From the Guidelines
Rectal swabs are recommended for sexually active men who have sex with men (MSM) as part of comprehensive sexually transmitted infection (STI) screening, particularly for those who engage in receptive anal intercourse. This recommendation is based on the high risk of asymptomatic infections such as gonorrhea and chlamydia in the rectum, which can cause complications if left untreated 1. The screening guidelines suggest that sexually active adolescent and young adult MSM should be screened for pharyngeal, rectal, and urethral gonorrhea infection annually if engaging in receptive oral or anal intercourse or insertive intercourse, respectively 1. Some key points to consider include:
- The frequency of screening should be every 3 to 6 months if the individual is at high risk due to multiple or anonymous partners, sex in conjunction with illicit drug use, or having sex partners who participate in these activities 1.
- The testing involves inserting a cotton swab about 1-2 inches into the rectum and rotating it gently against the rectal walls to collect a sample.
- This targeted approach to STI screening helps identify infections that might otherwise go undetected with urine testing alone, allowing for appropriate treatment and preventing further transmission.
- Rectal swabs should be performed based on sexual practices and exposure risk rather than sexual identity alone. It is essential to prioritize the individual's sexual practices and exposure risk when determining the need for rectal swabs, rather than their sexual orientation 1.
From the Research
Rectal Swabs for Homosexual Men
- The Centers for Disease Control and Prevention (CDC) recommends screening for sexually transmitted infections (STIs) at all anatomic sites for men who have sex with men (MSM) 2.
- A study found that among MSM prescribed pre-exposure prophylaxis (PrEP), 55.9% were screened for rectal gonorrhea/chlamydia, and positivity rates were 11.1% for gonorrhea and 11.7% for chlamydia 2.
- Another study found that rectal samples had a higher positivity rate (10%) compared to urogenital specimens (2%) 3.
- The CDC guidelines recommend testing for gonorrhea and chlamydia at all anatomic sites, including the rectum, for individuals at high risk of STIs, such as MSM 4, 5, 6.
Recommendations for STI Screening
- The CDC recommends biannual screening for syphilis and gonorrhea/chlamydia at all anatomic sites for MSM PrEP users 2.
- A thorough evaluation for STIs, including rectal swabs, is essential for individuals at high risk of STIs, such as MSM 3, 6.
- Providers should consider offering screening based on sexual practices, and clarification of STI screening guidelines for PrEP users is needed 2.