Special dermatologic needs for men who have sex with men

Kenneth A. Katz, M.D., M.Sc., M.S.C.E., a dermatologist in San Francisco, occasionally finds himself asking male patients about their sex lives: Do they have intercourse with men? What about multiple partners? Condom use?

He has both their skin health and their overall health in mind. According to him, men who have sex with men-a category that includes gay and bisexual men-face unique risks of skin conditions because they’re more likely to suffer from HIV and other sexually transmitted diseases.

“Sexual orientation doesn’t put someone at risk,” he tells Dermatology Times in an interview prior to making a presentation at the summer meeting of the American Academy of Dermatology in Boston. “But behavior linked to these conditions does.”

Dr. Katz is presenting “Taking Care of Gay Men and Other Men Who Have Sex with Men: What the Dermatologist Needs to Know.”

“Dermatologists should appreciate that men who have sex with men are at higher risk of HIV and other sexually transmitted diseases,” he says. According to him, more than 80% of 20,000 syphilis cases in the United States were in gay and bisexual men, as were 75% of 45,000 new HIV cases.

These men also face higher risks of skin cancer, MRSA and meningococcemia, a rare bacterial infection. Earlier this summer, health officials reported an outbreak of meningococcemia in Southern California among gay and bisexual men; one man died. Other outbreaks have been reported over the past two years in the Chicago, Los Angeles and New York City areas.

Dr. Katz urges dermatologists to look for these signs that could indicate sexually transmitted diseases:

• Rashes or sores in the genital and perineal areas are a possible sign of syphilis or meningococcemia. In addition, he says, “a full body rash can be a manifestation of acute HIV infection and is a hallmark of secondary syphilis.”

• Purpuric lesions, non-blanching spots of blood that escaped the blood vessels under the skin, can be a sign of meningococcemia, among other diseases.

• Spots on the soles and palms are a hallmark of secondary syphilis.

How can a dermatologist sensitively bring up a patient’s sexual history when his or her condition suggests a possible link to an STD?

Dr. Katz says something like this: “I ask all my patients with a rash like yours some sensitive questions about their sexual history because it’s important to my care for you. Is that OK with you?”

If the patient agrees, he says, “then I’ll ask in a straightforward and nonjudgmental way: Are you sexually active? What are the genders of your sex partner or partners? What’s your HIV and sexually transmitted disease status? How frequently do you use condoms during sex? What’s your vaccination history?”

Keep in mind, Dr. Katz says, that gay and bisexual men often haven’t felt comfortable discussing their sexual history with physicians.  

Disclosure: Dr. Katz reports no relevant disclosures.