Can an asymptomatic screening pathway for men who have sex with men be introduced safely at a level 3 sexual health service in the UK?

Abstract

To manage the rising demand on sexual health services in the UK, many clinics have introduced asymptomatic screening pathways for heterosexuals, which omit examination. In men who have sex with men however the screening of extragenital sites poses additional challenges. This study aimed to establish whether omitting examination of asymptomatic men who have sex with men would lead to clinically significant diagnoses being missed. The notes of all men who have sex with men who attended a UK level 3 sexual health clinic between 1 July 2011 and 30 June 2012 were retrospectively reviewed. Exclusion criteria included HIV-positive patients attending for HIV-related care, attendances for follow-up consultations not requiring a full sexual health screen, symptomatic patients, contacts of sexually transmitted infections and patients requesting an examination or a repeat prescription of a regularly used medication. In all, 920 consultations occurred during 12 months, of which 893 were reviewed; 476 (53.3%) consultations would have been eligible for screening on an asymptomatic pathway and, of these, 21 (4.4%) had abnormalities found at examination. Findings included genital warts, minor dermatological conditions and three cases of minor asymptomatic urological conditions. There were no clinically significant findings on examination of asymptomatic men who have sex with men requiring treatment, indicating that examination in this cohort may be of little benefit.

How to do it: setting up an asymptomatic screening pathway for men who have sex with men

“…BASHH2 therefore advise that services provide asymptomatic testing visits for MSM that are at convenient times and are efficient and easy to access to encourage regular attendances. They further state that examination is not required in asymptomatic MSM, as it is of limited value,5 6 and self-collected swabs are acceptable 2. New draft MSM guidance, out for consultation at the time of writing, provides the same recommendations 7.…”