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Screening for STDs in MSM

The following guidelines are adapted from King County Department of Health website. [Link]


Clinicians should ask all men if they've been sexually active with men, women, or both.

  1. HIV testing and STD screening should be performed on all sexually active MSM annually except those in long-term (> 1 year), mutually monogamous, HIV concordant relationships. Sexually active MSM include all MSM engaging in any anal, or oral sex. Screening should include the following tests:
    1. HIV (if patient is not previously known to be HIV infected)
    2. Serological testing for syphilis (i.e. RPR or other syphilis screening test)
    3. Rectal cultures or nucleic acid amplification tests for gonorrhea and chlamydial infection (men who report receptive anal sex only)+
    4. Pharyngeal culture or NAAT for gonorrhea+
  2. Repeat HIV and STD testing (as above) should be performed every 3 months in MSM with any one or more of the following risks:
    1. Diagnosis of a bacterial STD in the prior year (gonorrhea, chlamydial infection or early syphilis**)
    2. Methamphetamine or popper use in the prior year
    3. >10 sex partners (anal or oral) in the prior year
    4. Unprotected anal intercourse with a partner of unknown or discordant HIV status in the prior year

* Screening refers to testing in the absence of signs, symptoms or known exposure to an STD.

+ Existing data suggest that the Aptima Combo 2 test performs well on rectal and pharyngeal specimens and is more sensitive than culture. Laboratories performing the test must first perform an internal validation study. Clinicians should use caution in interpreting results of the Roche PCR (Roche Diagnostics) assay for gonorrhea, which is not specific, and the Becton Dickenson strand displacement assay, which has not been well studied and may be insensitive.

** Persons with early syphilis should be retested at 1, 3, 6, 9 and 12 months. Persons rescreening following an episode of urethral gonorrhea or chlamydial infection should be retested for urethral gonorrhea and chlamydia




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