnal Medicine, 158, 321–328. Scholar
  31. Kubicek, K., Beyer, W. J., Weiss, G., Iverson, E., & Kipke, M. D. (2010). In the dark: Young men’s stories of sexual initiation in the absence of relevant sexual health information. Health Education & Behavior, 37, 243–263. Scholar
  32. MacQueen, K. M., McLellan, E., Kay, K., & Milstein, B. (1998). Codebook development for team-based qualitative analysis. Field Methods, 10, 31.Google Scholar
  33. Marks, G., Crepaz, N., Senterfitt, J. W., & Janssen, R. S. (2005). Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndrome, 39, 446–453.CrossRefGoogle Scholar
  34. McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22, 276–282.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Meanley, S., Gale, A., Harmell, C., Jadwin-Cakmak, L., Pingel, E., & Bauermeister, J. A. (2015). The role of provider interactions on comprehensive sexual healthcare among young men who have sex with men. AIDS Education and Prevention, 27, 15–26. Scholar
  36. Metsch, L. R., Feaster, D. J., Gooden, L., Schackman, B. R., Matheson, T., Das, M., et al. (2013). Effect of riskreduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: The AWARE randomized clinical trial. Journal of the American Medical Association, 310, 1701–1710.Google Scholar
  37. Mimiaga, M. J., Goldhammer, H., Belanoff, C., Tetu, A. M., & Mayer, K. H. (2007). Men who have sex with men: Perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sexually Transmitted Diseases, 34, 113–119.CrossRefPubMedGoogle Scholar
  38. Muller, O., Sarangbin, S., Ruxrungtham, K., Sittitrai, W., & Phanuphak, P. (1995). Sexual risk behaviour reduction associated with voluntary HIV counselling and testing in HIV infected patients in Thailand. AIDS Care, 7, 567–572. Scholar
  39. Mustanski, B., Feinstein, B. A., Madkins, K., Sullivan, P., & Swann, G. (2017). Prevalence and risk factors for rectal and urethral sexually transmitted infections from self-collected samples among young men who have sex with men participating in the Keep It Up! 2.0 randomized controlled trial. Sexually Transmitted Diseases, 44, 483–488. Scholar
  40. Mustanski, B., Madkins, K., Greene, G. J., Parsons, J. T., Johnson, B. A., Sullivan, P., et al. (2017). Internet-based HIV prevention with at-home sexually transmitted infection testing for young men having sex with men: Study protocol of a randomized controlled trial of Keep It Up! 2.0. JMIR Research Protocols, 6, e1. Scholar
  41. Peters, R. P. H., Verweij, S. P., Nijsten, N., Ouburg, S., Mustsaers, J., Jansen, C. L., et al. (2011). Evaluation of sexual history-based screening of anatomic sites for chlamydia trachomatis and neisseria gonorrhoeae infection in men having sex with men in routine practice. BMC Infectious Diseases, 11, 203.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Rosenberg, N. E., Pettifor, A. E., De Bruyn, G., Westreich, D., Delany-Moretlwe, S., Behets, F., et al. (2013). HIV testing and counseling leads to immediate consistent condom use among south African stable HIV-discordant couples. Journal of Acquired Immune Deficiency Syndrome, 62, 226–233. Scholar
  43. Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., & Schleifer, R. (2006). Abstinence and abstinence-only education: A review of U.S. policies and programs. Journal of Adolescent Health, 38, 72–81.CrossRefPubMedGoogle Scholar
  44. Su, J. R., Beltrami, J. F., Zaidi, A. A., & Weinstock, H. S. (2011). Primary and secondary syphilis among black and Hispanic men who have sex with men: Case report data from 27 states. Annals of Internal Medicine, 155, 145–151. Scholar
  45. Taylor, S. J., & Bogdan, R. (1998). Introduction to qualitative research methods: A guidebook and resource (3rd ed.). New York: Wiley.Google Scholar
  46. Turner, A. N., Miller, W. C., Padian, N. S., Kaufman, J. S., Behets, F. M., Chipato, T., et al. (2009). Unprotected sex following HIV testing among women in Uganda and Zimbabwe: Short- and long-term comparisons with pre-test behaviour. International Journal of Epidemiology, 38, 997–1007. Scholar
  47. Weinhardt, L. S., Carey, M. P., Johnson, B. T., & Bickham, N. L. (1999). Effects of HIV counseling and testing on sexual risk behavior: A meta-analytic review of published research, 1985-1997. American Journal of Public Health, 89, 1397–1405.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Workowski, K. A., Bolan, G. A., & Centers for Disease, C., & Prevention. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommations and Reports, 64, 1–137.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Brian A. Feinstein
    • 1
    • 2
  • Trey V. Dellucci
    • 1
    • 2
    • 3
    • 4
  • Simon Graham
    • 3
    • 5
  • Jeffrey T. Parsons
    • 3
    • 4
    • 6
  • Brian Mustanski
    • 1
    • 2
    Email author
  1. 1.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Northwestern University Institute for Sexual and Gender Minority Health and WellbeingChicagoUSA
  3. 3.Center for HIV Educational Studies & Training (CHEST)Hunter College of the City University of New YorkNew YorkUSA
  4. 4.Health Psychology and Clinical Science Doctoral Training ProgramGraduate Center of the City University of New YorkNew YorkUSA
  5. 5.Centre for Epidemiology and Biostatistics, School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
  6. 6.Department of PsychologyHunter College of the City University of New YorkNew YorkUSA

Personalised recommendations