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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

Recommendations

  • Sexual orientation and gender identity

    In order to determine the need for and frequency of HIV and STI testing, clinicians should ask every patient about their sexual orientation and gender identity. In addition, clinicians should inquire about which body parts patients use for sex and the gender and sexual anatomy of patients’ sex partners. This information will help to most accurately frame shared decision-making discussions around HIV and STI screening.

  • Annual STI and HIV screening

    Clinicians should perform at least annual STI and HIV (if not previously diagnosed with HIV) screening* on all sexually active MSM and TNB persons who have sex with men. Sexually active MSM and TNB persons include those engaging in any anal, vaginal/frontal or oral sex. Screening should include the following tests:

    • HIV using a 4th generation (antigen/antibody) serological test, if the patient is not previously known to have HIV.
    • Serological testing for syphilis (i.e. RPR or other syphilis screening test).
    • For TNB people with a cervix who have vaginal/frontal sex, vaginal or cervical swabs for gonorrhea and chlamydia nucleic acid amplification.
    • Discussion of screening for rectal, pharyngeal, and urethral gonorrhea and chlamydial infection++ with testing performed based on shared decision-making. Such screening is usually done using a nucleic acid amplification test.

  • Repeat HIV and syphilis testing

    Repeat HIV and syphilis testing (as above) should be performed every 3-6 months in MSM and TNB 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 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)

  • Decision-making on repeat gonorrhea and chlamydial screening

    Whether and how often to perform repeat gonorrhea and chlamydial screening among patients without a cervix should be based on shared decision-making.

* 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.

++ Asymptomatic urethral gonorrhea is rare, while asymptomatic urethral chlamydial infection is more common.

** Clinicians should offer HIV PrEP to all HIV-negative MSM and TNB persons who have sex with men, and should explicitly recommend PrEP to all MSM and TNB persons who have sex with men with any of the following risks in the prior year: 1) diagnosis of gonorrhea or early syphilis; 2) methamphetamine use; 3) condomless receptive anal sex with someone other than a mutually monogamous partner; 4) history of exchanging sex for money, drugs or

  • Clinicians should also recommend that patients initiate PrEP if they have partner who is not virally suppressed.
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