MSM sexual health

Question 1

Which subtype HPV is cause of anogenital warts?

Answer 1

6 and 11

Question 2

Which subtype HPV is associated with anal neoplasia?

Answer 2

16, 18, 31 and 33

Question 3

Where else might high risk HPV persist in MSM and what consequence may occur?

Answer 3

Oropharynx

Oropharyngeal squamous cell carcinoma

Question 4

What is the clinical significance of high risk HPV in MSM with HIV?

Answer 4

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

Question 5

What additional risk factor increases risk of AIN and anal cancer in hr HPV MSM?

Answer 5

Smoking

Question 6

Which group might regular digital anorectal examination be effective as screening for anal cancer?

Answer 6

HIV +ve MSM >50 yrs old

Question 7

When performing HPV vaccination what is the minimum interval between vaccination dose 0, 1 and 2?

Answer 7

0-1 = 1 month
1-2 = 3 month
typical 0, 2 and 6 months

Question 8

When performing HPV vaccination when should the vaccination course be completed?

Answer 8

aim within 1 year

within 2 year clinically acceptable

Question 9

What is the prevalence of hrHPV in MSM strongly associated with?

Answer 9

numbers of sexual partners

Question 10

In MSM 16-20 yr olds reporting no prior receptive anal sex, what proportion have HPV infection?

Answer 10

10%

Question 11

In MSM 16-20 yr olds reporting greater than 4 receptive anal partners, what proportion have HPV infection?

Answer 11

47%

Question 12

London study - MSM 18-40 - proportion with ONE q-vaccine HPV type?

Answer 12

25%

Question 13

London study - MSM 18-40 - proportion with TWO q-vaccine HPV typeS?

Answer 13

7% (hence rationale for vaccination)

Question 14

Efficacy of qHPV vaccine in 16–26-year-old MSM against AIN?

Answer 14

50%

Question 15

efficacy of qHPV vaccine - reduction of warts - in 16–26-year-old MSM?

Answer 15

70%

Question 16

What specific substance-use are a marker of increased STI risk?

Answer 16

Binge EToH
inhaled nitrates
methamphetamine
grade 1A

Question 17

What tests should be offered for MSM at all services?

Answer 17

NAAT for GC/CT
HIV
Syphilis
Hepatitis B
if indicated Hepatitis C

Question 18

What proportion of gonorrhoea diagnoses in men are in MSM?

Answer 18

70%

Question 19

What non-penile intercourse practices are related to extra-genital infection?

Answer 19

Rimming
Fingering
Fisting
Sex toy use

Question 20

What proportion of rectal and pharyngeal infection are asymptomatic?

Answer 20

Rectal 70-90%

Throat 95-100%

Question 21

Which pharyngeal STI is most likely to spontaneously resolve?

Answer 21

Gonorrhoea high incidence:prevalence ratio

Question 22

Which STI is most associated with oral sex?

Answer 22

Urethral Gonorrhoea
and
primary syphilis

Question 23

Which STI is most associated with anal sex?

Answer 23

Urethral chlamydia

Question 24

Which group of MSM have a higher rate of mgen compared to CT or GC infection?

Answer 24

HIV +ve MSM

Question 25

HSV-2 is a significant risk factor for HIV acquisition among MSM, does suppressive therapy with aciclovir reduce this risk?

Answer 25

No

Question 26

Should MSM be vaccinated for hepatitis A?

Answer 26

No | Only during outbreaks to higher risk groups or if co-infection HIV, HBV, HCV

Question 27

The presence of which other STIs is associated with hepatitis C infection in MSM?

Answer 27

Syphilis and LGV

Question 28

When should hepatitis C testing be offered to MSM?

Answer 28

``` Routinely if - sex associated with injury or IVDU Annually if - eligible for 3 monthly HIV test -on PrEP - HIV +ve ```

Question 29

What proportion of syphilis diagnoses in men are in MSM?

Answer 29

84%

Question 30

What are localised MSM syphilis outbreaks often linked to?

Answer 30

Geospatial social networking apps

Question 31

Which MSM should be offered 3 monthly STI testing?

Answer 31

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

Question 32

How effective is text message prompt at increasing STI testing?

Answer 32

Significantly increased re-attendance for testing

Question 33

Which bacterial organisms are implicated in sexually transmitted enteric infections?

Answer 33

``` Shigella flexneri 3a, 2a and sonnei Campylobacter Ecoli Salmonella Yersinia enterocolitica ```

Question 34

What other causes of enteric infections in MSM?

Answer 34

Hepatitis A | Parasites

Question 35

Describe the symptoms of proctitis

Answer 35

Rectal pain Discharge Bleeding +/- tenesmus

Question 36

Which pathogens are implicated in proctitis?

Answer 36

Chlamydia + LGV Gonorrhoea T pallidum HSV

Question 37

Describe the symptoms of enteritis

Answer 37

Diarrhoea Abdominal pain Dysentry (severe diarrhoea with blood and mucous)

Question 38

Describe microscopy findings in proctitis

Answer 38

>10 PMNLs/high power field

Question 39

If a person with proctitis tests positive for rectal chlamydia what else needs to be checked?

Answer 39

Test for LGV serovar

Question 40

What risk factors are associated with enteric infection?

Answer 40

Multiple partners Group sex Chemsex Using and sharing sex toys including oral contact Oro-anal contact including oro-penile sex after anal sex

Question 41

General advice on how to avoid enteric infection?

Answer 41

Wash hands, genitals, perineum before sex Use condoms, latex gloves, dental dams Avoid sharing sex toys or douching equipment

Question 42

What is the technique 'hot spotting' in partner notification used for?

Answer 42

To identify/treat an index case that is anonymous | Health promotion takes place at likely venues

Question 43

Which UK PrEP study looked at daily dosing PrEP?

Answer 43

PROUD study

Question 44

Which PrEP study looked at on demand dosing PrEP?

Answer 44

IPERGAY

Question 45

What proportion of people experience GI side effects on PrEP ?

Answer 45

<10%

Question 46

How long do side effects from PrEP take to resolve?

Answer 46

<1 month

Question 47

What percentage reduction in bone density is associated with PrEP?

Answer 47

1%

Question 48

Condomless anal sex rates - PrEP and no PrEP?

Answer 48

PrEP 21% | no PrEP 12%

Question 49

What proportion of HIV transmission is from undiagnosed men?

Answer 49

82%