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HIV and sexually transmitted infection (STI) screening* recommendations

For Men who Have Sex with Men (MSM) and Transgender and Non-Binary (TG/NB) Persons Who Have Sex with Men

Clinicians should ask all patients the following questions:

  • What is your gender?+
  • What sex was recorded on your original birth certificate?+
  • Do you have sex with men, women, both men and women, or persons who are non-binary or of another gender?

  • Clinicians should perform at least annual HIV and STI screening on all sexually active MSM and TG/NB persons who have sex with men*. Sexually active MSM and TG/NB persons include those engaging in any anal, vaginal or oral sex. Screening should include the following tests:

    • HIV using a 4th generation serological test (if patient is not previously known to be HIV infected)
    • Serological testing for syphilis (i.e. RPR or other syphilis screening test)
    • Cervical gonorrhea and chlamydial infection among TG/NB persons with cervices who have vaginal sex; this can be done using vaginal or cervical specimens.
    • Clinicians should use shared decision-making to decide whether to test for rectal, pharyngeal, and urethral gonorrhea and chlamydial infection. Such testing should usually be done using a nucleic acid amplification test. ++

  • Repeat HIV and STI testing (as above) should be performed every 3-6 months in MSM and TG/NB persons who have sex with men with any of the following risks**:

    • Diagnosis of a bacterial STI in the prior year (gonorrhea, chlamydial infection or early syphilis)
    • Methamphetamine or popper (amyl nitrite) use in the prior year
    • >10 sex partners (anal or oral) in the prior year
    • Condomless anal intercourse with a partner of unknown or discordant HIV status in the prior year
    • Persons taking HIV pre-exposure prophylaxis (PrEP)

* Screening refers to testing in the absence of signs, symptoms or a known exposure to STI. Patients in long-term (> 1 year), mutually monogamous, HIV concordant relationships do not require HIV/STI screening.

+ Questions about current gender and sex at birth are ideally asked as part of clinic or office registration to allow appropriate recording of gender and pronouns in the medical record. 

++ Asymptomatic urethral gonorrhea is rare, while asymptomatic urethral chlamydial infections is more common. Clinicians should test for cervical gonorrhea and chlamydial infection on TG/NB persons with cervices who have vaginal sex; this can be done using vaginal or cervical specimens.

**Clinicians should offer HIV pre-exposure prophylaxis (PrEP) to all HIV-uninfected MSM and TG/NB persons who have sex with men, and should explicitly recommend PrEP to all MSM and TG/NB persons who have sex with men with any of the following risks: 1) diagnosis of gonorrhea or early syphilis in the prior year; 2) methamphetamine or popper use in the prior year; 3) history of providing money or drugs for sex in the prior year; or 4) a sex partner who is HIV-infected and not virally suppressed.

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