Methamphetamine use has been associated with risky sexual behaviour and sexually transmitted disease (STD)/HIV transmission among men who have sex with men (MSM). Field interview records for MSM early syphilis (ES) patients were reviewed for factors associated with methamphetamine use during January 2001 through December 2004. There were a total of 2915 ES cases reported during the study period. Of these, 1904 (65%) were MSM. Of these MSM, 167 reported methamphetamine use. Methamphetamine use was associated with having multiple sex partners (prevalence ratios [PR] 1.8, 95% confidence interval [CI] 1.4–2.4), not using condoms (PR 2.0, 95% CI 1.3–2.5), having anonymous sex partners (PR 1.1 95% CI 1.03–1.2), history of recent incarceration (PR 5.4, 95% CI 3.3–8.7), and meeting sex partners via the Internet (PR 1.6, 95% CI 1.3–2.1), at bathhouses (PR 1.6, 95% CI 1.2–2.0) and on the streets (PR 2.6, 95% CI 1.7–4.0). In multivariate analysis having multiple sex partners, not using condoms, recent incarceration and meeting sex partners at bathhouses were significantly associated with methamphetamine use. In conclusion, effective STD risk reduction interventions targeting MSM methamphetamine users are needed to curb risky sexual behaviour.