MSM - Men who have sex with men

Overview

  • There is a high prevalence and incidence of almost all STIs in men who have sex with men (MSM).
  • More than 80% of newly acquired HIV and greater than 90% of syphilis and gonorrhoea diagnosed in major cities and regional areas are diagnosed in MSM.
  • Anal and throat STIs are particularly unrecognised and under detected.
  • HIV positive MSM are at risk of other STIs because of higher unprotected anal intercourse with casual partners (UAIC).

Testing advice

All of the STI tests listed in the table below should be offered to all MSM at least once a year.

All MSM who fall into one or more of the following categories should be offered testing up to 4 times a year:

  • any unprotected anal sex
  • more than 10 sexual partners in six months
  • participate in group sex
  • use recreational drugs during sex
  • HIV-positive MSM should have:
    • syphilis testing at each occasion of CD4/VL monitoring
    • chlamydia/gonorrhoea testing should be considered at each occasion of CD4/VL monitoring.
InfectionConsideration
Gonorrhoea Collect ano-rectal swab and pharyngeal swab. Consider 
self-collection of samples for testing. If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment.

Urethral gonorrhea is rare in men without urethral symptoms, so urethral/urine testing is not recommended in asymptomatic men. However, combined Chlamydia trachomatis / Neisseria gonorrhoea assays are typically used in Australian laboratories.

Chlamydia Collect FPU, ano-rectal swab and pharyngeal swab. Consider 
self-collection of samples for testing.

The prevalence of gonorrhoea and chlamydia is different in the throat and urethra. However, currently most Australian laboratories use a combined chlamydia and gonococcus NAAT test.

Syphilis

If clinical suspicion of syphilis, refer to the syphilis guideline.

Hepatitis A

Vaccinate if not immune.

Further testing unnecessary after completing vaccination.

Hepatitis B

Vaccinate if not immune.

Consider serological testing after completing vaccination if high risk.

Hepatitis C

Test if concurrent HIV or if history of injecting drug use. Hepatitis C is not considered an STI except between HIV infected men having unprotected anal sex.
If antibody positive, test for hepatitis C NAAT to determine if patient has chronic hepatitis C.

HIV

Repeat test if patient exposed within previous 12 weeks (window period).

NAAT - Nucleic Acid Amplification Test
FPU – First pass urine

Specimen collection

Clinician collected |
Self-collection

Clinical indicators for testing:

  • It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.
  • Seek specialist advice about diagnostic testing for other less common, non-routinely screened infections such as M. genitalium.
  • STIGMA Guidelines provides additional information.

Follow up

Consider discussing the availability of non-occupational post-expoure prophylaxis and pre-exposure prophylaxis.

If test results are positive, refer to the management section for the relevant STI:

Even if all test results are negative, use the opportunity to:

  • Educate about condom use and risk minimisation
  • Vaccinate for hepatitis A and B, if susceptible
  • Consider vaccination for human papillomavirus (HPV), depending on age and number of sexual partners
  • Discuss recreational drug use and harm minimisation
  • Discuss and activate clinical and personal reminders for regular testing according to risk, especially if their behaviours indicate the need for more frequent testing

Auditable outcomes

90% of MSM are screened according to these guidelines.

Last Updated: Thursday, 31 March 2016