MSM

Question 1

MSM history

Answer 1

Standard history plus

Frequency and number of condomless anal sex
Serosorting
Seropositioning
Negotiating safety
Use of ARTs (TasP)
PrEP

?risk of enteric infections / HepA (rimming)

? Risk hepC (fisting)

Discuss ways of meeting partners including use of internet, saunas

Alcohol

Drugs including chemsex / practices such as booty bumping

Sexual dysfunction

Condom use and errors

Routine questioning about perianal symptoms
If rectal Sx:

• ask about tenesmus and constipation (a/w LGV)

Question 2

Asymptomatic MSM - what do you offer

Answer 2

Tests:
Triple site CT/GC
HIV / STS
HBV
HCV if indicated

Vaccinations:
HAV
HBV
HPV

PrEP if UPAI

Question 3

MSM associations with LGV

Answer 3

HIV +
HCV infection
Chemsex (particularly GHB)
UPAI
Fisting

Question 4

Routine LGV typing of symptomatic and asympto CT infection at any site recommended in…

Answer 4

HIV positive MSM

Question 5

Increased risk of HCV in MSM

Answer 5

• Presence of other STIs (syphilis, LGV especially)
• traumatic AI
• fisting
• shared sex toys
• group sex
• serosorting
• concomitant use of recreational Dx
  (Including chemsex)

Question 6

Which MSM do you offer routine HCV testing to?

Answer 6

• MSM in presence of additional risk factors (traumatic AI, chemsex, fisting, HIV / LGV)
• annually to men eligible for 3/12ly HIV screening and those taking or eligible for PrEP
• HIV+ - at least annual HCV test

Question 7

Frequency of STI and HIV testing Uk MSM

Answer 7

• annual STI / HIV screen (other than those with one long term mutually exclusive partner)

3- monthly STI testing including HIV :
- UAI with partner(s) of unknown HIV status over last 12/12
- >10 sexual partners over last 12/12
- Dx use (meth, GHB/GBL, inhaled nitrites) during sex over past 6/12
- Multiple or anon partners since last tested
- any unprotected sexual contact with a new partner since tested