STD Screening Recommendations For Men Who Have Sex With Men (MSM)
Who & When:
STD Screening for MSM Patients at the Initial Visit(1)
The following STD tests should be performed with MSM patients at the initial visit. These tests should be repeated at least yearly in MSM, or more frequently (i.e. at 3-6 month intervals) for MSM at highest risk (i.e., those who acknowledge having multiple anonymous partners or having sex in conjunction with illegal drug use, and patients whose sex partners participate in these activities).ii Most cases are asymptomatic, so screening is vitally important.
Gonorrhea:
Screen at the urethral site in patients with risk
Screen at the rectal and/or pharyngeal sites depending on exposure
Chlamydia:
Screen at the urethral site in patients with risk
Screen at the rectal site depending on exposure
Syphilis serology (RPR and/or VDRL)(2):
Hepatitis A, B, and C serology (unless known positive or vaccinated)
Consider Herpes Simplex Virus Type 2 type-specific serologic test(3)
How: Testing Technologies
Gonorrhea and Chlamydia
Tests to detect Chlamydia and Gonorrhea include the following:
Nucleic acid amplification tests (NAATs) are newer, highly-sensitive tests approved for both urine specimens and urethral swabs in men. Urine testing is non-invasive, easy to use in a clinical setting, and has high patient acceptability.
NAATs are commercially available under the names Amplicor (Roche), Aptima (GenProbe), and Probe Tec (BD).
These tests have a Sensitivity range of 85-95% and Specificity of 99%.
Testing and Vaccination for Hepatitis(4)
Pre-vaccination susceptibility testing
Hepatitis A and B vaccination are recommended for all MSM. For both Hepatitis A and Hepatitis B, pre-vaccination antibody titer testing may be cost-effective, but should not be a barrier to vaccination of persons at high risk of exposure, as vaccination of already immune persons is not harmful. If pre-vaccination testing is done, the first vaccine dose should be given at the same visit when serologic testing is done.
- For Hepatitis A, antibody to Hepatitis A Virus is the test of choice.
- For Hepatitis B, antibody to Hepatitis B Core Antigen is the test of choice.
Post-vaccination testing for response
- For Hepatitis A, no post-vaccination response testing is recommended.
- For Hepatitis B, post-vaccination response testing is recommended only for immunocompromised persons and for sex partners of persons with chronic Hepatitis B infection.
- Antibody to Hepatitis B surface antigen is the test of choice (± MIU/ml indicates protection).
- Post-vaccination testing should be performed 1-2 months after 3rd dose of vaccine for results to be meaningful.
- Source: MMWR: Sexually Transmitted Disease Guidelines. August 4, 2006. 55: RR-11
- See Evaluating Patients for Primary Syphilis and Evaluating Patients for Secondary Syphilis, available at www.STDcheckup.org
- See Summary Guidelines for the Use of Herpes Simplex Virus (HSV) Type 2 Serologies, available at www.STDcheckup.org
- Source: Centers for Disease Control and Prevention; www.cdc.gov/hepatitis
- inactivated Hepatitis A vaccine, GSK; EL. U. = Enzyme-linked immunosorbent assay units.
- inactivated Hepatitis A vaccine, Merck.
- combined Hepatitis A-Hepatitis B vaccine, GSK.
- recombinant Hepatitis B vaccine, GSK.
- recombinant Hepatitis B vaccine, Merck.
- recombined Hepatitis A-Hepatitis B vaccine, GSK.
** 720 EL. U. Hepatitis A vaccine, 20 mcg Hepatitis B vaccine.
** 720 EL.U. Hepatitis A vaccine, 20 mcg Hepatitis B vaccine