Anonymous on August 15, 2011

I’m a gay man..what tests should I get on a regular basis?

I’m a 42-year-old gay man who is rarely involved passively (receptively), in protected anal sex encounters. My question is whether I should get certain medical tests/screenings on a regular basis. I check my HIV status regularly and I’ve received a vaccination against hepatitis B, but I’m concerned about the human papillomavirus infection, among others.  

answered by Linda Lesondak, PhD on August 15, 2011

Thank you for your interest in maintaining your health, as well as protecting the well-being of your partner(s). Your doctor is the best person to talk to about these questions so you can discuss your full sexual history and possible STD risk factors. However, I’m happy to provide some thoughts on what may make sense for you.

First, it sounds like you’re already taking important steps to make sure you’re healthy. Staying on top of your HIV status and being vaccinated for hepatitis B are two excellent preventive measures. In addition to the hepatitis B vaccine, a hepatitis A vaccine also exists that you may want to consider. Both vaccines are recommended by the Centers for Disease Control and Prevention for sexually active gay and bisexual men.

You also mentioned protected anal sex encounters...making sure that you and your partners wear latex condoms during all sexual activity (even when there’s no penetration) is one of the most important precautions you can take to reduce the risk of a sexually transmitted infections.

That said, your concern about human papillomavirus (HPV) is well-founded. In fact, the Centers for Disease Control and Prevention (CDC) identify several STDs of particular concern for men who are gay, bisexual or who have sex with other men. This list includes HPV, which can be transmitted through contact with infected genital skin (for example from the penis or anus). And you probably know, HPV can cause genital and anal warts, as well as anal and oral cancer in men. Condoms can help prevent the risk of transmitting HPV during anal or oral sex but, because HPV can be transmitted through infected skin that includes areas not covered by condoms, there’s still a small risk of catching HPV while using them.

Talk to your doctor about anal cancer screening. Although no reliable HPV screening test exists for men, men who have sex with men can talk to their doctors about anal Pap tests that can screen for anal cancer related to HPV infection. Not every doctor knows how to do this procedure, but your doctor will be able to refer you to someone who does. Several studies show anal Pap tests to be beneficial, especially in men with HIV.

And although as a 42-year-old you don’t qualify for the HPV vaccine, the CDC encourages gay men younger than 26 to consider getting vaccinated. The HPV vaccine may help prevent genital warts, and potentially cancer of the anus or throat.

Bottom line? The CDC recommends that gay men be screened for HIV annually. Regular screening for gonorrhea, chlamydia, syphilis, herpes, hepatitis B and hepatitis C are also encouraged. Depending on the riskiness of your sexual activity, talk to your doctor about getting tested more frequently (every three or six months) if needed...for example, if you have a sexual encounter with a new partner or someone whose STD status you don’t know, it’s a good idea to get tested as soon as a potential infection is detectable. For more information about when a virus or bacteria is most likely to be detected, see our STD Testing Windows Guide.

For more information about HPV risk factors and prevention, please see our HPV Overview.

Thank again for writing. You’re on the right track by monitoring your health with STD testing and using protection. I encourage you to continue being diligent about your sexual health. Good luck.

Linda Lesondak, PhD

Dr. Lesondak is a Community Psychologist with the Chicago Department of Public Health. Her areas of expertise include STDs, HIV, preventive care, public health and community planning, as well as human sexuality and women’s health. Dr. Lesondak was educated at Georgia University in Atlanta.

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