Self-reported Screening for Rectal Sexually Transmitted Infections Among Men who Have Sex with Men

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Sexually Transmitted Diseases

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Background Rectal gonorrhea and chlamydia are common and predict HIV acquisition among men who have sex with men (MSM); however, screening for rectal sexually transmitted infections (STIs) is not routine.

Methods In 2017, we recruited sexually-active MSM in the Portland, Oregon metropolitan area through venue-based sampling. Our outcome of interest was self-reported rectal STI screening in the prior 12 months among those who had a healthcare visit in the same time period. Stratified by HIV status and pre-exposure prophylaxis (PrEP) use, we assessed the prevalence and predictors of screening.

Results Of 403 participants, 162 (40.2%) reported rectal STI screening. Sixty (25.7%) of 233 HIV-negative men who did not report PrEP use in the prior 12 months; 61 (69.3%) of the 88 HIV-negative men who reported PrEP use in the prior 12 months; and, 41 (59.4%) of 69 men living with HIV reported screening, respectively. Among HIV-negative men who did not report PrEP use in the prior 12 months, having a health care provider who offered HIV testing (adjusted prevalence ratio [aPR]=2.21; 95% confidence interval [CI]: 1.38, 3.52) and condomless anal sex with casual partners in the prior 12 months (aPR=1.63; 95%CI: 1.01, 2.65) were independently associated with rectal STI screening. HIV-negative men on PrEP who had a syphilis diagnosis in the prior 12 months were more likely to be screened than those without syphilis (aPR=1.33; 95%CI:1.11, 1.59). Men living with HIV who reported having a provider who always or often initiates conversations about sex were more likely to report screening compared to men who did not have such a provider (aPR=1.46; 95%CI: 1.06, 2.03).

Conclusions Rectal STI screening is not universal in a venue-based sample of sexually-active MSM. Implementing innovative, acceptable, and accessible screening practices, enhancing health literacy around STI screening, and improving provider comfort with talking about sex are paramount to increasing rectal STI screening.


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