Background. The Centers for Disease Control and Prevention developed screening and diagnostic testing guidelines for chlamydia and gonorrhea at urethral, rectal, and pharyngeal sites for men who have sex with men (MSM). However, in most clinical settings, rectal chlamydial testing is not performed for MSM, and primarily sexually transmitted disease (STD) clinics alone perform routine rectal and pharyngeal gonorrhea screening for asymptomatic men. Methods. We evaluated the prevalence of rectal, urethral, and pharyngeal chlamydial and gonococcal infections among MSM seen at the municipal STD clinic and the gay men’s community health center. We also determined the proportion of asymptomatic rectal infections, described the patterns of single and multiple anatomic sites of infection, and evaluated the proportion of chlamydial infections that would be missed and not treated if MSM were not routinely tested for chlamydia. We tested specimens using previously validated nucleic acid amplification tests (NAATs). Results. The prevalence of infection varied by anatomic site (chlamydia: rectal, 7.9%; urethral, 5.2%; and pharyngeal, 1.4%; for gonorrhea, rectal, 6.9%; urethral, 6.0%; and pharyngeal, 9.2%). Approximately 85% of rectal infections were asymptomatic supporting the need for routine screening. Because 53% of chlamydial infections and 64% of gonococcal infections were at nonurethral sites, these infections would be missed and not treated if only urethral screening was performed. In addition, 170% of chlamydial infections would be missed and not treated if MSM were tested only for gonorrhea. Conclusions. Because these infections enhance both HIV transmission and susceptibility, clinical settings serving MSM should evaluate the prevalence of chlamydial and gonococcal infections by anatomic site using validated NAATs.

Prevalence of Rectal, Urethral, and Pharyngeal Chlamydia and Gonorrhea Detected in 2 Clinical Settings among Men Who Have Sex with Men: San Francisco, California, 2003

The introduction of highly active antiretroviral therapy (HAART) has led to dramatic reductions in morbidity and mortality due to HIV infection. However, the resulting optimism and improved health status produced by HAART appears to have contributed to unanticipated consequences in men who have sex with men (MSM): loss of fear of acquiring and transmitting HIV, an increase in high-risk sex, decreased use of condoms, and a resurgence of gonorrhea and syphilis. Other factors, such as lack of knowledge of sexually transmitted diseases (STDs), use of the Internet as a venue to find sex partners, the increasing use of Viagra (Pfizer, New York, NY) as a recreational drug, and the apparent expanding role of oral sex in STD transmission are fueling these trends. Since ulcerative and inflammatory STDs facilitate HIV transmission, a new wave of HIV infection in MSM may be on the horizon. The rising STD rates and relapses in high-risk sexual behaviors in MSM, both HIV-infected and -uninfected MSM, have profound implications for public health and the clinical management of these patients. Clinicians should be aware of this turn of events, and implement new screening and counseling guidelines that have been issued in response to these alarming reports.

Sexually Transmitted Diseases in Men Who Have Sex with Men: An Epidemiologic Review.

In a retrospective analysis of asymptomatic men who have sex with men visiting an urban municipal sexually transmitted disease clinic, 83.8% of chlamydial and gonococcal infections would have been missed by urethral screening, compared with 9.8% by screening the rectum and pharynx. Extragenital screening is critical to the provision of comprehensive sexual health services for men who have sex with men.

Infections missed by urethral-only screening for chlamydia or gonorrhea detection among men who have sex with men.

https://www.id.theclinics.com/article/S0891-5520(07)00007-4/pdf

Behavioral aspects of HIV care: adherence, depression, substance use, and HIV-transmission behaviors.

Objectives. We sought to identify HIV-infection risk factors related to partner selection and sexual behaviors with those partners among men who have sex with men (MSM) in King County, Washington.Methods. Participants were recruited from HIV testing sites in the Seattle area. Recent HIV infection status was determined by the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) or a self-reported previous HIV-negative test. Data on behaviors with 3 male partners were collected via computer-based self-interviews. Generalized estimating equation models identified partnership factors associated with recent infection.Results. We analyzed data from 32 HIV-positive MSM (58 partners) and 110 HIV-negative MSM (213 partners). In multivariate analysis, recent HIV infection was associated with meeting partners at bathhouses or sex clubs, bars or dance clubs, or online; methamphetamine use during unprotected anal intercourse; and unprotected anal intercourse, except with HIV-negative primary partners.Con...

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2006.098582

Determinants of recent HIV infection among Seattle-area men who have sex with men.

THE FOLLOWING RECOMMENDATIONS for screening men who have sex with men (MSM) were developed by Public Health—Seattle & King County in response to rising rates of syphilis, gonorrhea, and chlamydial infection among MSM in King County, WA, 1–3 with attendant increased risk of transmission of HIV infection. These guidelines, which include a summary of counseling strategies for prevention of HIV infection and other sexually transmitted diseases (STDs), have been widely distributed among healthcare providers and populations at risk in King County. The guidelines are one component of several prevention strategies developed in collaboration with community partners, including agencies and individuals representing MSM at risk. Some elements of the screening recommendations are based on local studies of the prevalence of STD and of behavioral risks among MSM in King County, 4 whereas others are based on local clinical experience and expert opinion. The resurgence of STD and of behavioral risks for HIV transmission appear to be widespread among MSM in industrialized countries, 5–7 and it is likely that these recommendations are broadly applicable to MSM in other geographic areas. However, local trends and regionally derived data should be used whenever possible to develop guidelines that will be most useful in particular geographic areas and populations. For example, the recommendation for routine screening for rectal but not urethral gonococcal and chlamydial infection in asymptomatic MSM is based on extensive screening data in King County, 4 but may not be applicable in all settings. The remainder of this document reproduces the recommendations distributed in King County. Other local, state, and national health agencies and professional organizations also should move promptly to address this public health crisis.

Sexually transmitted disease and HIV screening guidelines for men who have sex with men

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Sexually transmitted disease and HIV screening guidelines for men who have sex with men