The data come from the European
Men Who Have Sex with Men Internet Survey (EMIS), which collected a wealth
of data from a large sample of men who have sex with men living in Europe in
For this analysis, data were included on 52,430 respondents
living in 40 large cities. Selected cities had both a population of over
500,000 and at least 300 survey respondents.
Overall 29.7% of respondents had been screened (i.e. had a
test for a sexually transmitted infection, in the absence of symptoms) in the
past year. The proportion ranged from 8.9% in Istanbul to 48.0% in Amsterdam.
Men who had been screened were then asked, in non-medical
language, what the screening consisted of.
Most men who had been screened said that they had given a
blood sample (92.1% overall, and over 85% in every city). Blood tests can detect HIV, syphilis and viral hepatitis.
“However, a blood test alone does not constitute a sexual
health screening, and a range of asymptomatic STIs will remain undiagnosed if
this is the only procedure performed”, comment the investigators.
In order to detect chlamydia or gonorrhoea in the penis, a
sample is needed either from urine or from a swab of the urethra (“having
something inserted into your penis”, in the language of the survey). However,
less than half (48.7%) of all screenings included such a procedure.
In a few cities, these procedures were common – Amsterdam, Birmingham,
London and Manchester (all above 88%).
But fewer than 40% of screened men reported the procedure in
the following cities – Athens, Barcelona, Belgrade, Budapest, Lyon, Milan,
Paris, Sofia, Valencia and Warsaw.
To diagnose rectal chlamydia or gonorrhoea, a sample is
needed from an anal swab, especially as there often aren’t noticeable symptoms.
But just 16.0% of screened men reported anal swabbing. The procedure was more
commonly reported by men living in Amsterdam, London and Manchester (all above
In contrast, fewer than 10% of men who had been screened in
the following cities had had an anal swab – Belgrade, Brussels, Bucharest, Istanbul,
Lyon, Paris, Porto, Valencia and Warsaw.
Similarly fewer than 20% of screened men in these cities
reported it – Athens, Barcelona, Budapest, Cologne/Bonn, Kiev, Lisbon, Milan,
Munich, Riga, Rome, Sofia, and Zurich.
Manifestations of anal or genital warts may only be identified
and treated if there is a physical examination of both the penis and anus.
However, this only occurred for 17.9% of the men who had been screened.
Performance was relatively good for men living in Amsterdam, Dublin, London, Manchester and Stockholm (all above 50%).
But fewer than 20% of screened men in these cities reported
a physical examination – Athens, Barcelona, Belgrade, Brussels, Bucharest,
Cologne/Bonn, Istanbul, Kiev, Lisbon, Lyon, Madrid, Milan, Munich, Paris,
Porto, Riga, Rome, Sofia, Tallinn, Valencia and Warsaw.
There was a strong correlation between anal swabs and
physical examinations – sexual health services appear to offer neither or both.
The authors note that gonorrhoea can be transmitted during
oral sex between men, and that throat swabs are needed to detect it, although their survey did not ask about this procedure.
All of the diagnostic procedures were more likely to be performed on
men with diagnosed HIV and men with a greater number of sexual partners.
Underlining the concern raised by the results, another
paper in Sexually Transmitted Infections demonstrates
that testing just one anatomical site will lead to infections being missed.
Over a three-year period clinicians in Geleen, the Netherlands tested all 2436 men
who have sex with men attending their STI clinic for chlamydia and gonorrhoea with samples from three sites – the
urethra, the rectum and the throat.
There were 254 cases of chlamydia and 154 of gonorrhoea. For both, a majority of infections were identified in samples from the rectum
and/or throat, but not the urethra –
68.5% and 76.0%, respectively.