Background Little is known about the epidemiology and burden of sexually transmitted infections (STI) in male commercial sex workers who have sex with men (MSM-CSWs) in the Netherlands and other Western countries. MSM-CSWs are often hard to reach for prevention and STI testing. This feasibility study aimed to reach MSM-CSWs, assess their socio-demographics and prevalence of HIV and other STI, and their risk profile.
Methods Retrospective, cross sectional study. Demographic and STI diagnosis data were retrieved from standardised medical records of MSM-CSWs consulted during outreach activities by a public health service in Southern Limburg, The Netherlands (2009 and 2010). Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were diagnosed by NAAT and serology was performed for HIV (HIV-Ag/Ab), syphilis (TPPA, FTA-ABS, VDRL) and hepatitis B (anti-HBc and HBsAg).
Results In 2009 and 2010 139 consultations by 99 MSM-CSW were performed. Their median age was 23.6 years; 56% of participants were of Romanian nationality, 20% of other (East) European nationality, 16% of South American nationality and 8% of Dutch nationality. Of participants, 50% self identified as homosexual, 33% as bisexual and 17% as heterosexual. All MSM-CSWs were tested for STI. Resultsof testing at first time consultation revealed that 45.5% was diagnosed with at least one STI—infection with CT was most prevalent (18.2%), followed by infection with NG (12.1%) and HIV (11.1%). Of participants, 24.2% had evidence of exposure to Treponema pallidum; half was infectious at time of diagnosis. Of participants, 28.3% had evidence of previous exposure to hepatitis B virus (anti-HBc positive); 8.1% was infectious at time of diagnosis (HBsAg positive). 24.2% was fully vaccinated against hepatitis B.
Conclusions Identification and recruitment for STI testing and prevention of this population at high risk for HIV and STI is shown to be feasible. Follow-up and retention appears to be a challenge. MSM-CSWs who have sex with men pose a serious STI acquisition and transmission risk regarding MSM-CSWs users. Further research is urgently required to address the needs of MSM-CSWs and explore prevention strategies. Furthermore, targeted health education to encourage safer sex is needed.