Far too rarely do gay men get tested for sexually transmitted infections and when they do, the checks are often inadequate. Yet syphilis & co. are a gateway for HIV
Horst* from Hamburg had a long odyssey behind him when he learnt the cause of his ailment. He had been plagued by severe bowel inflammation for six months. Neither his family doctor nor his proctologist could help him. Both suspected ulcerative colitis, a rare chronic disease. It was only a tip from a friend that finally brought Horst to the Infection Medicine Centre Hamburg, a well-known HIV specialist practice. After a detailed discussion, doctor Axel Adam had a rectal swab taken. A direct hit - Horst was suffering from chlamydia. These bacteria can easily be transmitted during anal intercourse. One antibiotic was enough, and Horst was healthy after just one week.
The fact that Horst could be suffering from a sexually transmitted infection had not initially occurred to the doctors consulted. "If I don't have anal intercourse on my list at all, then I don't swab my patients," specialist Axel Adam states succinctly. Yet chlamydia is one of the most common sexually transmitted infections (international abbreviation: STI, derived from "sexually transmitted infections") alongside gonococci ("gonorrhoea").
A study by the Robert Koch Institute (RKI) has shown that many STIs remain unrecognised, especially in the anal area. Over 14 per cent of the gay men examined had either gonococci or chlamydia (see HIV Report 06/2011, www.hivreport.de). A similarly high prevalence has already been found in men from San Francisco, the United Kingdom and Switzerland.
Infections in the buttocks massively increase the risk of HIV
The problem with this is that these diseases can not only cause serious damage to health in some cases, but also increase the risk of contracting HIV during sex. They are particularly dangerous in the buttocks: in a study from San Francisco, men who had had two rectal infections (chlamydia and/or gonococci) in the previous two years were eight times more likely to be infected with HIV. In some studies, the number of new infections in this group was as high as 15 out of 100 people. "This is the highest HIV incidence known to us worldwide," explains Armin Schafberger, medical officer at Deutsche AIDS-Hilfe. The reason is probably a mix of biology and certain behaviours. Schafberger's conclusion: "We need to educate gay men about the correlations and tell them that they should be tested more frequently for rectal infections."
The problem is that the German healthcare system is currently not geared towards detecting STIs. As with Horst, the necessary tests are usually simply not carried out. One reason for this is that neither doctors nor patients have chlamydia & co. on their radar. In addition, hardly any doctors still carry out physical examinations. "I learnt that you ask a patient to undress completely when they are first admitted and then touch them," reports Armin Schafberger from his student days. "Nowadays, you generally leave your trousers on in the doctor's surgery."
Blood tests can detect syphilis and HIV, but not gonococci and chlamydia. This is because they can settle in three places in the body at once: in the throat, in the urethra and in the bum - depending on what happened during sex. Only a swab or urine sample can provide clarity. "We need to raise awareness of these diseases among doctors," demands Schafberger, "and also among gay men, so that they demand these tests for themselves." Because these diseases in the rectum and throat are almost always asymptomatic, they are often never detected.
Check with looking and touching: Germany has some catching up to do
The Europe-wide EMIS survey of gay men has shown that there is another way. According to the survey, 44 per cent of gay men in the UK have had an STI check in the last 12 months, compared to just 28 per cent in Germany. The difference is even clearer when it comes to the course of the examination. In the UK, 27 per cent of respondents reported that the doctor had inspected their penis and anus. In Germany, this only happened in 6 per cent of cases.
The main reason for this discrepancy is the typical British GUM clinics (GUM is the English abbreviation for urogenital medicine), which can be found in every major city. They also provide STI counselling. "In such specialised facilities, it's completely natural for the doctor to examine the patient's glans and foreskin or perform a rectal examination," says Armin Schafberger. "Specialisation is an advantage."
Deutsche AIDS-Hilfe recommends: get tested once a year
Germany therefore has some catching up to do when it comes to sexually transmitted infections. Deutsche AIDS-Hilfe has had the topic on its agenda for a long time, for example in its project "Prevention in the doctor's surgery". Some health authorities, AIDS service organisations and gay prevention projects already offer STI checks. Patients often do the necessary anal swab themselves: in the toilet with a small cotton bud. "This should be a matter of course in a gay health centre," demands Armin Schafberger. "The process isn't so shameful there either." Many men are embarrassed to tell their GP that they have anal intercourse.
Once a sexually transmitted disease has been recognised, it can be treated well in most cases. As the symptoms are not always obvious, it is therefore advisable to get tested even if there are no acute symptoms. The German AIDS service organisation recommends that all men who have sex with men should be tested once a year for the following sexually transmitted diseases: HIV, syphilis, gonococci and chlamydia. Anyone who has more than ten sex partners per year should be tested for the three bacterial infections every six months. You should be immunised against hepatitis A and B.
*Name changed
