From the HIV/STD/TB Section, Public Health Division, Oregon Health Authority.
Department of Social Work, Portland State University, Portland, OR.
Sex Transm Dis. 2019 Oct;46(10):683-688. doi: 10.1097/OLQ.0000000000001046.
Rectal gonorrhea and chlamydia are common and predict human immunodeficiency virus (HIV) acquisition among men who have sex with men (MSM); however, screening for rectal sexually transmitted infections (STIs) is not routine.
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 health care visit in the same time period. Stratified by HIV status and preexposure prophylaxis (PrEP) use, we assessed the prevalence and predictors of screening.
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. The 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 with men who did not have such a provider (aPR, 1.46; 95% CI, 1.06-2.03).
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.
直肠淋病和衣原体感染在男男性行为者（MSM）中很常见，并且可以预测人类免疫缺陷病毒（HIV）的获得；然而，直肠性传播感染（STI）的筛查并非常规。
2017 年，我们通过基于场所的抽样，招募了俄勒冈州波特兰大都市区有性行为的 MSM。我们感兴趣的结果是在同一时期有医疗保健就诊的参与者中，在过去 12 个月内自我报告的直肠 STI 筛查。根据 HIV 状况和暴露前预防（PrEP）的使用情况，我们评估了筛查的流行率和预测因素。
在 403 名参与者中，有 162 名（40.2%）报告了直肠 STI 筛查。在过去 12 个月内未报告使用 PrEP 的 233 名 HIV 阴性男性中，有 60 名（25.7%）；在过去 12 个月内报告使用 PrEP 的 88 名 HIV 阴性男性中，有 61 名（69.3%）；以及，69 名 HIV 阳性男性中，有 41 名（59.4%）报告了筛查。在过去 12 个月内未报告使用 PrEP 的 HIV 阴性男性中，有提供 HIV 检测的医疗保健提供者（调整后的患病率比 [aPR]，2.21；95%置信区间 [CI]，1.38-3.52）和过去 12 个月与偶然伴侣发生无保护肛交行为（aPR，1.63；95%CI，1.01-2.65）与直肠 STI 筛查独立相关。过去 12 个月中患有梅毒的接受 PrEP 治疗的 HIV 阴性男性比没有梅毒的男性更有可能接受筛查（aPR，1.33；95%CI，1.11-1.59）。报告有提供者经常或经常主动谈论性的 HIV 阳性男性比没有提供者的男性更有可能接受筛查（aPR，1.46；95%CI，1.06-2.03）。
在有性行为的 MSM 的基于场所的样本中，直肠 STI 筛查并非普遍。实施创新、可接受和可及的筛查实践，提高 STI 筛查的健康素养，提高提供者对性话题的舒适度，对于增加直肠 STI 筛查至关重要。
