title: Knowledge, attitudes, and practices regarding syphilis screening among men who have sex with men in San Francisco.
abstract: BACKGROUND
  Syphilis screening for men who have sex with men (MSM) in San Francisco (SF) is recommended every 3 to 6 months. We surveyed MSM in SF to determine the prevalence and factors associated with complying with that recommendation, identify screening barriers, and investigate whether identifying low perceived syphilis risk as a reason for not testing correlated with syphilis risk factors.
  
  
  METHODS
  We conducted a cross-sectional survey as part of the National HIV Behavioral Surveillance System. We used logistic regression to analyze factors associated with complying with the SF-specific screening recommendation and with identifying low perceived risk as a reason for not testing. We analyzed data on screening barriers descriptively.
  
  
  RESULTS
  Among 441 MSM, 37.5% (95% confidence interval [CI], 31.5%-43.6%) complied with the recommendation. Compliance was associated with human immunodeficiency virus infection (odds ratio [OR], 3.6; 95% CI, 1.7-7.8), more than 10 male sex partners (OR, 4.3; 95% CI, 1.6-12.0), having unprotected anal sex with a casual partner (OR, 4.2; 95% CI, 2.0-8.9), and knowing the recommendation (OR, 4.1; 95% CI, 2.1-8.2). Low perceived risk, time constraints, and not knowing that one should get screened were identified as reasons for not testing by 61.7%, 18.9%, and 18.8%, respectively. Identifying low perceived risk as a reason for not testing was associated with having more than 10 sex partners (OR, 0.2; 95% CI, 0.1-0.5).
  
  
  CONCLUSIONS
  Attempts to improve compliance with the syphilis screening recommendation should include education regarding recommended screening frequency and syphilis risk factors and interventions to increase screening convenience.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Katz
authors.forename: Henry Fisher
authors.initials: HF
authors.lastname: Raymond
authors.forename: Kyle T
authors.initials: KT
authors.lastname: Bernstein
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
mesh_terms: D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012495:San Francisco / Q000453:epidemiology; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors