JACKSONVILLE, FLA. — Positive test results for rectal gonorrhea and syphilis were common in asymptomatic men who have sex with men among patients seeking care at a large primary care clinic, according to a poster presentation at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
The researchers reviewed 21,784 medical visits to Fenway Community Health Center in Boston by men who have sex with men (MSM). Fenway is the largest primary care clinic for MSM in New England and is a participating site in the CDC's MSM Prevalence Monitoring Project. The nearly 22,000 visits by MSM were culled from years 2003 and 2004.
“This is a primary care clinic—so it is not MSM data from an STD clinic,” said Donna Helms, ORISE (Oak Ridge Institute for Science and Education) fellow in the Division of STD Prevention at the National Center for HIV, STD, and TB Prevention at the CDC. “This clinic also provides elderly care, cardiac care, and treats local university students seeking health care.”
Overall, 4,977 MSM (23%) were tested for an STD. The mean age was 38 years; 82% were white, 5% were black, 4% were Hispanic, and 9% selected other or nondisclosed ethnicity.
A total of 66% of those MSM tested for an STD were asymptomatic. “The asymptomatic were screened because we're seeing such high rates of gonorrhea and exposure to STDs. We screen those who report high-risk activity, such as no condom use or anonymous sex, and those who report exposure to STDs,” Ms. Helms said in an interview.
In total, 7% of the asymptomatic MSM tested positive for at least one STD, compared with a 20% positivity rate among symptomatic MSM. Ms. Helms and her associates examined positive results according to the reasons for testing. For example, 17% reported being exposed to an STD, 7% reported having high-risk sex, and 4% were detected during routine screening.
“Urethral gonorrhea and rectal gonorrhea positivity rates were high,” Ms. Helms said. Among all asymptomatic MSM tested, 10% had urethral gonorrhea and 6% had rectal gonorrhea. Other findings included seroreactivity for syphilis in 6% and pharyngeal gonorrhea in 2%.
Because of these findings, Ms. Helms recommended that MSM who report exposure to STDs or who engage in high-risk sexual activity should be screened for STDs. “We need a standardized questionnaire for screening, especially to identify the asymptomatic,” she added.