Primary Care for Men who have Sex with Men (MSM)

By NikR | Posted Feb 23 2017 | 5 Comments  
Cover art from Black Man in a White Coat, by Damon Tweedy.

Cover art from Black Man in a White Coat, by Damon Tweedy.

 

As a doctor (who happens to be a longtime Cypher Avenue member), I suppose I should have said something sooner. But I think now is as good time as any.

Primary care is integral to your health. Just like maintenance is important for your car, it’s also important for your body. It’s not good enough to show up when you’re sick- you need to periodically check in with your doctor to anticipate problems you may not even be aware that exists.

For full disclosure, again, I’m a primary care doctor. Yes, I do this for a living. My purpose here is to help you think about optimizing your health and to help you determine where there might be improvements.

Primary care for men who have sex with men (MSM) is like most primary care- preventative. MSM is not a PC term- it describes behavior, not orientation, so it’s more useful.

Before you go to see your doctor, prepare an agenda of issues that you’d like to discuss. This will help guide the interview and possible interventions.

Ideally you should have a doctor (or PA or NP) who is open to you and is not judgmental. I’m one of those people. Yes, I have many gay patients…and even though I’m not out to many of them, I think the word might be out that there might be a young, black, gay male primary doctor who prescribes PrEP and also does home visits. I say this to say, find someone you trust. And if it doesn’t work, ask for a transfer or seek another provider. There are plenty of LGBT or LGBT-friendly clinics around.

These are some of the things I discuss with patients:

*General health, hospital admissions, family history, current medications, allergies.
Social stuff like living situation (is it secure or not?), work life, drug or substance use (smoking increases risk of cancer, alcohol increases risk of cirrhosis, other drugs increase STD risk and dependency).

*Depression and anxiety – both very common with at least 20% of the population experiencing at least one episode in life.

*Fitness, obesity, diabetes, high blood pressure, cholesterol.

*General immunizations like flu and tetanus.

*Age-specific concerns like osteoporosis, vitamin deficiencies, erectile dysfunction (yes, also happens in the 20s!).

Specific MSM Issues

Sex practices – I break it down. Are you top? Bottom? Vers? Using condoms or not? Using drugs during or not? HIV status of partner(s)? Number of recent partner (s). Yes, all uncomfortable questions, but important to ensure we can decrease risk factors. This ends up being a long discussion since I also recommend STI testing and provide education on PrEP and even PEP (pre and post-exposure prophylaxis for HIV prevention).

Intimate partner violence – friends, it happens. We need a plan to keep you safe if it’s happening.

Cancer screening (if necessary) – including prostate, testicular, colon cancer, rectal cancer. Please note that information regarding screening has changed, and generally, NO, you DON’T need an anal pap…unless you are HIV positive.

Immunization Status – Hep A, Hep B, HPV (until 26), bacterial meningitis (everyone)

STI Screening – when done properly, you should have every possible site of exposure tested. So, if you’re an “oral top” (or whatever people call themselves now… ), your penis and throat need to be cultured/tested. Vers dudes need 3 site testing – throat, penis, rectum. For “total bottoms”, 2 sites. This should be done at least every 6 months. For some, every 3-6 months is needed. You’ll also need blood tests for: syphilis, HIV and at least Hep C. Know your status friends!

STI screening is really important since untreated STIs facilitate HIV transmission. So yes, chlamydia increases the possibility of contracting HIV. That’s one reason why the health department calls people to tell them about possible exposures. I can’t stress this enough.

Whew, ok that was a lot. Let me know if you have any questions @NikR

 

 

About the Author
NikR

NikR is a doctor and long time Cypher Avenue reader and contributor.

   
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5 Comments Feel Free To Join The Cypher.

  1. TreDaDon
    TreDaDon | February 24th, 2017
    +1
  2. ControlledXaos
    ControlledXaos | February 24th, 2017
    0
  3. African King
    African King | February 24th, 2017
    0
  4. BlackOnyx1 | February 26th, 2017
    0
  5. takeyourmeds91
    takeyourmeds91 | March 5th, 2017
    0




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