Background U.S. STD clinics are closing. MSM are a priority population for STD treatment. We evaluated differences between MSM diagnosed with STI in an STD clinic and MSM diagnosed in other venues.

Methods We randomly sampled and interviewed MSM reported with gonorrhoea, chlamydial infection, or early syphilis in King County, Washington, 2007–2012. We weighted for interview non-response based on race, ethnicity, STI diagnosis, STD clinic diagnosis (vs. elsewhere), and year.

Results A total of 2,865 (38%) of 7,568 MSM cases were randomly selected, of whom 2107 (73.5%) were interviewed; 1275 (61%) interviewed men were STD clinic patients. STD clinic patients were less likely to have stable housing (91% vs. 95%, p = 0.003) or a college degree (34% vs. 44%, p < 0.0001), and more likely to be unemployed (28% vs. 23%, p = 0.01). Both groups were similar in terms of age, race, ethnicity, and HIV status. STD clinic patients were more likely to be diagnosed with gonorrhoea (57% vs. 47%, p < 0001), to report a prior diagnosis of bacterial STI (68% vs.55% p < 0.0001), and to have sought care because of symptoms (45% vs. 39%) or a partner with an STD (27% vs. 8%, p < 0.0001), and less likely to be diagnosed with chlamydia (55% vs. 61%, p = 0.007). STD clinic patients reported having more partners (mean 16.3 vs. 11.7, p = 0.0008) in the prior year, and more methamphetamine (18% vs.11%, p < 0.0001), Viagra (18% vs. 13%, p = 0.006) and popper use (26% vs. 19%, p = 0.0004). HIV-uninfected STD clinic patients were more often HIV-tested (84% vs. 78%, p = 0.001) at the time of STI diagnosis. HIV-infected MSM diagnosed in the STD clinic were less likely to have a primary HIV care provider than other MSM (80% vs. 96%, p < 0.0001).

Conclusion STD clinics serve an economically disadvantaged, high risk and disproportionately symptomatic subset of the larger population of MSM with bacterial STI.