Robert Koch Institute, Department for Infectious Diseases Epidemiology, Berlin, Germany.
BMC Infect Dis. 2011 May 18;11:132. doi: 10.1186/1471-2334-11-132.
In Germany, testing and treatment of sexually transmissible infections (STIs) services are not provided by one medical discipline, but rather dispersed among many different providers. Common STIs like gonorrhoea or Chlamydia infection are not routinely reported. Although men who have sex with men (MSM) are particularly vulnerable to STIs, respective health care utilization among MSM is largely unknown.
A sexual behaviour survey among MSM was conducted in 2006. Questions on self-reported sexual behaviour, STI-related health care consultation and barriers to access, coverage of vaccination against hepatitis, screening for asymptomatic STIs, self-reported history of STIs, and partner notification were analysed. Analysis was stratified by HIV-serostatus (3,511 HIV-negative/unknown versus 874 positive).
General Practitioners, particularly gay doctors, were preferred for STI-related health care. Low threshold testing in sex-associated venues was acceptable for most respondents. Shame and fear of homophobic reactions were the main barriers for STI-testing. More than half of the respondents reported vaccination against hepatitis A/B. HIV-positive MSM reported screening offers for STIs three to seven times more often than HIV-negative or untested MSM. Unlike testing for syphilis or hepatitis C, screening for asymptomatic pharyngeal and rectal infections was rarely offered. STIs in the previous twelve months were reported by 7.1% of HIV-negative/untested, and 34.7% of HIV-positive respondents.
Self-reported histories of STIs in MSM convenience samples differ significantly by HIV-serostatus. Higher rates of STIs among HIV-positive MSM may partly be explained by more testing. Communication between health care providers and their clients about sexuality, sexual practices, and sexual risks should be improved. A comprehensive STI screening policy for MSM is needed.
在德国，性传播感染（STIs）的检测和治疗服务并非由单一医学学科提供，而是分散在许多不同的提供者中。常见的 STIs，如淋病或衣原体感染，并未常规报告。尽管男男性行为者（MSM）特别容易感染 STIs，但 MSM 对相应医疗保健的利用情况在很大程度上尚不清楚。
2006 年对 MSM 进行了性行为调查。分析了自我报告的性行为、与 STI 相关的医疗保健咨询以及获取障碍、乙型肝炎疫苗接种覆盖率、无症状 STI 筛查、自我报告的 STI 病史和性伴侣通知等问题。分析按 HIV 血清学状态（3511 例 HIV 阴性/未知与 874 例阳性）进行分层。
全科医生，特别是同性恋医生，是 MSM 首选的 STI 相关医疗保健提供者。大多数受访者都接受在性相关场所进行低门槛检测。感到羞耻和害怕恐同反应是 STI 检测的主要障碍。超过一半的受访者报告接种了甲型肝炎/乙型肝炎疫苗。HIV 阳性 MSM 报告接受 STI 筛查的频率是 HIV 阴性或未接受检测的 MSM 的三到七倍。与梅毒或丙型肝炎检测不同，很少提供无症状咽和直肠感染筛查。12 个月内有 7.1%的 HIV 阴性/未检测和 34.7%的 HIV 阳性受访者报告了 STIs。
在 MSM 便利样本中，自我报告的 STI 病史在 HIV 血清学状态上存在显著差异。HIV 阳性 MSM 中 STIs 的发生率较高，部分原因可能是检测次数更多。应改善医疗保健提供者与患者之间关于性行为、性实践和性风险的沟通。需要为 MSM 制定全面的 STI 筛查政策。
