Caring for gay men and other men who have sex with men (MSM) in a dermatology settings requires medical knowledge and cultural sensitivity, but few dermatologists have had formal training in caring for this group of patients, according to Ken Katz, M.D., chief of Outpatient Pharmacy and Therapeutics, Kaiser Permanente in San Francisco.
Unfortunately, men who have sex with men often have had negative experiences in health care settings, which can affect subsequent interactions with dermatologists, said Dr. Katz in a presentation made on July 28 at the 2018 AAD Summer Meeting in Chicago.
An estimated 3.6% of men in the United States identify as gay or bisexual , which translates to 2.4 million gay men (2.2%) and 1.5 million bisexual men (1.4%). However, it is important to bear in mind that the sexual orientation someone identifies as refers to the gender(s) they are attracted to, and this might not correlate with their sexual behaviour, Dr. Katz said. “A self-identified gay man might not be sexually active, and a self-identified straight man might have male sexual partners.”
In terms of risk of dermatology-relevant diseases and conditions, gay men and other men who have sex with men are at higher risk of certain infectious diseases, such as HIV and other sexually transmitted diseases, Kaposi sarcoma, invasive meningococcal disease, and Staphylococcus aureus infections. They also have a higher risk of some non-infectious diseases, including skin cancer (and indoor tanning, a risk factor for skin cancer) and, among acne patients, mental health concerns.
As a result of the different epidemiology, preventive health recommendations from the Centers for Disease Control and Prevention (CDC) and other public health agencies differ for sexually active gay men and other men who have sex with men compared with men who have sex only with women.
It is recommended that sexually active men who have sex with men be screened at least annually for HIV (if not known to be living with HIV infection), syphilis, and gonorrhoea and chlamydia (in the urethra, throat, and rectum); receive sexual health-related vaccinations against HPV (through age 26), hepatitis A, hepatitis B, and, (in certain areas) meningococcal disease. Pre-exposure prophylaxis for HIV (PrEP) should also be considered for those meeting CDC criteria. “Dermatologists who are caring for gay men or other men who have sex with men should be aware of those recommendations, make their patients aware, and refer appropriately when needed,” Katz said.
Eliciting a sexual history, when clinically appropriate, can be critical in determining pre-test probability of certain diseases and in making preventive health recommendations, and this needs to be done in “a respectful, non-judgmental way,” Katz said. “Many doctors, including dermatologists, might not be comfortable taking a sexual history, especially for gay men,” he acknowledged, “but practice makes perfect. And often it’s only the doctor who’s uncomfortable; studies show that most patients are comfortable providing a sexual history to their doctors.”
REFERENCE
Katz K. U025 - Taking Care of Gay Men and Other Men Who Have Sex with Men: What the Dermatologist Needs to Know. Saturday, July 28; 4:30 PM - 5:30 PM. AAD Summer Meeting, July 26-29, 2018, Hyatt Regency Chicago, Chicago, IL.
https://www.aad.org/scientificsessions/sam2018/SessionDetails.aspx?id=11953
