title: Syphilis Experiences and Risk Perceptions Among Repeatedly Infected Men Who Have Sex with Men.
abstract: BACKGROUND
  In urban areas of the United States, syphilis is a major public health issue for men who have sex with men, despite widespread efforts to curtail a growing epidemic; repeated infections are not uncommon in this population. The ways that men who have sex with men experience and conceptualize syphilis, and how their attitudes and beliefs impact their risk for infection, are poorly understood.
  
  
  METHODS
  In-depth interviews were conducted in 2010-2011 with 19 Los Angeles County men aged 21-54 who reported having male sex partners and had had two or more early syphilis infections within the previous five years. Interview transcripts were analyzed inductively to uncover themes.
  
  
  RESULTS
  Participants had considerable knowledge about syphilis symptoms, transmission and consequences, and most felt that syphilis was a highly stigmatized disease. They had had 2-5 infections in the past five years, and the majority believed they were at risk for another infection because of their sexual risk behaviors. Many had a sense of fatalism about being infected again, and some expressed that this possibility was an acceptable part of being sexually active. Concern about syphilis often decreased as men experienced more infections. Most participants reported short-term sexual behavior changes after a syphilis diagnosis to prevent transmission; however, few were willing to make long-term behavior changes.
  
  
  CONCLUSIONS
  Additional qualitative studies of men who have sex with men should be conducted to better understand the continuing syphilis epidemic and to help identify the most promising intervention strategies.
authors.affiliation: Research analyst, research and program evaluation, at the Sexually Transmitted Disease Program, Los Angeles County Department of Public Health. aaron@sentientresearch.net.
authors.forename: Aaron
authors.initials: A
authors.lastname: Plant
authors.affiliation: Doctoral candidate, Department of Epidemiology, University of California, Los Angeles (UCLA).
authors.forename: Shauna
authors.initials: S
authors.lastname: Stahlman
authors.affiliation: Associate professor, Department of Epidemiology, UCLA.
authors.forename: Marjan
authors.initials: M
authors.lastname: Javanbakht
authors.affiliation: Disease intervention specialist supervisor, at the Los Angeles Gay and Lesbian Center.
authors.forename: Johnny
authors.initials: J
authors.lastname: Cross
authors.affiliation: Director of communications, research and program evaluation, at the Sexually Transmitted Disease Program, Los Angeles County Department of Public Health.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Montoya
authors.affiliation: Medical director, at the Los Angeles Gay and Lesbian Center.
authors.forename: Robert
authors.initials: R
authors.lastname: Bolan
authors.affiliation: Acting director, Tuberculosis Control Program, Los Angeles County Department of Public Health.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kerndt
mesh_terms: D000328:Adult; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012747:Sexual Partners / Q000523:psychology; D013587:Syphilis / Q000523:psychology* / Q000635:transmission; D055815:Young Adult