Charin, Gideon, Symonds, Ynez, Scholfield, Clare, Graham, Cynthia and Armstrong, Heather (2022) Three-site screening for sexually transmitted infections in men who have sex with men using online self-testing in an English sexual health service. Sexually Transmitted Infections. (doi:10.1136/sextrans-2021-055243).
Abstract
Objectives: among men who have sex with men (MSM) in the United Kingdom (UK), chlamydia (CT) and gonorrhoea (NG) infections commonly occur asymptomatically at extragenital sites. Therefore, MSM seeking sexual health services are offered three-site (oropharyngeal, rectal, and urogenital) STI screening. To increase access to screening, some UK sexual health services enable asymptomatic service users to order free STI screening kits online for self-sampling at home. We sought to assess prevalence of overall and extragenital CT/NG infection amongst asymptomatic MSM who used online self-testing in Hampshire, UK.
Methods: we assessed prevalence of CT/NG infections from non-pooled samples amongst asymptomatic cisgender MSM using an administrative database with results from 5,601 STI screening kits returned between 20/12/2016-31/01/2020. We compared number of diagnoses of extragenital infection with urogenital results of the same individuals to determine prevalence of infection that would have been missed with urine testing alone.
Results: amongst 5051 valid CT and 5040 valid NG asymptomatic test results, overall prevalence was 5.9% (298/5051) and 4.5% (228/5040), respectively. Amongst MSM with asymptomatic CT, 71.8% (214/298) had extragenital infection only, 2 (1, N=298) =56.71, p<0.001. Amongst those with asymptomatic NG, 89.9% (205/228) had extragenital infection only, 2 (1, N=228) =145.281, p<0.001.
Conclusions: overall, most CT/NG infections amongst asymptomatic MSM who used online self-testing were extragenital. Given this and the likelihood of onward transmission from asymptomatic infection, it is recommended that three-site testing remain standard for MSM and free screening services be expanded in easily accessible ways.
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