Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

Abstract

Abstract.Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009-May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.

Characteristics of gonorrhoea cases notified in inner and south-western Sydney, Australia: results of population-based enhanced surveillance

“…As such, misclassification of bisexual men or MSM as heterosexual may have resulted in the small number of heterosexual males being reported as having extra-genital infection, a pattern of infection described among MSM. 5 While a high response rate maximises the internal validity of our findings, it is possible that nonresponding doctors may have been less likely to be engaged in risk factor identification, STI screening and treatment.…”

“…27 NAAT is the recommended test for all sites; however, culture is also recommended before treatment to monitor antibiotic resistance. 5,28 The small proportion of culture results notified is concerning, given global concerns about an increase in antibiotic resistance. 29 Our results suggest that clinicians require ongoing education about testing and reminders of the importance of obtaining gonococcal cultures before treatment for ongoing gonococcal surveillance.…”

“…This underscores the importance of regular and frequent asymptomatic STI testing among MSM, as recommended in national guidelines. 5 Current guidelines for asymptomatic MSM recommend gonorrhoea testing of pharyngeal and rectal swabs, and a first-void urine specimen. 5 It has been noted that while comprehensive STI testing among MSM has improved, many still do not undergo recommended tests.…”

“…5 Current guidelines for asymptomatic MSM recommend gonorrhoea testing of pharyngeal and rectal swabs, and a first-void urine specimen. 5 It has been noted that while comprehensive STI testing among MSM has improved, many still do not undergo recommended tests. 27 NAAT is the recommended test for all sites; however, culture is also recommended before treatment to monitor antibiotic resistance.…”

“…[1][2][3][4] Regular testing of high-risk populations is recommended for individual and public health benefits. 5,6 In Australia, the highest notification rates in urban areas occur in MSM, although characteristics of those infected are not well described. 1,7 Australian notification rates have risen steadily since 1993, with a substantial increase in New South Wales (NSW), 1 mirroring similar increases observed in Europe and the United States since 2009.…”