(P237) Comparing men who have sex with women, men who have sex with men only and men who have sex with men and women visiting a public STD clinic

Background: Men reporting same-sex behaviors are disproportionately impacted by sexually transmitted infections (STI). Differences in behaviors and clinical characteristics in men who have sex with men only (MSMO), men who have sex with men and women (MSMW), and men who have sex with women only (MSW) are not well described.



Methods: First visits to two Baltimore City STI clinics 2011-2016 from MSMO and MSMW compared to an age-matched random sample of MSW were analyzed. Acute STI (aSTI) included diagnosis of chlamydia (CT), gonorrhea (NG), nongonococcal urethritis (NGU) or primary or secondary syphilis. Chi-squared tests and logistic regression were utilized to examine associations.



Results: Amongst N=1226 MSMO, N=491 MSMW and N=1717 MSW, 68.0%, 73.5%, and 83.1% respectively identified as Black/African American; mean age (29.8) was similar across groups. MSMW were most likely to report ≥2 partners in last 6 months (73.5%), followed by MSMO (67.2%) and MSW (60.2%) (p≤0.01). “Always” condom use was reported by 17.4%, 20.4%, and 14.1% of MSMO, MSMW, and MSW (p≤0.01). Reported substance use was low excepting binge drinking which was similar across groups (22.3-24.4%). There were no significant differences in aSTI (34.6-36.5%), but amongst those tested, MSW were most likely to be diagnosed with urogenital CT (21.7%) followed by MSMW (8.3%) and MSMO (3.9%) (p≤0.01). MSMW were more likely to be diagnosed with urogenital NG (11.6%) than MSW (7.7%) and MSMO (8.3%) (p=0.01). The proportion of MSMW and MSMO diagnosed with rectal (17.4-19.5%) or pharyngeal (2.7-3.1%) CT, rectal (18.7-21.9%) or pharyngeal (11.7-13.2%) NG, NGU (25.2%), or syphilis (5.5-6.5%) was similar. MSW were less likely to be diagnosed with pharyngeal NG (3.4%) and syphilis (0.6%), and more likely to be diagnosed with NGU (36.9%) than MSMO and MSMW, (p< 0.01). Older age was protective against aSTI diagnosis in MSW and MSMO but not in MSMW, whereas consistent condom use was protective against aSTI in MSW (aOR:0.60, p< 0.01) and MSMW (aOR:0.54 p=0.03) but not in MSMO.

Conclusion: Differences in behaviors and clinical characteristics associated with STI diagnoses suggest that MSMO, MSMW and MSW have diverse sexual health needs and require tailored messaging and interventions to improve sexual health outcomes.