Members of the LGBTQ+ community include people who are:

• Lesbian
• Gay
• Bisexual
• Transgender
• Queer or Questioning
• Elsewhere on the gender and sexuality spectrum or allies to the community

On this page you'll find information about health issues that are specific to the LGBTQ+ community.

Understanding LGBT Health

In order to effectively address LGBT health issues, we need to securely and consistently collect SOGI information in national surveys and health records. This will allow researchers and policy makers to accurately characterize LGBT health and disparities.

Understanding LGBT health starts with understanding the history of oppression and discrimination that these communities have faced. For example, in part because bars and clubs were often the only safe places where LGBT individuals could gather, alcohol abuse has been an ongoing problem.

Social determinants affecting the health of LGBT individuals largely relate to oppression and discrimination. Examples include:

• Legal discrimination in access to health insurance, employment, housing, marriage, adoption, and retirement benefits
• Lack of laws protecting against bullying in schools
• Lack of social programs targeted to and/or appropriate for LGBT youth, adults, and elders
• Shortage of health care providers who are knowledgeable and culturally competent in LGBT health

The physical environment that contributes to healthy LGBT individuals includes:

• Safe schools, neighborhoods, and housing
• Access to recreational facilities and activities
• Availability of safe meeting places
• Access to health services

LGBT health requires specific attention from health care and public health professionals to address a number of disparities, including:

• LGBT youth are 2 to 3 times more likely to attempt suicide.
• LGBT youth are more likely to be homeless.
• Lesbians are less likely to get preventive services for cancer.
• Gay men are at higher risk of HIV and other STDs, especially among communities of color.
• Lesbians and bisexual females are more likely to be overweight or obese.
• Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
• Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
• LGBT populations have the highest rates of tobacco, alcohol, and other drug use.

Continuing Issues in LGBT Health

A number of issues will need to continue to be evaluated and addressed over the coming decade, including:

• Nationally representative data on LGBT Americans
• Prevention of violence and homicide toward the LGB community, and especially the transgender population
• Resiliency in LGBT communities
• LGBT parenting issues throughout the life course
• Elder health and well-being
• Exploration of sexual/gender identity among youth
• Need for a LGBT wellness model
• Recognition of transgender health needs as medically necessary

Many terms are associated with sexual and gender identities, and terminology continues to evolve. Below are some of the terms currently used by the Division of Adolescent and School Health. This list and the definitions offered may change over time.

• Bisexual: A person who is attracted to both people of their own gender and other genders.
• Cisgender: Individuals whose current gender identity is the same as the sex they were assigned at birth.
• Gay: A person who is attracted primarily to members of the same gender. Gay is most frequently used to describe men who are attracted primarily to other men, although it can be used for men and women.
• Gender: The cultural roles, behaviors, activities, and attributes expected of people based on their sex.
• Gender Expression: How an individual chooses to present their gender to others through physical appearance and behaviors, such as style of hair or dress, voice, or movement.
• Gender Identity: An individual’s sense of their self as man, woman, transgender, or something else.
• Gender Minority: Individuals whose gender identity (man, women, other) or expression (masculine, feminine, other) is different from their sex (male, female) assigned at birth.
• Gender Nonbinary: Individuals who do not identify their gender as man or woman. Other terms to describe this identity include genderqueer, agender, bigender, gender creative, etc.
• Gender Nonconforming: The state of one’s physical appearance or behaviors not aligning with societal expectations of their gender (a feminine boy, a masculine girl, etc.).
• Heterosexual or Straight: A man who is primarily attracted to women or a woman who is primarily attracted to men.
• Intersex: Persons with variations in physical sex characteristics, including variations in anatomy, hormones, chromosomes or other traits, that differ from expectations generally associated with male and female bodies.
• Lesbian: A woman who is primarily attracted to other women.
• LGBTQ: Acronym that refers to the lesbian, gay, bisexual, transgender, and queer/questioning community.
• Queer: An umbrella term sometimes used to refer to the entire LGBT community.
• Questioning: For some, the process of exploring and discovering one’s own sexual orientation, gender identity, or gender expression.
• Sex: An individual’s biological status as male, female, or something else. Sex is assigned at birth and associated with physical attributes, such as anatomy and chromosomes.
• Sexual Minority: Individuals who identify as gay, lesbian, or bisexual, or who are attracted to or have sexual contact with people of the same gender.
• Sexual Orientation: Refers to a person’s sexual and emotional attraction to another person and the behavior and/or social affiliation that may result from this attraction (lesbian, gay, bisexual, etc.)
• SGM: Acronym for sexual and gender minorities.
• SGMY: Acronym for sexual and gender minority youth.
• SMY: Acronym for sexual minority youth.
• Transgender: Individuals whose current gender identity differs from the sex they were assigned at birth.

Transgender is an umbrella term for persons whose gender identity or expression (masculine, feminine, other) is different from their sex (male, female) at birth. Gender identity refers to one’s internal understanding of one’s own gender, or the gender with which a person identifies. Gender expression is a term used to describe people’s outward presentation of their gender.

Gender identity and sexual orientation are different facets of identity. Everyone has a gender identity and a sexual orientation, but a person’s gender does not determine a person’s sexual orientation. Transgender people may identify as heterosexual, homosexual, bisexual, or none of the above.

Sexual orientation and gender identity/expression are important aspects of a young person’s identity. Understanding and expressing sexual orientation and gender and developing related identities are typical development tasks that vary across children and youth. For example, some youth may be unsure of their sexual orientation, whereas others have been clear about it since childhood and have expressed it since a young age. Expressing and exploring gender identity and roles is a part of normal development. The process of understanding and expressing one’s sexual orientation and gender identity is unique to each individual. It is not a one-time event and personal, cultural, and social factors may influence how one expresses their sexual orientation and gender identity.

There is currently no universally-accepted acronym inclusive of all youth who are not heterosexual and/or express their gender in diverse ways. The commonly-used acronym — LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity) — refers to the communities included in the “LGBTTTQQIAA” acronym (see Figure 1). This youth topic primarily uses “LGBTQ+” as an inclusive term for simplicity, except when describing research studies explicitly focused on more narrowly-specific communities.

Figure 1: Communities included in the “strong LGBTTTQQIAA” acronym

Resiliency and Protective Factors

Research on LGBTQ+ youth has focused on the risk factors and disparities these young people experience compared with youth who are not LGBTQ+. However, more recently there has been research on resiliency and protective factors, which offers a strength-based focus on LGBTQ+ youth well-being. For instance, LGBTQ+ youth who have access to spaces that affirm their sexual orientation and gender identity report lower rates of attempting suicide and experiencing supportive environments.

Several factors that can help improve outcomes for LGBTQ+ young people include:

• Addressing LGBTQ+-related stigma, discrimination, and violence
• Building on the strengths of LGBTQ+ youth
• Fostering supports such as family acceptance and safe, affirming environments in schools and other settings

Federal and local policies and practices increasingly acknowledge and focus on the experiences and needs of LGBTQ+ youth. Numerous national advocacy and other organizations are also giving greater attention to LGBTQ+ youth in their work. Fostering safe, affirming communities and youth-serving settings such as schools for all youth requires efforts to address the challenges described here. At the same time, it is also important to acknowledge and build on the strengths, resilience, and factors that protect LGBTQ+ youth from risk, such as connection to caring adults and peers and family acceptance. Parental support of sexual orientation and gender expression provide uniquely strong benefits to positive well-being and mental health in young adulthood and are related to higher levels of self-esteem and lower levels of depression, suicidal ideation, and suicide attempts.

Young people who identify as LGBTQ+ can experience various challenges because of how others respond to their sexual orientation or gender identity/expression. This is also true for youth who are questioning their sexual orientation or gender identity, or may be perceived as LGBTQ+ or gender variant by others.In a 2021 survey of nearly 35,000 LGBTQ+ youth, 75 percent reported having experienced discrimination based on their sexual orientation or gender identity at least once in their lifetime. These negative experiences include high rates of physical and emotional bias and violence; rejection by schools, employment, and communities because of their sexual orientation and/or gender identity/expression.

Research shows that due to these challenges and the associated stress, LGBTQ+ youth are at risk for negative health outcomes and are more likely to attempt suicide, experience homelessness, and use illegal drugs These issues may also contribute to anxiety, depressive symptoms, and feelings of isolation. Youth who express their gender in ways that vary from societal expectations for their perceived sex or gender are at risk for high levels of childhood physical, psychological, and sexual abuse. They are also at risk for school victimization. As a result, they may have poorer well-being than lesbian, gay, and bisexual peers whose gender expression is more closely aligned with societal expectations.

Though Two-Spirit may now be included in the umbrella of LGBTQ, The term "Two-Spirit" does not simply mean someone who is a Native American/Alaska Native and gay.

Traditionally, Native American two-spirit people were male, female, and sometimes intersexed individuals who combined activities of both men and women with traits unique to their status as two-spirit people. In most tribes, they were considered neither men nor women; they occupied a distinct, alternative gender status. In tribes where two-spirit males and females were referred to with the same term, this status amounted to a third gender. In other cases, two-spirit females were referred to with a distinct term and, therefore, constituted a fourth gender. Although there were important variations in two-spirit roles across North America, they shared some common traits:

• Specialized work roles. Male and female two-spirit people were typically described in terms of their preference for and achievements in the work of the "opposite" sex or in activities specific to their role. Two-spirit individuals were experts in traditional arts - such as pottery making, basket weaving, and the manufacture and decoration of items made from leather. Among the Navajo, two-spirit males often became weavers, usually women and men's work, as well as healers, which was a male role. By combining these activities, they were often among the wealthier members of the tribe. Two-spirit females engaged in activities such as hunting and warfare, and became leaders in war and even chiefs.
• Gender variation. A variety of other traits distinguished two-spirit people from men and women, including temperament, dress, lifestyle, and social roles.
• Spiritual sanction. Two-spirit identity was widely believed to be the result of supernatural intervention in the form of visions or dreams and sanctioned by tribal mythology. In many tribes, two spirit people filled special religious roles as healers, shamans, and ceremonial leaders.
• Same-sex relations. Two-spirit people typically formed sexual and emotional relationships with non-two-spirit members of their own sex, forming both short- and long-term relationships. Among the Lakota, Mohave, Crow, Cheyenne, and others, two-spirit people were believed to be lucky in love, and able to bestow this luck on others.

Most Indigenous communities have specific terms in their own languages for the gender-variant members of their communities and the social and spiritual roles these individuals fulfill; with over 500 surviving Native American cultures, attitudes about sex and gender can be very diverse. Even with the modern adoption of pan-Indian terms like Two-Spirit, not all cultures will perceive two-spirit people the same way, or welcome a pan-Indian term to replace the terms already in use by their cultures.

The disruptions caused by conquest and disease, together with the efforts of missionaries, government agents, boarding schools, and white settlers resulted in the loss of many traditions in Native communities. Two-spirit roles, in particular, were singled out for condemnation, interference, and many times violence. As a result, two-spirit traditions and practices went underground or disappeared in many tribes.

Today, lesbian, gay, bisexual, and transgender native people throughout North America are reviving the two-spirit role and its traditions. National gatherings of two-spirit people have been held since the early 1990s, and regional gatherings are held in many parts of the country.

Most lesbian, gay, bisexual, (LGB) youth are happy and thrive during their adolescent years. Having a school that creates a safe and supportive learning environment for all students and having caring and accepting parents are especially important. Positive environments can help all youth achieve good grades and maintain good mental and physical health. However, some LGB youth are more likely than their heterosexual peers to experience negative health and life outcomes.

For youth to thrive in schools and communities, they need to feel socially, emotionally, and physically safe and supported. A positive school climate has been associated with decreased depression, suicidal feelings, substance use, and unexcused school absences among LGB students.

Experiences with Violence

Compared with other students, negative attitudes toward LGB persons may put these youth at increased risk for experiences with violence. ‘Violence’ can include behaviors such as bullying, teasing, harassment, and physical assault.

According to data from the 2015 national Youth Risk Behavior Survey (YRBS), of surveyed LGB students:

• 10% were threatened or injured with a weapon on school property
• 34% were bullied on school property
• 28% were bullied electronically
• 23% of LGB students who had dated or went out with someone during the 12 months before the survey had experienced sexual dating violence in the prior year
• 18% of LGB students had experienced physical dating violence
• 18% of LGB students had been forced to have sexual intercourse at some point in their lives.

Effects on Education and Mental Health

Exposure to violence can have negative effects on the education and health of any young person and may account for some of the health-related disparities between LGB and heterosexual youth. According to the 2015 YRBS, LGB students were 140% (12% v. 5%) more likely to not go to school at least one day during the 30 days prior to the survey because of safety concerns, compared with heterosexual students. While not a direct measure of school performance, absenteeism has been linked to low graduation rates, which can have lifelong consequences.

A complex combination of factors can impact youth health outcomes. LGB youth are at greater risk for depression, suicide, substance use, and sexual behaviors that can place them at increased risk for HIV and other sexually transmitted diseases (STDs).Nearly one-third (29%) of LGB youth had attempted suicide at least once in the prior year compared to 6% of heterosexual youth. In 2014, young gay and bisexual men accounted for 8 out of 10 HIV diagnoses among youth.

What Schools Can Do

Schools can implement evidence-based policies, procedures, and activities designed to promote a healthy environment for all youth, including LGB students. For example, research has shown that in schools with LGB support groups (such as gay-straight alliances), LGB students were less likely to experience threats of violence, miss school because they felt unsafe, or attempt suicide than those students in schools without LGB support groups. A recent study found that LGB students had fewer suicidal thoughts and attempts when schools had gay-straight alliances and policies prohibiting expression of homophobia in place for 3 or more years.

To help promote health and safety among LGB youth, schools can implement the following policies and practices (with accompanying citations)

• Encourage respect for all students and prohibit bullying, harassment, and violence against all students.
• Identify “safe spaces”, such as counselors’ offices or designated classrooms, where LGB youth can receive support from administrators, teachers, or other school staff.
• Encourage student-led and student-organized school clubs that promote a safe, welcoming, and accepting school environment (e.g., gay-straight alliances or gender and sexuality alliances, which are school clubs open to youth of all sexual orientations and genders).
• Ensure that health curricula or educational materials include HIV, other STD, and pregnancy prevention information that is relevant to LGB youth (such as ensuring that curricula or materials use language and terminology.
• Provide trainings to school staff on how to create safe and supportive school environments for all students, regardless of sexual orientation or gender identity, and encourage staff to attend these trainings.
• Facilitate access to community-based providers who have experience providing health services, including HIV/STD testing and counseling, social, and psychological services to LGBTQ+ Youth.

What Parents Can Do

Positive parenting practices, such as having honest and open conversations, can help reduce teen health risk behaviors. How parents engage with their LGB teen can have a tremendous impact on their adolescent’s current and future mental and physical health. Supportive and accepting parents can help youth cope with the challenges of being an LGB teen. On the other hand, unsupportive parents who react negatively to learning that their daughter or son is LGB can make it harder for their teen to thrive. Parental rejection has been linked to depression, use of drugs and alcohol, and risky sexual behavior among teens.

To be supportive, parents should talk openly and supportively with their teen about any problems or concerns. It is also important for parents to watch for behaviors that might indicate their teen is a victim of bullying or violence―or that their teen may be victimizing others. If bullying, violence, or depression is suspected, parents should take immediate action, working with school personnel and other adults in the community.

Ways Parents Can Influence the Health of Their LGB Youth

More research is needed to better understand the associations between parenting and the health of LGB youth. The following are research-based steps parents can take to support the health and well-being of their LGB teen:

Talk and listen.

Parents who talk with and listen to their teen in a way that invites an open discussion about sexual orientation can help their teen feel loved and supported. Parents should have honest conversations with their teens about sex and how to avoid risky behaviors and unsafe situations.

Provide support.

Parents who take time to come to terms with how they feel about their teen’s sexual orientation will be more able to respond calmly and use respectful language. Parents should develop common goals with their teen, including being healthy and doing well in school.

Stay involved.

Parents who make an effort to know their teen’s friends and know what their teen is doing can help their teen stay safe and feel cared about.

Be proactive.

Parents can access many organizations and online information resources to learn more about how they can support their LGB teen, other family members, and their teen’s friends.

Sexual minority youth (SMY) refers to youth who identify as lesbian, gay, or bisexual (LGB), who are not sure of their sexual identity, or who have any same sex partners. CDC’s 2017 Youth Risk Behavior Survey data show substantial health disparities that exist among an estimated 2.6 million sexual minority students, placing them at risk for negative health outcomes, including HIV infection and other sexually transmitted diseases (STDs).

Students who have sexual contact with both sexes are at higher risk than students with only same-sex sexual contact for multiple sexual risk behaviors.

Many LGBTQ youth thrive during adolescence, but, stigma, discrimination, and other factors put them at increased risk for negative health and life outcomes. CDC works with education and public health partners to address health risks and disparities among LGBTQ youth. Together, we can improve the health and lives of sexual minority youth so they achieve their social, emotional, and academic potential.

Compared to their heterosexual peers, sexual minority students are more likely to have:

Transgender and other gender diverse youth experience stigma and discrimination that put them at increased risk for poor mental health and suicide, substance use, experiencing violence, risky sexual behaviors, and other health risks.

Yet, adolescents are resilient. Quality sexual health education, access to health care services, and safe and supportive environments can help all youth thrive in the face of risk and are critically important for transgender and other gender diverse youth.

Understanding the experience of transgender youth will help improve school environments, parental relationships, health services, and sexual health education and help to create more supportive environments for transgender youth.

Key Findings

School Environments

• Transgender youth report feeling isolated and excluded in school environments.
• Transgender youth express resilience by actively coping with these stressors through advocating for their needs and seeking out (and finding) connection with supportive staff and friends.

Sexual Health Education

• Transgender youth consider school-based sexual health education unhelpful due to a lack of relevant information, inadequately trained teachers, and a perceived negative tone toward sexuality.
• Transgender youth rely upon alternate sources of sexual health information, particularly online, where they found relevant information and a sense of community.

Parental Relationships

• Transgender youth report receiving parental support generally in the form of housing, advice, affirmation, and expressions of love or caring.
• Transgender youth report parents struggled to provide support specific to their gender identity, such as
  • being emotionally supportive when youth came out to their parents as transgender,
  • chosen name and pronoun usage, and
  • assistance with social, legal, and medical gender affirmation processes.

Health Services

• Transgender youth report facing challenges to accessing culturally competent and gender affirming health care, such as a lack of provider knowledge of transgender issues and inconsistent use of chosen name and pronouns.

Significance for Schools, Parents, and Healthcare Providers

We all have a role in supporting transgender youth.

Schools can:

• Review and implement policies and practices to ensure inclusivity,
• Take steps to affirm gender identity,
• Intervene in bullying on campus, and
• Provide or refer students to comprehensive, affirming, sexual health services.

Parents can:

• Seek out resources and programming to assist with understanding, accepting, and gender-affirming behaviors.

Healthcare providers and office staff can:

• Take part in transgender cultural competency trainings, and
• Establish clinic protocols relating to confidentiality and chosen name and pronoun use.

Resilience and Transgender Youth Project Overview

CDC worked with and funded ICF (a research and evaluation firm) to design and implement the Resilience and Transgender Youth Project in order to better understand the lives of transgender adolescents and young adults.

Racially diverse transgender youth and parents of transgender youth participated in interviews and focus groups over a three-year time period. In these conversations, they discussed their definitions of gender and health, as well as protective factors at individual, relationship, school, and community levels.

Terminology

Transgender is a term for people whose gender identity or expression is different from their sex assigned at birth. Gender identity refers to a person’s internal understanding of their own gender. Gender expressiondescribes a person’s outward presentation of their gender (for example, how they dress). Transgender women describes people who were assigned the male sex at birth but identify as women. Transgender men describes people who were assigned the female sex at birth but identify as men.

The Numbers

• A 2017 paper used meta-analysis and synthesized national surveys to estimate that 1 million adults in the United States are transgender.
• From 2009 to 2014, 2,351 transgender people were diagnosed with HIV in the United States.
• Eighty-four percent (1,974) were transgender women, 15% (361) were transgender men, and less than 1% (16) had another gender identity.
• Around half of transgender people (43% [844] of transgender women; 54% [193] of transgender men) who received an HIV diagnosis from 2009 to 2014 lived in the South.
• According to current estimates, around a quarter (22-28%) of transgender women are living with HIV, and more than half (an estimated 56%) of black/African American transgender women are living with HIV.
• Among the 3 million HIV testing events reported to CDC in 2015, the percentage of transgender people who received a new HIV diagnosis was more than 3 times the national average.
• Nearly two thirds of transgender women and men surveyed by the Behavioral Risk Factor Surveillance System (BRFSS) in 2014 and 2015 from 28 jurisdictions reported never testing for HIV.

Prevention Challenges

• Multiple factors have put transgender people at risk for HIV infection and transmission, including multiple sexual partners, anal or vaginal sex without condoms or medicines to prevent HIV, injecting hormones or drugs with shared syringes and other drug paraphernalia, commercial sex work, mental health issues, incarceration, homelessness, unemployment, and high levels of substance misuse compared to the general population, as well as violence and lack of family support.
• HIV behavioral interventions developed for other at-risk groups have been adapted for use with transgender people. However, the effectiveness of these interventions is understudied. According to a 2017 study, most existing interventions target behavior change among transgender women, with only one HIV prevention program evaluated for transgender men. Evidence-based multilevel interventions that address the structural, biomedical, and behavioral risks for HIV among transgender populations, including transgender men, are needed to address disparities in HIV prevalence.
• Many transgender people face stigma, discrimination, social rejection, and exclusion that prevent them from fully participating in society, including accessing health care, education, employment, and housing. These factors affect the health and well-being of transgender people, placing them at increased risk for HIV.
• Transgender women and men might not be sufficiently reached by current HIV testing measures. Tailoring HIV testing activities to overcome the unique barriers faced by transgender women and men might increase rates of testing among these populations.
• Transgender men’s sexual health has not been well studied. Transgender men, particularly those who have sex with cisgender (persons whose sex assigned at birth is the same as their gender identity or expression) men, are at high risk for infection. Over half of transgender men with diagnosed HIV infection had no identified or reported risk. Additional research is needed to understand HIV risk behavior among transgender men, especially those who have sex with other men.
• Insensitivity to transgender issues by health care providers can be a barrier for transgender people diagnosed with HIV and seeking quality treatment and care services. Few health care providers receive proper training or are knowledgeable about transgender health issues and their unique needs. This can lead to limited health care access and negative health care encounters.
• Transgender women and men might not fully engage in medical care. In the United States, transgender and other gender minority youth are an at-risk group understudied in HIV prevention (e.g., PrEP) and HIV treatment. In one study, medical gender affirmation and stigma in HIV care were each independently associated with elevated odds of having missed HIV care appointments. In a study of transgender men living with HIV who were receiving medical care, 60% had maintained an undetectable viral load over the previous 12 months. A 2015 study found that 50.8% of transgender women who were receiving medical care had maintained an undetectable viral load over the previous 12 months. Sustaining an undetectable viral load through effective treatment is the best thing people living with HIV can do to stay healthy and protect their sexual partners. People living with HIV who sustain an undetectable viral load have effectively no risk of sexually transmitting HIV to an HIV-negative partner.
• Transgender-specific data are limited. Some federal, state, and local agencies do not collect or have complete data on transgender individuals. Using the two-step data collection method of asking for sex assigned at birth and current gender identity can help increase the likelihood that transgender people are correctly identified in HIV surveillance programs. Accurate data on transgender status can lead to more effective public health actions.

Once nearly eliminated in the U.S., syphilis is increasing, especially among gay, bisexual, and other men who have sex with men (MSM).

What is syphilis?

Syphilis is a sexually transmitted infection that can cause serious health problems if it is not treated. Syphilis is divided into stages (primary, secondary, latent, and tertiary), and there are different signs and symptoms associated with each stage..

Should I be concerned about syphilis?

Most cases of syphilis in the United States are among gay, bisexual, and other men who have sex with men. (MSM), and syphilis has been increasing among MSM for more than a decade. If syphilis is not treated, it can cause serious health problems, including neuralgic (brain and nerve) problems, eye problems, and even blindness. In addition, syphilis is linked to an increased risk of transmission of HIV infection.

How could I get syphilis?

Any sexually -active person can get syphilis. Syphilis can be transmitted during anal sex and oral sex, as well as vaginal sex. Syphilis is passed from person to person through direct contact with a syphilis sore. In men, sores can occur on or around the penis, around the anus, or in the rectum, or in or around the mouth. These sores can be painless, so it is possible to have them and not notice them. Correct use of condoms can reduce the risk of syphilis if the condom covers the sores. However, sometimes sores occur in areas not covered by a condom. It is still possible to get syphilis from contact with these sores. You cannot get syphilis through casual contact with objects such as toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What does syphilis look like?

Syphilis is divided into stages (primary, secondary, latent, and tertiary), and there are different signs and symptoms associated with each stage. A person with primary syphilis generally has a sore or sores at the original site of infection. These sores usually occur on or around the genitals, around the anus or in the rectum, or in or around the mouth. These sores are usually (but not always) firm, round, and painless. Symptoms of secondary syphilis include skin rash, swollen lymph nodes, and fever. The signs and symptoms of primary and secondary syphilis can be mild, and they might not be noticed. During the latent stage, there are no signs or symptoms. Tertiary syphilis is associated with severe medical problems and is usually diagnosed by a doctor with the help of multiple tests. It can affect the heart, brain, and other organs of the body.

How common is syphilis among MSM?

Between 2018 and 2019, the number of reported primary and secondary (P&S) cases in the United States increased by 11%, and there were 38,992 P&S syphilis cases reported in 2019. Most (47%) of these cases were among MSM only and men who have sex with both men and women.

How can I reduce my risk of getting syphilis?

The only way to avoid getting syphilis or other STDs is to not have anal, oral, or vaginal sex.

If you are sexually active, doing the following things will lower your chances of getting syphilis:

• Being in a long-term mutually monogamous relationship with a partner who has been tested for syphilis and does not have syphilis
• Using latex condoms the right way every time you have sex. Condoms prevent the spread of syphilis by preventing contact with a sore. Sometimes sores can occur in areas not covered by a condom. Contact with these sores can still transmit syphilis.

How do I know if I have syphilis?

The only way to know is by getting tested. Many men who get syphilis do not have any symptoms for years, yet they remain at risk for health problems if they are not treated. Additionally, the painless sores that show up during the early stages of syphilis often go unrecognized by the person who has them. Individuals who are unaware of their infection can spread it to their sex partners.

How will my doctor know if I have syphilis?

Have an honest and open talk with your healthcare provider about your sexual history and ask whether you should be tested for syphilis or other STDs. Your doctor can do a blood test to determine if you have syphilis. Sometimes, healthcare providers will diagnose syphilis by testing fluid from a syphilis sore. If you are a sexually active man who has sex with men, who is living with HIV, and/or who has partner(s) who have tested positive for HIV or syphilis, you should get tested regularly for syphilis.

What is the link between syphilis and HIV?

In the United States, approximately half of MSM with primary and secondary (P&S) syphilis were also living with HIV. In addition, MSM who are HIV-negative and diagnosed with P&S syphilis are more likely to be infected with HIV in the future. Having a sore or break in the skin from an STD such as syphilis may allow HIV to more easily enter your body. You may also be more likely to get HIV because the same behaviors and circumstances that put you at risk for getting other STDs can also put you at greater risk for getting HIV.

Can syphilis be cured?

Yes, syphilis can be cured with the right medicine from your healthcare provider. However, treatment might not undo damage that the infection has already done.

I’ve been treated. Can I get syphilis again?

Having syphilis once does not protect you from getting it again. Even after you’ve been successfully treated, you can still be reinfected. Only laboratory tests can confirm whether you have syphilis. Follow-up testing by your healthcare provider is recommended to make sure that your treatment was successful.

Because syphilis sores can be painless and hidden in the vagina, anus, under the foreskin of the penis, or in the mouth, it may not be obvious that a sex partner has syphilis. Unless you know that all of your sex partner(s) have been tested and treated, you may be at risk of getting syphilis again from an infected partner.

Cigarette smoking in the United States is responsible for 480,000 deaths per year, and certain populations are more likely to smoke than others. One population especially at risk for engaging in tobacco use is the lesbian, gay, bisexual, transgender LGBT community.

Although LGBT individuals make up a small percentage of the total U.S. population, according to the National Health Information Survey nearly 20 percent of lesbian, gay, or bisexual adults (transgender identity was not specifically recorded in this survey) reported being current cigarette smokers. In comparison, about 14 percent of non-LGB adults were current smokers. Among young adults — ages 18-24 — the rates are even higher. LGBT young adults are nearly twice as likely to use tobacco as their non-LGBT counterparts, and over 40 percent of LGBT young adults are occasional cigarette smokers, meaning they have smoked at least one cigarette in their lifetime, but have not smoked daily in the last 30 days.

Risk Factors

FDA Tobacco
Education Resource Library

Causes of this disparity may include both psychological and environmental risk factors. LGBT individuals experience risk factors like internalized homophobia, stress due to societal stigma, and negative reactions to their disclosure of sexual orientation or “coming out” that may contribute to increased smoking rates.

In addition to these risk factors, higher rates of tobacco use among LGBT individuals can also be attributed — at least in part — to targeted marketing by the tobacco industry. Tobacco companies will often advertise at Gay Pride parties and other events specific to the LGBT community. In LGBT lifestyle publications and media, tobacco ads often portray tobacco use as normal and widely accepted behavior. This strategic marketing plays a part in the initiation and continued use of tobacco products among LGBT young adults.

Health Impacts

Tobacco use remains the leading cause of preventable disease and death in the United States. The LGBT community may be at higher risk for health conditions that are related to smoking cigarettes, such as heart disease, and every year tens of thousands of LGBT lives are cut short by tobacco.