Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Prevalence of sexually transmissible infections and HIV in men attending sex-on-premises venues in Australia: a systematic review and meta-analysis of observational studies

Catriona Ooi A B F , Fabian Y. S. Kong C , David A. Lewis D E and Jane S. Hocking C
+ Author Affiliations
- Author Affiliations

A Clinic 16, 2C Herbert Street, St Leonards, NSW 2065, Australia.

B Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW 2006, Australia.

C Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Parkville, Vic. 3010, Australia.

D Western Sydney Sexual Health Centre, 162 Marsden Street, Parramatta, NSW 2150, Australia.

E Westmead Clinical School, Faculty of Health and Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Darcy Road, Westmead, NSW 2145, Australia.

F Corresponding author. Email: catriona.ooi@health.nsw.gov.au

Sexual Health 17(2) 135-148 https://doi.org/10.1071/SH19150
Submitted: 30 August 2019  Accepted: 23 December 2019   Published: 31 March 2020

Abstract

Background: In Australia, men who have sex with men (MSM) have high rates sexually transmissible infections (STIs) and sex-on-premises venue (SOPV) patrons are at risk. This paper assesses Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis and HIV prevalence in men tested at Australian SOPVs and describes testing services. Methods: EMBASE, Medline, PubMed and international conference proceedings were searched for articles reporting on-site SOPV testing between 1 January 2000 and 31 January 2017. Meta-analysis calculated pooled prevalence estimates of STIs by anatomical site. Results: Twelve cross-sectional studies were identified. Most (8/12) were local sexual health clinics (SHC) outreach services. Participants’ mean age was 41.1 years (95% confidence interval (CI) 37.0–43.3; range 17 to 84 years). Testing included CT and NG (9/12), HIV (8/12) and syphilis (5/12). CT and NG prevalence overall summary estimates were 3.4% (95% CI 1.9–5.2%, I2 = 88.7%, P < 0.01) and 1.3% (95% CI 0.7–2.2%, I2 = 75.5%, P < 0.01) respectively. CT and NG prevalence was highest in the ano-rectum and oro-pharynx respectively. The HIV and syphilis pooled estimates were 2.3% (95% CI 1.6–2.9%, I2 = 93.1%, P < 0.01) and 3.2% (95% CI 1.8–4.6%, I2 = 72.8%, P < 0.01) respectively. Participation rate varied. Conclusion: This review examines HIV and STI testing in Australian SOPVs before HIV pre-exposure prophylaxis (PrEP). Findings indicate a high prevalence of STIs. PrEP use and resultant condomless sex may influence STI prevalence. Further research is required to determine the effect of PrEP on the STI prevalence among SOPV patrons.

Additional keywords: chlamydia, gonorrhoea, outreach, screening, syphilis.


References

[1]  The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2017. Kensington: University of New South Wales; 2017.

[2]  The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2014. HIV supplement. Kensington: The Kirby Institute, University of New South Wales; 2014.

[3]  Ward H, Ronn M. Contribution of sexually transmitted infections to the sexual transmission of HIV. Curr Opin HIV AIDS 2010; 5 305–10.
Contribution of sexually transmitted infections to the sexual transmission of HIV.Crossref | GoogleScholarGoogle Scholar | 20543605PubMed |

[4]  Zetola NM, Bernstein KT, Wong E, Louie B, Klausner JD. Exploring the relationship between sexually transmitted diseases and HIV acquisition by using different study designs. J Acquir Immune Defic Syndr 2009; 50 546–51.
Exploring the relationship between sexually transmitted diseases and HIV acquisition by using different study designs.Crossref | GoogleScholarGoogle Scholar | 19367993PubMed |

[5]  Santella AJ, Schlub TE, Ooi C, Varma R, Holt M, Prestage G, et al Sexual behaviour and HIV prevention needs of men attending a suburban sex on premises venue. Sex Health 2015; 12 383–9.
Sexual behaviour and HIV prevention needs of men attending a suburban sex on premises venue.Crossref | GoogleScholarGoogle Scholar | 26188482PubMed |

[6]  Grierson J, Smith AMA, von Doussa H. An ordinary night out. A report on the research project Pivotal, Peripheral or Positional: understanding SOPVs for intervention, monograph number 68. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University; 2008.

[7]  Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11 217–29.
Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence.Crossref | GoogleScholarGoogle Scholar | 24690473PubMed |

[8]  Wilkinson AL, El-Hayek C, Spelman T, Fairley CK, Leslie D, McBryde ES, et al A ‘test and treat’ prevention strategy in Australia requires innovative HIV testing models: a cohort study of repeat testing among ‘high-risk’ men who have sex with men. Sex Transm Infect 2016; 92 464–6.
A ‘test and treat’ prevention strategy in Australia requires innovative HIV testing models: a cohort study of repeat testing among ‘high-risk’ men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 26801226PubMed |

[9]  Conway DP, Holt M, Couldwell DL, Smith DE, Davies SC, McNulty A, et al Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney. J Int AIDS Soc 2015; 18 20221
Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney.Crossref | GoogleScholarGoogle Scholar | 26318960PubMed |

[10]  Zablotska I, Holt M, de Wit J, McKechnie M, Mao L, Prestage G. Gay men who are not getting tested for HIV. AIDS Behav 2012; 16 1887–94.
Gay men who are not getting tested for HIV.Crossref | GoogleScholarGoogle Scholar | 22538372PubMed |

[11]  Holt M, Hull P, Lea T, Guy R, Bourne C, Prestage G, et al Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003–2012. Sex Transm Infect 2014; 90 208–15.
Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003–2012.Crossref | GoogleScholarGoogle Scholar | 24234070PubMed |

[12]  Pell C, Donohoe S, Conway D. Health care services for men who have sex with men in different Australian states and territories since the emergence of HIV. Sex Health 2008; 5 161–8.
Health care services for men who have sex with men in different Australian states and territories since the emergence of HIV.Crossref | GoogleScholarGoogle Scholar | 18588781PubMed |

[13]  Knight V, Gale M, Guy R, Parkhill N, Holden J, Leeman C, et al A novel time-limited pop-up HIV testing service for gay men in Sydney, Australia, attracts high-risk men. Sex Health 2014; 11 345–50.
A novel time-limited pop-up HIV testing service for gay men in Sydney, Australia, attracts high-risk men.Crossref | GoogleScholarGoogle Scholar | 25163573PubMed |

[14]  Bingham TA, Secura GM, Behel SK, Bunch JG, Simon PA, MacKellar DA. HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001–2002. Sex Transm Dis 2008; 35 631–6.
HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001–2002.Crossref | GoogleScholarGoogle Scholar | 18545142PubMed |

[15]  Binson D, Woods WJ, Pollack L, Paul J, Stall R, Catania JA. Differential HIV risk in bathhouses and public cruising areas. Am J Public Health 2001; 91 1482–6.
Differential HIV risk in bathhouses and public cruising areas.Crossref | GoogleScholarGoogle Scholar | 11527785PubMed |

[16]  Melendez-Torres GJ, Nye E, Bonell C. Is location of sex associated with sexual risk behaviour in men who have sex with men? Systematic review of within-subjects studies. AIDS Behav 2016; 20 1219–27.
Is location of sex associated with sexual risk behaviour in men who have sex with men? Systematic review of within-subjects studies.Crossref | GoogleScholarGoogle Scholar | 25972073PubMed |

[17]  Pastuszczak M, Bociaga-Jasik M, Sitko M, Wojas-Pelc A. HIV infection and sex in sex-on-premises venues are associated with a higher risk of syphilis reinfection among men who have sex with men. Postepy Dermatol Alergol 2018; 35 481–4.
HIV infection and sex in sex-on-premises venues are associated with a higher risk of syphilis reinfection among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 30429705PubMed |

[18]  Zhao J, Chen L, Cai WD, Tan JG, Tan W, Zheng CL, et al HIV infection and sexual behaviors among non-commercial men who have sex with men at different venues. Arch Sex Behav 2014; 43 801–9.
HIV infection and sexual behaviors among non-commercial men who have sex with men at different venues.Crossref | GoogleScholarGoogle Scholar | 23982566PubMed |

[19]  Wood M, Ellks R, Grobicki M. Outreach sexual infection screening and postal tests in men who have sex with men: are they comparable to clinic screening? Int J STD AIDS 2015; 26 428–31.
Outreach sexual infection screening and postal tests in men who have sex with men: are they comparable to clinic screening?Crossref | GoogleScholarGoogle Scholar | 24912535PubMed |

[20]  Hengel B, Jamil MS, Mein JK, Maher L, Kaldor JM, Guy RJ. Outreach for chlamydia and gonorrhoea screening: a systematic review of strategies and outcomes. BMC Public Health 2013; 13 1040
Outreach for chlamydia and gonorrhoea screening: a systematic review of strategies and outcomes.Crossref | GoogleScholarGoogle Scholar | 24188541PubMed |

[21]  Lea T, Murphy D, Rosengarten M, Kippax K, de Wit J, Schmidt H, et al. Gay men’s attitudes to biomedical HIV prevention: key findings from the PrEPARE Project 2015. Sydney: Centre for Social Research in Health, UNSW Australia; 2015.

[22]  Hardwick C, White D, Osman H. An audit of the results of the Roche Amplicor gonorrhoea test on female genital samples–a cheaper and more sensitive method than culture in an urban English population. Int J STD AIDS 2007; 18 347–8.
An audit of the results of the Roche Amplicor gonorrhoea test on female genital samples–a cheaper and more sensitive method than culture in an urban English population.Crossref | GoogleScholarGoogle Scholar | 17524199PubMed |

[23]  Bromhead C, Miller A, Jones M, Whiley D. Comparison of the cobas 4800 CT/NG test with culture for detecting Neisseria gonorrhoeae in genital and nongenital specimens in a low-prevalence population in New Zealand. J Clin Microbiol 2013; 51 1505–9.
Comparison of the cobas 4800 CT/NG test with culture for detecting Neisseria gonorrhoeae in genital and nongenital specimens in a low-prevalence population in New Zealand.Crossref | GoogleScholarGoogle Scholar | 23467604PubMed |

[24]  Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 557–60.
Measuring inconsistency in meta-analyses.Crossref | GoogleScholarGoogle Scholar | 12958120PubMed |

[25]  Lau A, Kong FYS, Huston W, Chow EPF, Fairley CK, Hocking JS. Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis. Sex Transm Infect 2019; 95 361–7.
Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 31097677PubMed |

[26]  Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011; 343 d4002
Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials.Crossref | GoogleScholarGoogle Scholar | 21784880PubMed |

[27]  Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol 2007; 36 666–76.
Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography.Crossref | GoogleScholarGoogle Scholar | 17470488PubMed |

[28]  Currie M, Del Rosario R, Martin S, Tyson A, Morgan D, Todkill M, et al. Home and away: comparing in-clinic and outreach chlamydia testing. Proceedings of the 2011 Australasian Sexual Health Conference; 28–30 September 2011; Canberra, ACT, Australia. Darlinghurst, NSW: Australasian Society for HIV Medicine; 2011.

[29]  Del Rosario R, Currie M, Tyson A, Martin S, Morgan D, Fairall D, et al. Outreach clinics: uncovering undetected HIV and STIs in the community. Proceedings of the Australasian HIV and AIDS Conference; 26–28 September 2011; Canberra, ACT, Australia. Darlinghurst, NSW: Australasian Society for HIV Medicine; 2011.

[30]  Del Rosario R, Currie M, Tyson A, Morgan D, Fairall D, Habel P, et al. THE ACT PACT Program: finding HIV and sexually transmitted infections through outreach clinics. Proceedings of the Australasian HIV and AIDs Conference; 23–25 October 2013; Darwin, NT, Australia. Darlinghurst, NSW: Australasian Society for HIV Medicine; 2013.

[31]  Bennett C, Knight V, Knox D, Gray J, Hartmann G, McNulty A. An alternative model of sexually transmissible infection testing in men attending a sex-on-premises venue in Sydney: a cross-sectional descriptive study. Sex Health 2016; 13 353–8.
An alternative model of sexually transmissible infection testing in men attending a sex-on-premises venue in Sydney: a cross-sectional descriptive study.Crossref | GoogleScholarGoogle Scholar |

[32]  Lister NA, Smith A, Tabrizi S, Hayes P, Medland NA, Garland S, et al Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men at male-only saunas. Sex Transm Dis 2003; 30 886–9.
Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men at male-only saunas.Crossref | GoogleScholarGoogle Scholar | 14646635PubMed |

[33]  Lister NA, Smith A, Tabrizi SN, Garland S, Hayes P, Fairley CK. Comprehensive clinical care on-site in men-only saunas: confidential STI/HIV screening outreach clinic. Int J STD AIDS 2005; 16 794–8.
Comprehensive clinical care on-site in men-only saunas: confidential STI/HIV screening outreach clinic.Crossref | GoogleScholarGoogle Scholar | 16336760PubMed |

[34]  Ooi C, Lewis D. Sexual health screening at a unique suburban sex on premises venue in Sydney, Australia. Proceedings of the 17th IUSTI World Congress; 9–12 May 2016; Marrakesh, Morocco. Rabat, Morocco: Institut National d’Hygiene; 2016.

[35]  Birrell F, Staunton S, Debattista J, Roudenko N, Rutkin W, Davis C. Pilot of non-invasive (oral fluid) testing for HIV within a community setting. Sex Health 2010; 7 11–6.
Pilot of non-invasive (oral fluid) testing for HIV within a community setting.Crossref | GoogleScholarGoogle Scholar | 20152090PubMed |

[36]  Holt M, Lea T, Asselin J, Hellard M, Prestage G, Wilson D, et al The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community-based, bio-behavioural survey. J Int AIDS Soc 2015; 18 20526
The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community-based, bio-behavioural survey.Crossref | GoogleScholarGoogle Scholar | 26563846PubMed |

[37]  Pedrana AE, Hellard ME, Wilson K, Guy R, Stoove M. High rates of undiagnosed HIV infections in a community sample of gay men in Melbourne, Australia. J Acquir Immune Defic Syndr 2012; 59 94–9.
High rates of undiagnosed HIV infections in a community sample of gay men in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 21992925PubMed |

[38]  Currie MJ, Martin SJ, Soo TM, Bowden FJ. Screening for chlamydia and gonorrhoea in men who have sex with men in clinical and non-clinical settings. Sex Health 2006; 3 123–6.
Screening for chlamydia and gonorrhoea in men who have sex with men in clinical and non-clinical settings.Crossref | GoogleScholarGoogle Scholar | 16800399PubMed |

[39]  Sturrock CJ, Currie MJ, Vally H, O’Keefe EJ, Primrose R, Habel P, et al Community-based sexual health care works: a review of the ACT outreach program. Sex Health 2007; 4 201–4.
Community-based sexual health care works: a review of the ACT outreach program.Crossref | GoogleScholarGoogle Scholar | 17931534PubMed |

[40]  Debattista J, Dwyer J, Anderson R, Rowling D, Patten J, Mortlock M. Screening for syphilis among men who have sex with men in various clinical settings. Sex Transm Infect 2004; 80 505–8.
Screening for syphilis among men who have sex with men in various clinical settings.Crossref | GoogleScholarGoogle Scholar | 15572624PubMed |

[41]  Dwyer J, Patten J, Debattista J, Lister G, Orth D. Community screening for Neisseria gonorrhoeae and Chlamydia trachomatis among patrons of sex-on-premises venues: two years later. Venereology 2000; 13 105–9.

[42]  Holt M, Mao L, Prestage G, Zablotska I, de Wit J. Gay community periodic surveys: national report 2010. Sydney: National Centre in HIV Social Research, The University of New South Wales; 2011.

[43]  Chan D, Stewart M, Smith M, Price T, Lusk J, Ooi C, et al The rise of targeted HIV oral rapid testing in Australia. Med J Aust 2015; 202 251–5.
The rise of targeted HIV oral rapid testing in Australia.Crossref | GoogleScholarGoogle Scholar | 25758695PubMed |

[44]  Pilcher CD, Louie B, Facente S, Keating S, Hackett J, Vallari A, et al Performance of rapid point-of-care and laboratory tests for acute and established HIV infection in San Francisco. PLoS One 2013; 8 e80629
Performance of rapid point-of-care and laboratory tests for acute and established HIV infection in San Francisco.Crossref | GoogleScholarGoogle Scholar | 24349007PubMed |

[45]  Emerson C, McCarty E, Fyfe J, Wilson Y, Cullen B. Reaching men in saunas HIV Med 2010; 11 100

[46]  Jin F, Prestage GP, Mao L, Kippax SC, Pell CM, Donovan B, et al Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: The Health in Men Study. Sex Transm Infect 2007; 83 113–9.
Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: The Health in Men Study.Crossref | GoogleScholarGoogle Scholar | 17005541PubMed |

[47]  Jin F, Prestage GP, Zablotska I, Rawstorne P, Kippax SC, Donovan B, et al High rates of sexually transmitted infections in HIV positive homosexual men: data from two community based cohorts. Sex Transm Infect 2007; 83 397–9.
High rates of sexually transmitted infections in HIV positive homosexual men: data from two community based cohorts.Crossref | GoogleScholarGoogle Scholar | 17556503PubMed |

[48]  Mayer KH, Ducharme R, Zaller ND, Chan PA, Case P, Abbott D, et al Unprotected sex, underestimated risk, undiagnosed HIV and sexually transmitted diseases among men who have sex with men accessing testing services in a New England bathhouse. J Acquir Immune Defic Syndr 2012; 59 194–8.
Unprotected sex, underestimated risk, undiagnosed HIV and sexually transmitted diseases among men who have sex with men accessing testing services in a New England bathhouse.Crossref | GoogleScholarGoogle Scholar | 22027871PubMed |

[49]  O’Byrne P, Dias R. Urine drop-off testing: a self-directed method for STI screening and prevention. Can J Hum Sex 2008; 17 53–59.

[50]  Callander D, Donovan B, Guy R. The Australian collaboration for coordinated enhanced sentinel surveillance of sexually transmissible infections and blood borne viruses: NSW STI report 2007–2014. Sydney: Kirby Institute, The University of New South Wales; 2015.

[51]  Jin F, Prestage GP, Mao L, Kippax SC, Pell CM, Donovan B, et al Transmission of herpes simplex virus types 1 and 2 in a prospective cohort of HIV-negative gay men: the health in men study. J Infect Dis 2006; 194 561–70.
Transmission of herpes simplex virus types 1 and 2 in a prospective cohort of HIV-negative gay men: the health in men study.Crossref | GoogleScholarGoogle Scholar | 16897652PubMed |

[52]  Templeton DJ, Jin F, Imrie J, Prestage GP, Donovan B, Cunningham PH, et al Prevalence, incidence and risk factors for pharyngeal chlamydia in the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia. Sex Transm Infect 2008; 84 361–3.
Prevalence, incidence and risk factors for pharyngeal chlamydia in the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 18596068PubMed |

[53]  Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999; 75 3–17.
From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection.Crossref | GoogleScholarGoogle Scholar | 10448335PubMed |

[54]  van Griensven GJ, van den Hoek JA, Leentvaar A, Coutinho RA. Surrogate markers for HIV incidence among homosexual men. J Infect Dis 1989; 159 1157–8.
Surrogate markers for HIV incidence among homosexual men.Crossref | GoogleScholarGoogle Scholar | 2723458PubMed |

[55]  Prestage G, Ferris J, Grierson J, Thorpe R, Zablotska I, Imrie J, et al Homosexual men in Australia: population, distribution and HIV prevalence. Sex Health 2008; 5 97–102.
Homosexual men in Australia: population, distribution and HIV prevalence.Crossref | GoogleScholarGoogle Scholar | 18588772PubMed |

[56]  Prestage G, Jin F, Zablotska I, Imrie J, Kaldor JM, Grulich AE. Trends in HIV prevalence among homosexual and bisexual men in eastern Australian states. Sex Health 2008; 5 103–7.
Trends in HIV prevalence among homosexual and bisexual men in eastern Australian states.Crossref | GoogleScholarGoogle Scholar | 18588773PubMed |

[57]  MacKellar DA, Hou SI, Whalen CC, Samuelsen K, Sanchez T, Smith A, et al Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV. Sex Transm Dis 2011; 38 419–28.
Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV.Crossref | GoogleScholarGoogle Scholar | 21183863PubMed |

[58]  Barbee LA, Dhanireddy S, Tat SA, Marrazzo JM. Barriers to bacterial sexually transmitted infection testing of HIV-infected men who have sex with men engaged in HIV primary care. Sex Transm Dis 2015; 42 590–594.
Barriers to bacterial sexually transmitted infection testing of HIV-infected men who have sex with men engaged in HIV primary care.Crossref | GoogleScholarGoogle Scholar | 26372931PubMed |

[59]  Budkaew J, Chumworathayi B, Pientong C, Ekalaksananan T. Conventional culture versus nucleic acid amplification tests for screening of urethral Neisseria gonorrhea infection among asymptomatic men who have sex with men. Pragmat Obs Res 2017; 8 167–73.
Conventional culture versus nucleic acid amplification tests for screening of urethral Neisseria gonorrhea infection among asymptomatic men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 28919833PubMed |

[60]  Page-Shafer K, Graves A, Kent C, Balls JE, Zapitz VM, Klausner JD. Increased sensitivity of DNA amplification testing for the detection of pharyngeal gonorrhea in men who have sex with men. Clin Infect Dis 2002; 34 173–6.
Increased sensitivity of DNA amplification testing for the detection of pharyngeal gonorrhea in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 11740704PubMed |

[61]  Newman C, Persson A, de Wit J, Holt M, Callander D, Schmidt H, et al. BRISE StraightMSM Study: understanding expert views on defining and reaching heterosexually-identified men who have sex with men for health promotion and care (short report). Sydney: Centre for Social Research in Health, UNSW Australia; 2016.

[62]  de Wit JB, Adam PC. To test or not to test: psychosocial barriers to HIV testing in high-income countries. HIV Med 2008; 9 20–2.
To test or not to test: psychosocial barriers to HIV testing in high-income countries.Crossref | GoogleScholarGoogle Scholar | 18557865PubMed |

[63]  Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, et al Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health 2002; 92 378–81.
Relationships of stigma and shame to gonorrhea and HIV screening.Crossref | GoogleScholarGoogle Scholar | 11867314PubMed |

[64]  Lorenc T, Marrero-Guillamon I, Llewellyn A, Aggleton P, Cooper C, Lehmann A, et al HIV testing among men who have sex with men (MSM): systematic review of qualitative evidence. Health Educ Res 2011; 26 834–46.
HIV testing among men who have sex with men (MSM): systematic review of qualitative evidence.Crossref | GoogleScholarGoogle Scholar | 21873612PubMed |

[65]  Traeger MW, Cornelisse VJ, Asselin J, Price B, Roth NJ, Willcox J, et al Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA 2019; 321 1380–90.
Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection.Crossref | GoogleScholarGoogle Scholar | 30964528PubMed |

[66]  Traeger MW, Schroeder SE, Wright EJ, Hellard ME, Cornelisse VJ, Doyle JS, et al Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: a systematic review and meta-analysis. Clin Infect Dis 2018; 67 676–86.
Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 29509889PubMed |

[67]  Grov C, Hirshfield S, Remien RH, Humberstone M, Chiasson MA. Exploring the venue’s role in risky sexual behavior among gay and bisexual men: an event-level analysis from a national online survey in the U.S. Arch Sex Behav 2013; 42 291–302.
Exploring the venue’s role in risky sexual behavior among gay and bisexual men: an event-level analysis from a national online survey in the U.S.Crossref | GoogleScholarGoogle Scholar | 22012413PubMed |

[68]  Xia Q, Tholandi M, Osmond DH, Pollack LM, Zhou W, Ruiz JD, et al The effect of venue sampling on estimates of HIV prevalence and sexual risk behaviors in men who have sex with men. Sex Transm Dis 2006; 33 545–50.
The effect of venue sampling on estimates of HIV prevalence and sexual risk behaviors in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 16735957PubMed |