Background Within sexual health clinics in the UK MSM are usually examined with clinician-taken swabs. In an effort to increase access and encourage regular screening, a minority of clinics across the UK are now using a fast-track asymptomatic pathway for MSM with patient-taken swabs. However the consequences of not examining asymptomatic MSM remain unclear.
Aim Would the introduction of a fast-track asymptomatic screening pathway for MSM lead to missed diagnoses or delayed or withheld treatment?
Method This was a retrospective case note review of all MSM attending our UK level 3 sexual health clinic between July 2011 and July 2012. Clinical findings, diagnoses and treatments given to asymptomatic MSM were analysed further.
Results 476 of 920 MSM attendances were asymptomatic presentations, of which 21 (4.4%) had positive findings on examination. Perianal abnormalities were detected in 1% (peri-anal warts n = 4, skin tags n = 1). Genital abnoramlities were penile warts (n = 2), epididymal cyst (n = 1), variocele (n = 1), unretractable foreskin (n = 1), and 3 dermatological finding (dry meatus, abrasion on penis and penile erythema). Contact bleeding on proctoscopy was found in 2 (0.4%) patients, and 7 (1.5%) cases of non-specific urethritis (NSU) were identified. All 9 of these cases were negative for Chlamydia trachomatis and Neisseria gonorrhoeae.
Conclusion Had the asymptomatic MSM attendances not involved examination, no significant clinical diagnoses would have been missed, or any treatment delayed or withheld. These findings suggest a fast-track asymptomatic screening pathway for MSM with patient-taken swabs could be introduced into UK sexual health clinics without concern. This in turn would increase sexual health screening for this high risk group. However consideration of missing perianal abnormalities in this group is needed as it may be of greater importance when compared to heterosexual males.
- asymptomatic screening
- men who have sex with men