Same-Sex Relationships

by Michael_Koger

The medical management of men who have sex with men (MSM) requires regular health screening as well as other approaches to disease control.

The co-occurrence of a sexually transmitted infection and human immunodeficiency virus (HIV) in same-sex relationship clients can be complex as these medical conditions tend to interact with each other. For example, viral hepatitis will infect some of these patients, and blood tests to identify its presence as well as other preventive measures are essential [1].

In fact, it is common for HIV to occur in patients who have gonorrhea, syphilis, chlamydia, trichomonas, or genital herpes. Since the medications to treat any of these will vary with the disease, their use with antiretroviral agents for HIV will pose concerns about drug interactions as well as side effects the patient will experience.

Viral Hepatitis

Vaccination is available for hepatitis A and B, and it is desirable to recommend that for patients who engage in risky sex and who have never had those illnesses.  There is no vaccine for hepatitis C, however, and though most cases of that infection are the result of injection drug use in which individuals share needles or syringes, it can also spread sexually.  All three forms of viral hepatitis transmit via contact with blood and body fluids [1].

Nevertheless, sexual transmission of hepatitis C is most likely to take place in MSM who are HIV-positive [1].  It especially occurs in those clients who have multiple sexual partners and who engage in unprotected anal sex [1].

Hepatitis A infection transmits via fecal-oral contact, and this places MSM who practice oral-anal sex at risk for its acquisition [1].

Other Vaccines

The use of human papillomavirus vaccine is also beneficial in these clients as it transmits through skin-to-skin contact between sexual partners.  The United States Food and Drug Administration has approved a new version of this vaccine which covers nine forms of the virus responsible for this condition [1].

Men who have sex with men have a risk of anal cancer which is 30 times higher than it is in heterosexual men.  Many physicians routinely recommend anal cytological screening for these clients.  Additionally, use of human papillomavirus vaccine can reduce the occurrence of precancerous tissue change in the anus [1].

Some MSM have acquired meningococcal meningitis, and vaccination has been useful for them.  Recommendation for its use to prevent this serious illness, however, will vary with the geographic area of the country [1].


The presence of more than one sexually transmitted infection, in men or in women, poses a medically-challenging situation particularly if HIV is present.  This may be because HIV weakens the immune system and makes it difficult to manage other diseases which co-exist.


  1. Wilkin, T.  (2015). Primary care for men who have sex with men.  New England Journal of Medicine, 373, 854-862.
  2. The photo shows a library at the Centers for Disease Control and is reprinted with permission from that organization.


The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 01/09/2016, Michael_Koger
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