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An Ounce of Prevention: Preventative Health Care for Gay Men

By Elizabeth R. Boskey, Ph.D., M.P.H., C.H.E.S.

A lot of gay men spend many hours each week working out their bodies and counting their caloric intake, but only go to the doctor when they're sick. That's not good, because even though it's not nearly as fun as heading to the gym, detecting and preventing disease early is actually one of the most important things you can do to help ensure not only your present, but also your future, health.

Outside of eating right and exercising, preventative health care basically comes in two forms—screening and vaccination. So what kind of preventative health care do you need? It changes as you age. The following information is based on guidelines created by the Agency for Healthcare Research and Quality, the American Cancer Society, and the Centers for Disease Control, and is written for an audience of men ages 20 to 50. Some of these recommendations are specifically for gay and bisexual men; others apply to all men.

Vaccines help to prevent diseases by stimulating your immune system to fight against them. Although most vaccines are given in childhood and provide lifelong protection, there are several vaccines that wear off periodically, are not given until adulthood, or are only used in certain high-risk populations, including gay and bisexual men.

  1. Hepatitis A and B Vaccines: Men who have sex with men are at more than 10 times the risk of acquiring Hepatitis B than the general population. The three-shot hepatitis B vaccine series is recommended for all men who have sex with men, as well as health care workers and several other high-risk groups. The vaccine has been available since 1982, and some scientists are now pushing for routine vaccination of all children and teenagers since, except for individuals with yeast allergies, it is one of the safest vaccines on the market. Many doctors also recommend that gay and bisexual men be vaccinated for Hepatitis A, which is a less serious disease than Hep B but which is also significantly more common in gay and bisexual men than the general population. There is not currently a vaccine for the Hepatitis C virus, also more prevalent in gay and bisexual men.
  2. Tetanus-Diphtheria Vaccine: Most people should get a tetanus vaccine once every 10 years. Since tetanus can be a fatal side effect of even a minor injury, and vaccination has very few side effects, it's well worth your time to stay up to date on your tetanus vaccinations.
  3. Flu Shot: Once you reach the age of 50, doctors recommend that you get a flu shot every single year. Younger men only need to get the flu shot if they suffer from certain chronic health care conditions such as lung disease or heart disease, if they have cancer, if they work in a health care setting, if they are HIV-positive, or if they frequently have close contact with someone who falls into one of those categories. However, there's no reason not to get a flu shot, if you just want to reduce your chances of getting sick.
  4. Pneumonia Vaccine: The pneumonia vaccine is a single shot, but it is not normally recommended for men under age 65 unless they are at high-risk of the disease. Risk factors are essentially the same as for needing earlier flu shots.
Cancer is a terrifying word. However, many cancers are highly treatable, particularly if they are caught early. Cancer screening should not be a daunting prospect, and does not necessarily mean you are at particularly high risk of disease. It's just a way for doctors to detect potential problems while they are still manageable.
  1. Anal/Rectal Cancer: Many anal and rectal cancers are caused by human papillomavirus (HPV), the same virus responsible for most cervical cancers. It is, in other words, a sexually transmitted cancer. Although no nationwide screening guidelines yet exist for anal cancer, if you practice receptive anal sex you should talk to your doctor about whether an anal Pap test may be a good idea for you. Some state guidelines recommend annual anal Pap tests for all men who have sex with men.
  2. Testicular Cancer: Testicular cancer is most often seen in men aged 15 to 39, and is the most common cancer in men aged 25 to 34. Despite this, it is still a relatively rare cancer and regular screening is not generally recommended. Most testicular cancer is found by men during self-examination.
  3. Colon Cancer: In general, testing for colorectal cancer does not start until age 50. However, if you have a history of colon polyps, or colorectal, breast, ovarian, or uterine cancers in your family history, you should talk to your physician about whether you need to begin screening at a younger age, as you may be at higher risk.
  4. Prostate Cancer: Testing for prostate cancer is generally not begun until after age 50, at which point many doctors screen their patients annually. While prostate cancer is common among men (over the course of a lifetime, one in six men will develop it), it is highly treatable if caught early.
Gay or straight, sexually transmitted disease screening should be a regular part of everyone's health care routine. Most sexually transmitted diseases are asymptomatic; however, note that no symptoms does not mean that they may not be having a detrimental effect on your health. Among other potential consequences, STD infections can increase your susceptibility to HIV. Fortunately, the vast majority of STDs, including HIV, can be prevented by practicing safer sex.
  1. HIV: The CDC recently changed its HIV testing guidelines to encourage the adoption of universal testing for all adults ages 13 to 64 during their regular physical exams. The CDC also recommends individuals with multiple partners consider seeking out testing at least once a year, and that people should also be tested for HIV before initiating a new sexual relationship. It goes without saying that gay and bisexual men with multiple partners should be tested regularly so that they know their HIV status.
  2. Gonorrhea and Chlamydia: Although testing for these STDs used to involve an unpleasant swab, many doctors can now test for both gonorrhea and Chlamydia with a simple urine test. That's great, because you should be tested for these diseases at least once a year as well if you are sexually active and have multiple partners, or if you are entering a new sexual relationship—trust us, you'll be glad you didn't pass one of these on to your prospective new boyfriend.
  3. Other STDs: In general, most physicians will not test you for other STDs, such as syphilis; trichomoniasis; hepatitis A, B, and C; and genital herpes, unless you have symptoms or know that you have been exposed. It is worth noting, however, that in recent years syphilis has been on the rise among men who have sex with men, and so some doctors are beginning to implement routine screening for their gay and bisexual patients. In general, be proactive about testing for these diseases if there's any chance you may have been exposed. Testing is easy and can be done by your doctor or at many public and private health clinics.
Heart disease, diabetes, and other chronic diseases are often easiest to treat if they are detected early in their development. The medical community has developed these guidelines for how often individuals need to be tested for these and other common ailments. Yes, many of these may seem like obvious advice, but studies have shown that too many men do no get these important health screenings:
  1. Cholesterol: Men should have their cholesterol checked at least once every five years starting at the age of 35. Individuals at high risk for heart disease, such as smokers, diabetics, and those with a family history of heart disease, may need to be tested earlier or more often.
  2. Blood Pressure: Your blood pressure should be checked at least once every two years. A blood pressure of 140/90 or greater is considered to be high blood pressure.
  3. Diabetes: Although the American Diabetes Association recommends diabetes screening every three years for individuals over the age of 45, most doctors primarily focus on testing those patients who have high blood pressure, high cholesterol, or other risk factors such as obesity.
  4. Dental Care: This one may seem particularly obvious, but visiting your dentist regularly is surprisingly important to maintaining your health as you age, as chronic low-grade infection and inflammation from gum and tooth disease can lead to many other serious health problems throughout your body. Most adults should visit their dentist once or twice a year for a teeth cleaning and gum-disease and tooth-decay check, but also for oral cancer screening if they use tobacco or are otherwise at risk.
  5. Eye Exams: Individuals with vision problems should see their eye doctor every two years. Adults with normal vision do not usually need to go for regular eye exams until they are old enough to undergo glaucoma testing. Talk to your doctor about when you should begin glaucoma testing, since current recommendations for initial testing vary between the ages of 20 to 65 years.
  6. Tuberculosis: Yearly, or biannual, tuberculosis (TB) testing is a fact of life for health care professionals and other individuals who work with high-risk populations. You should also be regularly screened for TB if you are HIV-positive or otherwise immuno-compromised, inject street drugs, live with someone with TB, or were born in a country where the disease is common.