Introduction As a result of high burden of infection, men who have sex with men (MSM) are a priority for sexually transmitted infection (STI) prevention interventions including promoting regular testing. Effective intervention design requires understanding of MSM’s knowledge and perceptions of STIs and their social representations which may affect attitudes and behaviour related to risk, testing and treatment. To inform STI prevention interventions and development of questions inclusion in an online survey that would link with surveillance data on testing and diagnosis we assessed MSM’s knowledge and attitudes towards STIs.

Methods We recruited a diverse sample of MSM in 4 English cities, through social networking and community organisations.61 MSM attended one of eight 90 min focus group discussions. Topics included knowledge of, and attitudes towards STIs. We ran a discussion and ranking exercise in which names of 11infections, specified below, printed in large font on separate sheets were laid out and respondents were asked what they knew about each and to rank them in order of most to least ‘scary’, giving reasons for their ranking. Infections included: HIV, syphilis, gonorrhoea, chlamydia, HPV/genital warts, genital herpes, Shigella, scabies, hepatitis A (HAV), B (HBV) and C (HCV). Discussions were audio recorded, transcribed and thematic data analysis conducted.

Results Participants demonstrated both wide and detailed knowledge as well as lack of awareness depending on individuals and infections. While the greatest knowledge and experience was of HIV, few had heard of or knew much about Shigella. No focus groups were unanimous in their ranking of infections and patterns were not the same across groups. HIV and HCV were ranked the two most ‘scary’ by all groups and syphilis was among the three most scary. Herpes was also ranked highly by all but one group while scabies was similarly ranked least scary. Other infections ranked between with no clear patterning within or between groups. The exercise produced a complex range of explanations relating to fear of individual infections and of STIs in general. Participants weighed up the scary and less scary attributes of the infections depending on the extent of their knowledge about and experience of them, their prevalence among MSM, associated stigma, transmission mechanisms, contagiousness, symptoms, severity and the availability, effectiveness and ease of use of vaccines, treatment and/or cure.

Conclusion While knowledge of individual STI infections varies, knowledge and awareness about Shigella was particularly low. MSM expressed a range of nuanced concerns related to individual STI sand STI testing and treatment. Fears influence and relate to each other e.g. considerable fear of a disfiguring infection may be reduced if the treatment is seen to be relatively easy, short and effective. MSM articulated a range of concerns which were subsequently used as categories in a self-completion survey to inform STI risk reduction, testing and treatment interventions.