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Assessing risk among MSM: service evaluation demonstrates feasibility of a single-question approach
  1. O Hennigan,
  2. G Whitlock
  1. Chelsea & Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr G Whitlock, Chelsea & Westminster Hospital, 56 Dean Street, Soho, London W1D 6AQ, UK; gary.whitlock{at}

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We evaluated the prevalence of sexually transmitted infections (STI) and their association with self-disclosed risk behaviour in men who have sex with men (MSM) attending a Central London sexual health service for asymptomatic STI screening.

Using computer touch screens, attenders enter data including demographics, number of sexual partners in the past 3 months and sexual history. All are asked the following question to assess for high-risk sexual behaviour: ‘Are you into any of these following: fisting, injecting, barebacking, chem sex’. These data are subsequently reviewed face-to-face by staff members later in the attendance and further information obtained.

During the 1 week between Monday, 3 August, and Saturday, 8 August 2015, we performed 913 asymptomatic screens in MSM at Dean Street Express, our asymptomatic screening service. We excluded 20 screens where there was an error in sample processing.

The median age of attenders was 32 years (IQR: 27–38 years). The median number of sexual partners in the previous 3 months was four (IQR: 0–6). The number of MSM with at least one asymptomatic STI (chlamydia, gonorrhoea, syphilis, HIV, hepatitis B and hepatitis C) was 20% (181/893), of which 1.1% (10/893) were newly diagnosed as HIV positive.

Thirty-one per cent (277) MSM identified themselves as high risk. Compared with low-risk MSM, high-risk MSM had a higher rate of all STIs (31% vs 15%, p<0.05) and HIV (2.2% vs 0.6%, p<0.05). Of the 277 high-risk MSM, 148 (53%) disclosed further details of risk: bareback sex (n=56), ‘chems’ (n=89) and fisting (n=28).

With one in five MSM attending our asymptomatic service being diagnosed with an STI, our evaluation supports the Public Health England statement that MSM have a high and increasing burden of STIs.1 MSM who disclose high-risk behaviour through their response to a single question have an increased risk of STIs. This allows us to identify those in need and offer them risk-reduction and further support.


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  • Contributors OH input the data. GW analysed the data and drafted for publication.

  • Competing interests None declared.

  • Ethics approval This is a service evaluation.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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