Rectal STI screening sorely lacking in sexually active MSM

  • Menza TW & al.
  • Sex Transm Dis
  • 8 Jul 2019

  • International Clinical Digest
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Takeaway

  • Sexually active men who have sex with men (MSM) are not routinely screened for rectal sexually transmitted infections (rSTIs).
  • Annual screening rate was 1 in 4 for HIV-negative MSM without preexposure prophylaxis (PrEP) use.

Why this matters

  • Increased STI screening, especially for rSTIs in MSM, is paramount to reducing overall burden.
  • Use screening to encourage PrEP uptake in HIV-negative patients, engage/reengage HIV-infected men in care to achieve/maintain viral suppression.

Key results

  • 403 MSM; 68.7% (277) reported screening for any STI, 40.2% (162) for rSTIs in the past 12 months.
  • rSTI screening rate by category:
    • HIV-negative, no PrEP (n=233): 25.7%.
    • HIV-negative, PrEP use (n=88): 69.3%.
    • HIV+ (n=69): 59.4%.
    • Status was unknown in 13 patients.
  • 20.3% (82) reported bacterial STI, 54.1% (218) reported condomless anal sex with casual partners, 52.4% (211) reported any receptive anal sex in past 3 months.
  • Multivariate rSTI screening predictors:
    • HIV-negative, no PrEP: provider-offered testing (adjusted prevalence ratio [aPR], 2.21, P=.001), condomless anal sex with casual partners (aPR, 1.63; P=.046).
    • HIV negative, PrEP: syphilis diagnosis (aPR, 1.33; P=.002).
    • HIV-positive: provider-initiated sex discussions (aPR, 1.46; P=.022).

Study design

  • Venue-based, time-space survey determining rSTI screening prevalence, factors predicting screening among MSM, June-December 2017.
  • Funding: CDC.

Limitations

  • Self-report bias.
  • Nongeneralizable.
  • Receptive anal sex analyzed outside main time frame.

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