Why MSM Patients Should See an MSM Provider
I always advise gay men to seek healthcare from providers who are also part of the MSM (men who have sex with men) community. Often, they respond by saying, “My doctor is straight, but he’s really good.” However, when patients say their doctor is “really good,” they usually mean that their doctor is kind, charismatic, or engaging—not necessarily that they are highly knowledgeable about MSM-specific healthcare needs. Most patients lack the medical expertise to evaluate whether their doctor is actually providing comprehensive care.
For instance, when I ask MSM patients if they routinely receive oral and anal STI screenings, if they’ve been vaccinated against Hepatitis A, or if they’ve been tested for high-risk anal HPV and discussed the option of an anal Pap smear, the answer is often “No.” This lack of preventative care is a clear indicator that their provider, however “good” they may seem, is not well-versed in MSM health concerns.
This week, I encountered yet another reason why MSM patients should see an MSM provider: the mismanagement of primary syphilis.
Syphilis is significantly more prevalent in the MSM community than in the heterosexual population. Many straight primary care providers have never seen a primary syphilis lesion outside of a textbook. Diagnosing syphilis in its earliest stages is particularly challenging because there is no widely available test for primary lesions—except for dark-field microscopy, a specialized tool that 99.9% of clinics do not have access to. A provider with deep experience in MSM health will recognize a syphilis lesion on sight and treat it immediately to prevent disease progression and further transmission.
The most commonly used syphilis screening test, the RPR (Rapid Plasma Reagin), often fails in the early stages of infection, producing false negatives. This means a doctor relying solely on RPR results may incorrectly rule out syphilis. An MSM-experienced provider, however, understands these limitations and treats based on clinical presentation rather than waiting for unreliable test results.
A Case Study in Misdiagnosis
A friend of mine recently visited a clinic serving the MSM community with a clear primary syphilis lesion. He had a history of syphilis, meaning his RPR test might stay positive indefinitely, even after treatment. In such cases, doctors track RPR titers to distinguish between past and new infections. A rising titer suggests active infection, while a low, stable titer indicates past, resolved infection.
Unfortunately, the provider he saw was unfamiliar with this nuance. Instead of treating the patient on clinical suspicion, he ordered an RPR, which came back negative—expected in early syphilis before the body produces detectable antibodies. The doctor misinterpreted this result and wrongly suspected LGV (lymphogranuloma venereum), another STI that can cause lesions. He prescribed doxycycline, which, while somewhat effective against syphilis, is not the standard first-line treatment.
Weeks later, the lesion worsened. The doctor, confused by the patient’s report of pain (since syphilis chancres are usually painless), ordered another round of testing. By now, the patient’s syphilis was partially treated but still transmissible. When the RPR finally turned weakly positive, the doctor mistook this as evidence of past syphilis rather than a new, untreated infection. The patient was misdiagnosed again, sent to dermatology, and given a steroid cream—completely inappropriate for syphilis treatment.
The patient ultimately came to me for advice. I urged him to return to the clinic and demand proper syphilis treatment. However, by that point, he had unknowingly exposed multiple sexual partners while having an active syphilis chancre for over 45 days. Even when confronted with the request for treatment, the doctor hesitated, insisting that “syphilis lesions aren’t painful.” Fortunately, the patient was finally treated, but only after unnecessary confusion and delay.
Additional Reasons MSM Patients Should See an MSM Provider
Comprehensive Sexual Health Screenings – MSM providers are more likely to perform routine rectal and pharyngeal STI screenings, which many general practitioners overlook.
Up-to-Date Knowledge of MSM-Specific STIs – Conditions like syphilis, HPV-related anal cancer, and Mycoplasma genitalium are more common in MSM and require specialized knowledge.
PrEP & PEP Expertise – MSM providers are more likely to proactively offer and properly monitor PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) for HIV prevention.
Affirming, Non-Judgmental Care – MSM providers understand the nuances of MSM sexual health, mental health, and cultural experiences, leading to more open discussions and better health outcomes.
Understanding of Unique Risk Factors – MSM face higher rates of certain cancers, mental health challenges, and substance use disorders, which experienced providers are more attuned to identifying and managing.
Conclusion
Having a doctor who is “nice” isn’t enough. MSM patients deserve healthcare providers who are knowledgeable about the unique risks, challenges, and preventative measures relevant to their health. Seeing an MSM provider isn’t just about comfort—it’s about ensuring you receive the highest standard of care.
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