Background The aim of this study is to gain a better understanding of the knowledge, attitudes, motivations and behaviors with regard to syphilis and syphilis risk among men who have sex with men (MSM) in Beirut who are repeatedly infected.

Methods Interviews were conducted with 17 MSM diagnosed with syphilis at least twice within the previous 5 years in a sexually transmitted infections (STI) clinic and checkpoint in Beirut. The focus of the interviews was on participants’ general attitudes, personal concern, risk perceptions and self-reported sexual behaviors in relation to syphilis. Data were analyzed using Qualitative Thematic Analysis.

Results The number of early syphilis infections ranged from 2 to 3 and participants had a high level of knowledge about syphilis transmission, symptoms, health consequences if untreated. Most of the participants attributed their syphilis infections to their high number of sex partners and to a lack of consistent condom use with sexual partners. The majority attributed their infection to oral sex. The majority did not express concerns about getting syphilis again, and none appeared to be aware of the connection between syphilis and HIV risk. Conversely, almost all participants expressed concerns about infecting others. There was evidence of significant stigma in relation to syphilis in the Lebanese MSM community.

Conclusion The significant stigma associated with syphilis translates into decreased discussion and, thus, awareness of the infection. Syphilis risk was associated with multiple sexual partners and to periods of especially high-risk behavior. Knowledge about syphilis risk, and especially about the relationship between syphilis risk and HIV risk, was lacking. There appears to be little willingness to modify high-risk behaviors, suggesting that an awareness-raising campaign to change attitudes and behaviors in Lebanese MSM could be fruitful.

Disclosure No significant relationships.