Offer gay men screens for anal STIs regardless of reported risk

Rubbing of the penis against the anus without a condom, or brief insertion of the penis without a condom into the anus followed by withdrawal, are sexual activities reported by some gay men visiting commercial sex venues in Melbourne, Australia, according to a study published on February 6^th in the online edition of Sexually Transmitted Infections.

The investigators suggest that these activities could explain the large number of anal sexually transmitted infections diagnosed in gay men who did not report unprotected anal sex. They therefore recommend that all gay men, regardless of their reported risk behaviour, should be offered screens for anal infections during visits to sexual health clinics.

Studies in many industrialised countries have shown a high prevalence of sexually transmitted infections amongst gay men, including those who visit commercial venues where there is sex on the premises. There is some evidence that men who visit such venues are more likely to engage in risky sexual practices, and that sex on premises venues can be the focus for outbreaks of sexually transmitted infections.

No recent study has looked at the full range and frequency of sexual activities in gay sex on premises venues. Therefore investigators in Melbourne recruited 200 men in late 2006/early 2007 who used sex on premises venues and asked them about the type and frequency of sex they had in such venues.

The median number of visits to a sex on premises venue in the previous month was three. A wide range of sexual activities were reported, with 83% reporting oral sex and 42% anal sex.

But other forms of sexual activities that involved penile-anal contact without intercourse were also widely reported. For example, 40 men (27%) reported receptive “nudging” (touching or rubbing of the penis against the anus) and 20 men these men reported no anal intercourse. Furthermore, ten men (5%) reported receptive “dipping” (transient, unprotected insertion of the penis into the anus), and of these two (1%) reported no other form of receptive anal sex.

Unprotected insertive anal sex with ejaculation in a sex in premises venue was reported by four men (2%), with three individuals (1.5%) telling investigators that they had had unprotected receptive anal sex with ejaculation in a sex on premises venue.

Almost half the men (93, 47% had a regular partner). Sexual activity with a casual male partner outside of the sex on premises venues was reported by 49% of men.

Sex with casual partners in sex on premises venues was significantly less likely than sex with casual partners outside these venues to involve oral sex (p < 0.01), unprotected insertive anal sex (p = 0.04), unprotected receptive anal sex (p = 0.01), and rimming (p = 0.01). However, men were significantly more likely to have group sex at sex on premises venues (p = 0.03). The investigators call for further research to determine why there was less reported risk behaviour in sex on premises venues.

“Substantial penile-anal contact that did not involve anal intercourse occurred at sex on premises venues”, comment the investigators.

They note that approximately a third of gay men diagnosed with anal sexually transmitted infections reported no unprotected anal sex. The investigators suggest that activities like nudging and dipping “may explain anal infections in the absence of anal sex.”

On the basis of their findings the investigators recommend that “screening for anal infections should be offered to all men who have sex with men, including those who do not report anal intercourse.”