Screening for STDs in MSM

[print pdf 91kb] Updated 10/3/06

The following guidelines are adapted from King County Department of Health website. (last updated 10/20/2005):

HIV TESTING and STD SCREENING* RECOMMENDATIONS
for MEN WHO HAVE SEX WITH MEN (MSM)

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 relationships. Sexually active MSM include all MSM engaging in any anal, or oral sex.
	--	Screening should include the following tests*:
		1.	HIV (if not previously known to be HIV infected)
		2.	RPR
		3.	Urethral test for gonorrhea and chlamydial infection (men who report insertive anal sex)
		4.	Rectal cultures for gonorrhea and chlamydial infection (men who report receptive anal sex only)+
		5.	Pharyngeal culture for gonorrhea
2)	Repeat HIV and STD testing (as above) should be performed at 3-6 months follow-up for the following persons:
	--	All persons, regardless of sexual orientation, diagnosed with gonorrhea, chlamydial infection or early syphilis**.
	--	MSM with any one or more of the following risk factors:
		1.	Unprotected anal intercourse with a partner of unknown or discordant HIV status in the last year
		2.	Bacterial STD diagnosis
		3.	Methamphetamine use in the last year
	--	Persons rescreening following an episode of urethral gonorrhea or chlamydial infection should be retested for urethral gonorrhea and chlamydia.
	--	When to screen within the 3-6 month timeframe should be decided with the patient.

* Screening refers to testing in the absence of signs, symptoms or known exposure to an STD. Consider, regardless of history of condom use during exposure.

+ Limited data suggest nucleic acid amplification tests perform well on rectal specimens. These tests should be used if culture is unavailable. Caution should be used in interpreting PCR (Roche Diagnostics) results for gonorrhea.

** Persons with early syphilis should be retested at 1, 3, 6, 9 and 12 months.

CDC guideline on STD treatment
http://www.cdc.gov/std/treatment/

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