Sexually Transmitted Disease and HIV Screening Guidelines for Men Who Have Sex With Men

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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.GuidelinesThe frequencies of gonorrhea, chlamydial infection, and infectious syphilis have risen dramatically since 1997 in MSM in King County, indicating an increased risk for transmission of HIV, the cause of AIDS. Similar trends are being seen among MSM in many other geographic areas in North America and Europe. Local surveillance has documented high rates of STD among King County MSM both with and without HIV infection, and has also demonstrated high frequencies of unprotected sex, sex with anonymous partners, and related behaviors among many MSM. The reasons for these trends are uncertain, but several signs point to improved management of HIV infection and enhanced survival, which in turn probably have direct and indirect effects on sexual behavior. “Epidemic fatigue” and “safer sex burnout” also are likely to be involved.Public Health—Seattle & King County, in collaboration with community partners, has taken numerous steps to address the resurgence of STD infection and HIV risk among MSM. In addition, Public Health now makes the following recommendations for STD/HIV screening for agencies and clinicians who provide health care to MSM. This document also summarizes longstanding recommendations for counseling MSM for STD/HIV prevention.Screening RecommendationsSexual history: Using a straightforward, nonjudgmental approach, clinicians should routinely determine whether their male adult and teen patients are sexually active with other men, women, or both, and should ask MSM whether they have been sexually active with men in the preceding year.All men who have had sex with other men in the preceding year should have the following screening tests at least once a year:–HIV serology (if HIV negative or not previously tested)–Syphilis serology–Pharyngeal culture for Neisseria gonorrhoeae*MSM who have had receptive anal intercourse in the preceding year also should have the following tests at least once a year:–Rectal culture for N gonorrhoeae

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