MSM sexual health Flashcards
Which subtype HPV is cause of anogenital warts?
6 and 11
Which subtype HPV is associated with anal neoplasia?
16, 18, 31 and 33
Where else might high risk HPV persist in MSM and what consequence may occur?
Oropharynx
Oropharyngeal squamous cell carcinoma
What is the clinical significance of high risk HPV in MSM with HIV?
higher frequency of hrHPV persistence of hrHPV increased incidence anal dysplasia increased progression to AIN and anal cancer increased relapse of AIN and anal cancer
What additional risk factor increases risk of AIN and anal cancer in hr HPV MSM?
Smoking
Which group might regular digital anorectal examination be effective as screening for anal cancer?
HIV +ve MSM >50 yrs old
When performing HPV vaccination what is the minimum interval between vaccination dose 0, 1 and 2?
0-1 = 1 month
1-2 = 3 month
typical 0, 2 and 6 months
When performing HPV vaccination when should the vaccination course be completed?
aim within 1 year
within 2 year clinically acceptable
What is the prevalence of hrHPV in MSM strongly associated with?
numbers of sexual partners
In MSM 16-20 yr olds reporting no prior receptive anal sex, what proportion have HPV infection?
10%
In MSM 16-20 yr olds reporting greater than 4 receptive anal partners, what proportion have HPV infection?
47%
London study - MSM 18-40 - proportion with ONE q-vaccine HPV type?
25%
London study - MSM 18-40 - proportion with TWO q-vaccine HPV typeS?
7% (hence rationale for vaccination)
Efficacy of qHPV vaccine in 16–26-year-old MSM against AIN?
50%
efficacy of qHPV vaccine - reduction of warts - in 16–26-year-old MSM?
70%
What specific substance-use are a marker of increased STI risk?
Binge EToH
inhaled nitrates
methamphetamine
grade 1A
What tests should be offered for MSM at all services?
NAAT for GC/CT HIV Syphilis Hepatitis B if indicated Hepatitis C
What proportion of gonorrhoea diagnoses in men are in MSM?
70%
What non-penile intercourse practices are related to extra-genital infection?
Rimming
Fingering
Fisting
Sex toy use
What proportion of rectal and pharyngeal infection are asymptomatic?
Rectal 70-90%
Throat 95-100%
Which pharyngeal STI is most likely to spontaneously resolve?
Gonorrhoea high incidence:prevalence ratio
Which STI is most associated with oral sex?
Urethral Gonorrhoea
and
primary syphilis
Which STI is most associated with anal sex?
Urethral chlamydia
Which group of MSM have a higher rate of mgen compared to CT or GC infection?
HIV +ve MSM
HSV-2 is a significant risk factor for HIV acquisition among MSM, does suppressive therapy with aciclovir reduce this risk?
No
Should MSM be vaccinated for hepatitis A?
No
Only during outbreaks to higher risk groups or if co-infection HIV, HBV, HCV
The presence of which other STIs is associated with hepatitis C infection in MSM?
Syphilis and LGV
When should hepatitis C testing be offered to MSM?
Routinely if - sex associated with injury or IVDU Annually if - eligible for 3 monthly HIV test -on PrEP - HIV +ve
What proportion of syphilis diagnoses in men are in MSM?
84%
What are localised MSM syphilis outbreaks often linked to?
Geospatial social networking apps
Which MSM should be offered 3 monthly STI testing?
UAI with unknown/serodiscordant HIV status past 12 months
>10 sexual partners past 12 months
Drug use past 6 months
multiple or anonymous partners
any unprotected sexual contact since last test
treatment for STI past 12 months
How effective is text message prompt at increasing STI testing?
Significantly increased re-attendance for testing
Which bacterial organisms are implicated in sexually transmitted enteric infections?
Shigella flexneri 3a, 2a and sonnei Campylobacter Ecoli Salmonella Yersinia enterocolitica
What other causes of enteric infections in MSM?
Hepatitis A
Parasites
Describe the symptoms of proctitis
Rectal pain
Discharge
Bleeding
+/- tenesmus
Which pathogens are implicated in proctitis?
Chlamydia + LGV
Gonorrhoea
T pallidum
HSV
Describe the symptoms of enteritis
Diarrhoea
Abdominal pain
Dysentry (severe diarrhoea with blood and mucous)
Describe microscopy findings in proctitis
> 10 PMNLs/high power field
If a person with proctitis tests positive for rectal chlamydia what else needs to be checked?
Test for LGV serovar
What risk factors are associated with enteric infection?
Multiple partners
Group sex
Chemsex
Using and sharing sex toys including oral contact
Oro-anal contact including oro-penile sex after anal sex
General advice on how to avoid enteric infection?
Wash hands, genitals, perineum before sex
Use condoms, latex gloves, dental dams
Avoid sharing sex toys or douching equipment
What is the technique ‘hot spotting’ in partner notification used for?
To identify/treat an index case that is anonymous
Health promotion takes place at likely venues
Which UK PrEP study looked at daily dosing PrEP?
PROUD study
Which PrEP study looked at on demand dosing PrEP?
IPERGAY
What proportion of people experience GI side effects on PrEP ?
<10%
How long do side effects from PrEP take to resolve?
<1 month
What percentage reduction in bone density is associated with PrEP?
1%
Condomless anal sex rates - PrEP and no PrEP?
PrEP 21%
no PrEP 12%
What proportion of HIV transmission is from undiagnosed men?
82%
