LGBT culture–trained
STD physician NYC*

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All patients seen by a doctor

*competency training
geared toward the MSM/LGBTQ community

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AT A GLANCE

Recommended preventative vaccines for LGBT community

Hepatitis A

(Two shots, 6 months to a year apart. Protection lasts at least 25 years.)
Hepatitis B

(Three shots at day 0, 1 month, and 6 months. Protection lasts at least 25 years)
HPV (Gardasil)

(Three shots at day 0, 2 months, and 6 months. Protection lasts a lifetime.)

How often to get tested?

Yearly
Every 3–6 months for people with multiple partners or partners who are strangers

What needs to be tested?

HIV
Syphilis
Urine for chlamydia and gonorrhea if you’ve had insertive rectal sex (were “top”)
Rectum for chlamydia and gonorrhea if you’ve had receptive rectal sex (were “bottom”)
Oral area for gonorrhea if you’ve given oral sex
Hepatitis C
Hepatitis BsAg

FAQs on testing

The risk of contracting HIV, gonorrhea, syphilis, and genital herpes is higher for homosexual people, especially for men who have sex with men. Dr. Fuzayloff, an experienced and LGBT culture–trained STD doctor from NYC, will answer the most commonly asked questions and questions relevant to the LGBT community here.

How is STD testing different for LGBT persons?
Testing recommendations for members of the LGBT community are different in the following ways:
- More frequent STD testing is necessary for most people for these reasons:
  - Higher prevalence of STDs
  - The type of sex practiced (rectal sex is 18 times riskier for HIV acquisition)
  - More lifetime sex partners
  - More casual sex
- Rectal and oral swabs for chlamydia and gonorrhea are often necessary
  Both chlamydia and gonorrhea stay in the part of the body contacted during sex, so a negative test of one body part (e.g., the penis or vagina) does not rule out gonorrhea in another body part (e.g., the mouth or rectum). So, in addition to routine urine and vaginal swab tests, rectal and oral swab testing is necessary.
- Some STDs are preventable through vaccination, which is encouraged in the homosexual community
  - Hepatitis A
  - Hepatitis B
  - HPV
How often should LGBT persons be tested for STDs?
STD testing frequency in the LGBT community depends on how active the person is:
- All sexually active gay, bisexual, and transgender persons should be tested at least once a year.
- Homosexual males who have multiple or anonymous partners should be tested every 3–6 months.
HIV/AIDS
Many men who have sex with men (MSM) are at higher risk of HIV infection—42% of all newly diagnosed HIV infections are in MSM.
How long after potential exposure should HIV testing be done?
Different types of HIV tests should be done at different times:
- The ultrasensitive HIV RNA PCR test used for early detection can be done 5 days after exposure
- The HIV RNA PCR test can be done 10 days after exposure
- The HIV fourth-generation test (Ab/Ag) can be done as early as 13 days after exposure
- The HIV third-generation test (Ab) can be done as early as 22 days after exposure
What reduces the chance of getting HIV?
The rate of HIV transmission has decreased because more people are following these practices, which are recommended:
- Safe sex
- Preexposure prophylaxis (PrEP) — effective as soon as 7 days after starting the medication
- Post-exposure prophylaxis (PEP)—should be initiated within 72 hours of risky exposure
Syphilis
The number of newly diagnosed syphilis cases is going up. This disease primarily occurs in men who have sex with men.
How long after potential exposure should syphilis testing be done?
Different types of tests need to be done at different times:
- RPR: 2–3 weeks after exposure
- VDRL: 3–6 weeks after exposure
- FTA-ABS: 3–4 weeks after exposure
- TPPA: 3–4 weeks after exposure
Gonorrhea

The prevalence of gonorrhea is increasing in men who have sex with men. An oral reservoir of gonorrhea and having unprotected oral sex may be the reason. Half of people with gonorrhea have chlamydia at the same time.
How is gonorrhea testing different?
Unlike other infections, after gonorrhea is acquired through physical contact with an infected person, it remains where the contact occurred. Therefore, even with a negative test of one body part, a person could have gonorrhea in another part of the body. Testing is needed of all parts of the body that came into contact with the infected person’s body and that are capable of being infected with gonorrhea.

Both males and females can have urine and urethral tests, while vaginal swab testing is, of course, done on females. If oral sex was involved in the suspected exposure, the person who “gave” oral sex should have throat swab testing. If anal sex was involved, the person who “received” it should have anal swab testing.
HSV-2, or “genital herpes”
Higher rates of HSV-2 infection are found in homosexual people. And herpes virus sores make people more susceptible to HIV infection.
Herpes testing types:
If you don’t have symptoms, only an IgG blood test can be done:
- 3 weeks after exposure: 50% accuracy
- 6 weeks after exposure: 70% accuracy
- 12 weeks after exposure: 92% accuracy
If you have symptoms:
- When the first blisters appear, a swab test can be done
- For a swab test to be done, a sample must be collected from a herpes lesion. The window of time to collect a sample is very short, so testing should not be delayed.
Who should get an anal Pap smear test?
There are no national guidelines regarding anal PAP smear testing. Some medical societies advise high-risk people who belong to one of these groups to this test:
- People who “receive” anal intercourse
- People with genital warts
- HIV-positive people
- Patients with immunosuppressive conditions or who are taking medication that suppresses the immune system
- People who have been diagnosed with high-risk HPV anywhere (e.g., vaginally)
For anyone whose anal Pap smear test is abnormal, a high-resolution anal anoscopy is recommended.
How often should an anal PAP smear be done?
Anal Pap smear recommendations for males:
- HIV negative: every 2–3 years
- HIV positive: yearly

LGBT Vaccinations FAQs

What should I know about hepatitis immunization?
- Hepatitis, or liver damage, can be caused by hepatitis A, hepatitis B, or hepatitis C virus. These viral infections can be fatal or lead to very serious long-term issues such as liver cancer.
- Most men who have sex with men are at high risk for hepatitis A and hepatitis B. Preventative vaccination is available, but most men are not vaccinated.
- Hepatitis vaccination is recommended for all men who have sex with men.
- There is no vaccine for hepatitis C; the only effective method of protection is safe sex. But a new effective treatment for hepatitis C does exist.
Hepatitis A vaccination schedule
Two shots (6 months to a year apart) provides protection for at least 25 years
Hepatitis B vaccination schedule
Three shots (day 0, 1 month, and 6 months) provide protection for at least 25 years

What information is available about HPV vaccination?
What are the statistics regarding contracting HPV chance and anal cancer?
- The chance that men having sex with men will contract HPV is around 60%–75%.
- Most HPV infections are benign and cleared by the immune system over time, but very small portion of them (the malignant type) can cause anal cancer.
- Anal cancer is not a common type of the cancer, but men having sex with men are 80 times more likely to get it than others are.
- Most anal cancers are due to HPV 16 and 18 (Gardasil vaccine protects against them)
- The HPV vaccine (Gardasil) prevents people from contracting the most common types—but not all—of HPV viruses, both benign and malignant.
HPV vaccine schedule
Ideally the HPV vaccine should be obtained at age 11 or 12 (before becoming sexually active).

Gardasil schedule:
- Age 11 or 12: 2 shots provide long-term protection
- Ages 13–26: 3 shots provide long-term protection
- Gardasil vaccine is advised for everyone of any age who “receives” anal receptive sex (is “bottom”). Three shots provide partial immunity.
Who should get vaccinated against HPV at a later age?
- HPV vaccination at a later age is referred to as a “catch-up” vaccination. The vaccine is less effective after a person becomes sexually active because of the potential for contracting HPV with each exposure. Most sexually active people are exposed to one or more HPV types, not all of which are targeted by vaccination.
- Ideally, HPV vaccination should be done before the beginning of sexual activity.
- HPV vaccination is not recommended for all adults over the age of 26.
- Instead, HPV vaccination is clinically recommended based on the need for the vaccine. These are the groups of people who should consider getting it at any age:
  - Men having sex with men
  - People with multiple sex partners
  - HIV patients
Should I be vaccinated against HPV-9 if I have been vaccinated against HPV 4 or HPV-2?
Routine HPV 9 vaccination for people who have been immunized against other HPV vaccine types is not recommended. It is, however, recommended to certain groups of people:
- Men having sex with men
- People with multiple sex partners
- HIV patients
Am I protected if I have an incomplete HPV vaccine series?
The chance of acquiring HPV after 1 dose of the vaccine (instead of the recommended 3) is significantly less. But there is not enough clinical evidence, as of now, to conclude that one dose is sufficient.

People in the following groups should start the recommended vaccine dosing schedule from the beginning:
- Men having sex with men
- People with multiple sex partners
- HIV patients
What is the benefit of HPV vaccination after having genital warts?

Ninety percent of all genital warts are type 6 or 11. Most people are infected with one or the other of these serotypes. Vaccination will help prevent infection with an HPV serotype a person has not already acquired. Therefore, vaccination will be recommended to some people who are members of high-risk groups even after they have been treated for visible genital warts.