From the Guidelines
For men who have sex with men (MSM), comprehensive STI testing should include swabs from multiple sites: throat, rectum, and urethra, as well as blood tests, with testing occurring regularly every 3-6 months or more frequently with multiple partners. To collect a throat swab, use a sterile swab to rub the tonsil area and back of the throat for 10-15 seconds, as this is a common site for asymptomatic infections 1. For rectal swabs, gently insert a moistened swab about 1-2 inches into the rectum, rotate against the rectal walls for 10-20 seconds, and withdraw, as rectal chlamydia and gonorrhea infections are common in MSM who engage in receptive anal intercourse 1. Urethral swabs involve inserting a small swab about 1 inch into the urethra, rotating gently, and removing, which is essential for detecting urethral chlamydia and gonorrhea infections in MSM who engage in insertive intercourse.
Some key points to consider when swabbing for STIs in MSM include:
- Self-collection is often possible for throat and rectal swabs, which can increase testing frequency and reduce barriers to care 1.
- Abstaining from urinating for at least one hour before urethral testing improves accuracy, as urine can contaminate the swab and reduce the sensitivity of the test.
- Regular testing is crucial because early detection allows for prompt treatment, preventing complications and reducing transmission to partners, particularly in high-risk individuals with multiple or anonymous partners, or those who engage in sex in conjunction with illicit drug use 1.
- Many clinics now offer self-collection options in private settings, which can increase testing frequency and reduce barriers to care.
- It's essential to test all potential exposure sites because infections can be present without symptoms, particularly in the throat and rectum, and asymptomatic infections can still be transmitted to partners 1.
From the Research
STI Screening for Men Who Have Sex with Men
To swab for STIs in men who have sex with men, the following steps can be taken:
- The US Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3-6 months for men who have sex with men (MSM) using human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) 2
- Screening should include tests for gonorrhea, chlamydia, syphilis, and other STIs
- Nucleic acid amplification tests (NAATs) can be used to diagnose gonorrhea and chlamydia, and can be performed on self-collected specimens such as urine or rectal swabs 3
- Pharyngeal and rectal swabs may also be necessary to detect infections in these areas 2
Anatomic Sites for Swabbing
The following anatomic sites should be considered for swabbing:
- Urethra: for diagnosis of gonorrhea and chlamydia
- Rectum: for diagnosis of gonorrhea and chlamydia
- Pharynx: for diagnosis of gonorrhea
- Blood sample: for diagnosis of syphilis and other STIs
Frequency of Screening
The frequency of screening for STIs in men who have sex with men should be: