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Background: The high and continually increasing prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases among men who have sex with men (MSM) in China underscores the critical importance of examining the exact sexual networks that result in HIV transmission, as well as HIV infection, using powerful sampling methods, such as respondent-driven sampling (RDS), to improve the sexual health of this population.Methods: Using RDS, a cross-sectional study was conducted among MSM in Wenzhou, Zhejiang province, China from December 2013 to June 2014. The type of sex, numbers of anal sex partners, male oral sex partners and vaginal sex partners, condom use during each type of sex over the previous 6 months, prevention behaviors, risk perception, and the burdens of HIV and syphilis were investigated and analyzed.Results: Of 424 MSM, a great number of them did anal sex, male oral sex, and vaginal sex during the previous 6 months, and weighted estimates for the prevalence that MSM did not conduct these sexual behaviors were 11.2 % (95 % confidence interval [CI] =6.7-16.50 %), 20.3 % (95 % CI = 15.2-27.1 %), and 58.9 % (95 % CI = 52.1-65.8 %), respectively. Multiple sexual partners, engaging in regular, casual and commercial sex, and lack of condom use during all types of sex were common among MSM. The estimated HIV and syphilis prevalences were 22.8 % (95 % CI = 16.9-28.5 %) and 9.7 % (95 % CI = 6.4-13.6 %), respectively. Of the participants, 53.5 % (95 % CI = 45.3-60.2 %) received HIV-related interventions during the previous year, 48.1 % (95 % CI = 39.7-55.1 %) had never been tested for HIV, and only 14.1 % (95 % CI =10.1-19.2 %) perceived a risk of contracting HIV. Multiple logistic regression analysis revealed that age over 44 years (adjusted odds ratio [AOR] = 3.60, 95 % CI = 1.34-9.64), a monthly income of 3001-4000 yuan (approximately 470-630 US$) (AOR = 1.96, 95 % CI = 1.67-3.60), multiple anal sex partners (AOR = 1.93, 95 % CI = 1.15-3.24), awareness of the possibility of contracting HIV (AOR = 3.18, 95 % CI = 1.56-6.48), and current syphilis infection (AOR = 3.01, 95 % CI = 1.44-6.29) were predictors of HIV infection.Conclusions: HIV transmission has become highly prevalent and will likely become more prevalent among MSM and their female partners if these risky sexual networks persist. Our findings call for urgent and effective interventions to prevent the rapid transmission of HIV among MSM in Wenzhou. [ABSTRACT FROM AUTHOR]