ORIGINAL STUDY The Efficacy of Clinic-Based Interventions Aimed at Increasing Screening for Bacterial Sexually Transmitted Infections Among Men Who Have Sex With Men: A Systematic Review Huachun Zou, MD, MS,* Christopher K. Fairley, FRACP, PhD,*† Rebecca Guy, PhD,‡ and Marcus Y. Chen, FAChSHM, PhD*† Background: In many countries, the prevalence of bacterial sexu- ally transmitted infections (STIs) among men who have sex with men (MSM) is high. We undertook a systematic review to identify clinic- based strategies for increasing screening and detection of bacterial STIs among MSM. Methods: We reviewed studies that compared screening for or detection of gonorrhea, chlamydia, and syphilis in the presence and the absence of an intervention. The primary end points were STI screening, rescreening, or detection rates. Results: Of 1809 studies identified, 8 fulfilled the inclusion criteria; of these, 4 studies demonstrated significant increases in screening rates for gonorrhea and chlamydia using different strategies (odds ratio range, 1.4 –1.9). These included the following: use of a computer alert on an electronic medical record; the introduction of clinic guidelines on STI screening; and short text messaging reminders for repeat STI screening. A further 4 studies demonstrated increases in syphilis testing (odds ratio range, 2.3–21.4), with increased detection of asymptomatic early syphilis in 2 studies. Strategies used included regular serological screening for syphilis during routine human immunodeficiency virus (HIV) care, syphilis serology included with blood tests performed as part of HIV monitoring, use of a computer alert on an electronic medical record, and an electronic medical record system to enhance syphilis retesting after syphilis treatment. Conclusions: A range of interventions has been used, including the application of newer technologies targeting clinicians and patients that appear to be efficacious at increasing screening of MSM for bacterial STIs. Wider application of such interventions could improve STI screening and control in this high-risk population. I n many countries, the prevalence of bacterial sexually trans- missible infections (STIs) such as gonorrhea, chlamydia, and syphilis is high among men who have sex with men (MSM). 1–4 STIs in MSM are of particular public health importance be- cause of their potential to increase human immunodeficiency virus (HIV) transmission. Recent studies have demonstrated associations between chlamydia, gonorrhea, and syphilis infec- tion and HIV seroconversion. 5,6 More frequent screening for bacterial STIs has the po- tential to improve detection of these largely asymptomatic infections, interrupting transmission and improving control. For HIV-infected men, the detection and treatment of other STIs could potentially reduce onward transmission of HIV. Guidelines in a number of countries call for regular screening of MSM. For example, US and Australian guidelines recom- mend that all MSM be screened for urethral and rectal chla- mydia, pharyngeal and rectal gonorrhea, syphilis, and HIV at least once a year, with 3 to 6 monthly screening of higher-risk MSM. 7,8 However, available data suggest that the rate of screening for these infections among MSM is low in many countries. 9 –12 Barriers to clinicians performing and men under- taking screening for STIs have been identified and include clinicians’ lack of awareness and skills to undertake STI screening, as well as perceptions among some MSM that STIs are less serious than HIV. 13,14 To help inform strategies that clinical services can use to help increase STI screening of MSM, we undertook a system- atic review to identify clinic-based interventions efficacious at increasing screening and detection of gonorrhea, chlamydia, and syphilis among MSM. METHODS Review Strategy We conducted a systematic review by searching MEDLINE for studies between 1990 and June 2011 using the following key words and variations: “men who have sex with men” or “MSM” or “gay” or “homosexual” or “bisexual”; and “syphi- lis” or “chlamydia” or “gonorrhea” or “gonorrhoea” or “sexu- ally transmitted disease” or “STD” or “sexually transmitted infection” or “STI”. Only English language publications were included. Reference lists of selected studies were also checked for other potentially relevant studies. A publication was considered for inclusion if it reported on the evaluation of a clinic-based intervention aimed at increasing bacterial STI screening rates (proportion of men screened); re- screening rates (proportion of men screened again); or detection rates (proportion of men tested diagnosed with an infection) in MSM, and if it included a control group or control period. Studies were excluded if they did not include a control group or control period; reported screening rates in the absence From the *Sexual Health Unit, School of Population Health, Uni- versity of Melbourne, Melbourne, VIC, Australia; †Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; and ‡Kirby Institute, University of New South Wales, Sydney, NSW, Australia The authors thank Chris Bourne and Anna Hotton for providing de- tailed information of the interventions. Correspondence: Marcus Chen, FAChSHM, PhD, Melbourne Sexual Health Centre, 580 Swanston St, Carlton, VIC 3053, Australia. E-mail: mchen@mshc.org.au. Received for publication October 27, 2011, and accepted December 20, 2011. DOI: 10.1097/OLQ.0b013e318248e3ff Copyright © 2012 American Sexually Transmitted Diseases Association All rights reserved. 382 Sexually Transmitted Diseases ● Volume 39, Number 5, May 2012