Approach to sexually transmitted infection testing for men who have sex with men

Objective To provide a guide on appropriate sexually transmitted infection (STI) testing for primary care providers to use with patients who identify as men who have sex with men (MSM).

Sources of information Canadian guidelines for STI testing and enteric and protozoan infections; Ontario guidelines for HIV screening and mpox; and US guidelines for STI testing.

Main message Across Canada rates of sexually transmitted bacterial, enteric, protozoan, and systemic infections—including HIV and mpox—have been steadily increasing among cisgender and transgender MSM. Despite often having similar clinical presentations, these infections have different incubation periods and testing approaches and must be ruled out effectively to guide diagnosis and treatment for MSM-identifying patients who present with symptoms of various conditions. Clinical information and screening recommendations, however, are often found in multiple guidelines rather than in a single source, thus further complicating these clinical encounters. This document provides a consolidated set of evidence and recommendations for STI testing in MSM.

Conclusion Testing approaches for STIs should be comprehensive and based on the patient’s reported risk factors and clinical presentation. Where ongoing STI risk is identified and negative laboratory test results are received, MSM should also be counselled on recommendations for repeat screening and HIV prevention services, such as preexposure prophylaxis.