STI Laboratory Testing and Treatment for Men Who Have Sex with Men

Laboratory Testing Protocol

The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) require comprehensive three-site testing for gonorrhea and chlamydia (urogenital, rectal, and pharyngeal) using nucleic acid amplification tests (NAATs), along with syphilis serology and HIV testing 1, 2
Gonorrhea and Chlamydia testing should include three-site NAAT testing: Urogenital (first-void urine specimen or urethral swab) 3, Rectal (rectal swab, even if asymptomatic) 4, and Pharyngeal (oropharyngeal swab, even if asymptomatic) 4
Syphilis screening should be performed using a treponemal-specific test first (EIA/chemiluminescence immunoassay) 4
HIV testing should be performed at the initial visit and repeated based on risk factors 4, 5

For uncomplicated urethritis/cervicitis (gonorrhea and/or chlamydia), the recommended treatment is Ceftriaxone 250 mg IM single dose for gonorrhea, plus azithromycin 1 gram orally single dose or doxycycline 100 mg orally twice daily for 7 days for chlamydia 6, 7
Dual therapy is recommended because coinfection rates are high, and routine cotreatment may prevent development of antimicrobial resistance 6
Quinolones (ciprofloxacin, ofloxacin) should not be used for gonorrhea treatment in MSM due to high rates of quinolone-resistant N. gonorrhoeae in this population 6

Sexual partners should be evaluated and treated if contact occurred within 60 days preceding symptom onset (or 60 days before testing for asymptomatic patients) 8, 3, 7
Patients should abstain from sexual activity until they and their partners complete treatment and are asymptomatic 8, 9

Patients should be reevaluated if symptoms persist after 3 days of treatment, requiring reassessment of diagnosis and therapy 8, 9
Test of cure is not routinely recommended unless symptoms persist, treatment compliance is questionable, or pregnancy is involved 6
Patients who "fail" therapy or have repeat positive tests are most likely reinfected by untreated partners rather than experiencing true treatment failure 1, 2