TY - JOUR AU - Schmidt, Axel J. AU - Rasi, Manuela AU - Esson, Cate AU - Christinet, Vanessa AU - Ritzler, Michael AU - Lung, Thomas AU - Hauser, Christoph V. AU - Stoeckle, Marcel AU - Jouinot, Florent AU - Lehner, Andreas AU - Lange, Katharina AU - Konrad, Torsten AU - Vernazza, Pietro PY - 2020/12/31 Y2 - 2024/03/29 TI - The Swiss STAR trial – an evaluation of target groups for sexually transmitted infection screening in the sub-sample of men JF - Swiss Medical Weekly JA - Swiss Med Wkly VL - 150 IS - 5153 SE - Original article DO - 10.4414/smw.2020.20392 UR - https://smw.ch/index.php/smw/article/view/2929 SP - w20392 AB - <p><strong>OBJECTIVES</strong> <p>In Switzerland, universal health insurance does not cover any routine testing for sexually transmitted infections (STIs), not even in individuals at high risk, and extra-genital swabbing is not standard of care. We determined the prevalence and incidence of human immunodeficiency virus (HIV), viral hepatitis and non-viral STIs in a multicentre prospective observational cohort of multi-partner men who have sex with men (MSM) and other men.</p> <strong>MATERIALS AND METHODS</strong> <p>Between January 2016 and June 2017, we offered free STI testing to all men with multiple sexual partners (three or more in the previous 12 months), with follow-up examinations every 6 months. We used multiplex polymerase chain-reaction testing (for<em> Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium</em>) on pooled swabs (pharynx, urethra/vagina, anus), and antibody tests for HIV and <em>Treponema pallidum</em> at every visit, and for hepatitis B/C at baseline.</p> <strong>RESULTS</strong> <p>We screened 779 multi-partner MSM and 92 other men. Previously undiagnosed HIV was found in 0.5% vs 0.0%, respectively and <em>T. pallidum</em> antibodies in 15.3% vs 1.1%. STIs requiring antibiotic treatment comprised: active syphilis 1.7% vs 0.0%; <em>N. gonorrhoeae</em> 10.3% vs 0.0%; <em>C. trachomatis</em> 8.7% vs 1.1%. One in four MSM versus 1 in 100 other multi-partner men had any of these three STIs at baseline. 10.4% vs 1.3% had a history of hepatitis B, 31.9% vs 47.3% had no immunity (HBs-AB &lt;10 IU/l). Ten MSM had HCV antibodies (1.4%), with 8 out of the 10 being MSM with HIV; HCV seroprevalence was 0.3% among HIV-negative MSM. In MSM, incidence of the three bacterial STIs was 25.5 per year over 333 person years of follow-up, HIV incidence was 0.3%. Non-condom-use (in the last 3 months) for anal/vaginal sex was not associated with STIs. Independent risk factors were sex with men (adjusted odds ratio [aOR] 16.4) and the number of sexual partners (aOR 2.3 for &gt;20).</p> <strong>CONCLUSION</strong> <p>Among MSM, but not among other multi-partner men, STIs, mostly asymptomatic, are common. Given the high risk of onward transmission, low-cost or free routine screening of multi-partner MSM is a public health priority.</p></p> ER -