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Original research
An update on the performance of STI services for gay and bisexual men across European cities: results from the 2017 European MSM Internet Survey
  1. Jason Doran1,
  2. Peter Weatherburn1,
  3. Ford Hickson1,
  4. Ulrich Marcus2,
  5. David Reid1,
  6. Axel Jeremias Schmidt1
  1. 1Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
  2. 2Department of Infectious Diseases Epidemiology, Robert Koch Institut, Berlin, Germany
  1. Correspondence to Dr Axel Jeremias Schmidt, Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London WC1H 9SH, UK;{at}


Objectives Rectal STIs compromise health and are common in men who have sex with men (MSM). However, the European-MSM-Internet-Survey (EMIS-2010) showed that in 2010, the prevalence of anal swabbing during STI screening by MSM varied widely across 40 European cities. In this paper, we replicate a variety of measures of STI testing performance using 2017–18 data and extending the geographic spread of the analysis.

Methods Data were analysed from the EMIS-2017, a 33-language online sexual health survey accessible from 18 October 2017 to 31 January 2018. We focus on a subsample of 38 439 respondents living in the same 40 European cities we reported on in 2010. For a broader perspective, we also included an additional 65 cities in the analysis (combined n=56 661). We compared the prevalence of STI screening in MSM and disclosure of same-sex sexual contacts to the healthcare provider. We applied multivariable logistic regression models to compare the odds of MSM receiving each of four diagnostic procedures, including anal swabbing in the previous 12 months, controlling for age, HIV diagnosis, pre-exposure prophylaxis use and number of sexual partners.

Results In 2017, across 40 European cities, the proportion of respondents screened for STIs ranged from under 19% in Belgrade to over 59% in London. At an individual level, in comparison to London, the adjusted OR (AOR) of having received anal swabbing ranged from 0.03 in Belgrade, Bucharest and Istanbul to 0.80 in Oslo, with little evidence for a difference in Amsterdam and Dublin. Since 2010, most cities in West and South-west Europe have substantially narrowed their performance gap with London, but some in East and South-east Europe have seen the gap increase.

Conclusions Although comprehensive STI screening in MSM has expanded across many European cities, the low prevalence of anal swabbing indicates that rectal STIs continue to be underdiagnosed, particularly in East/South-east Europe.

  • homosexuality
  • screening
  • sexual health
  • policy
  • health services research

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  • Handling editor Tristan J Barber

  • Twitter @JasonRDoran, @sigmaresearch1

  • Correction notice The article has been corrected since it was published. The captions for Figures 1 and 3 have been updated.

  • Contributors JD performed the statistical analysis and wrote the manuscript. PW, AJS, UM, FH and DR designed EMIS-2017. FH and DR drafted and pretested the questionnaire; AJS co-ordinated the study and the EMIS network, led this paper, supervised the statistical analyses and co-wrote the manuscript. All authors contributed to the manuscript and agreed on the final version.

  • Funding EMIS-2017 was carried out as part of ESTICOM, under the service contract 2015 71 01 with The Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union. Other financial contributions were received from: Swedish Ministry of Health for recruitment in the Nordic Countries; The Arctic University of Norway and University Hospital of North Norway for Russia; Israel Ministry of Health for Israel; Public Health Agency of Canada for Canada; Office of the WHO Representative in the Philippines for the Philippines.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval EMIS-2017 received a favourable ethical opinion from the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine (review reference 14421/RR/8805) on 31 July 2017.

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

  • Data availability statement Data are available on reasonable request. EMIS data are not yet publicly available. For questions on data access, please contact

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