Anal self-examination for syphilis detection among men who have sex with men (MSM) - Attitudes and acceptability

Sep 27, 2026

Uploaded by jayni

Studies indicate men who have sex with men (MSM) who practice receptive anal sex are more likely to present with secondary syphilis, possibly because anorectal primary lesions are missed. This qualitative study explored MSM attitudes toward regular anal self-examination to detect primary syphilis. Twenty MSM participated in semi-structured interviews, yielding four major themes and twelve sub-themes on reasons, resources, partner examination, and acceptability.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Background and rationale

Primary syphilis lesions may be missed

Study aim and design

Qualitative descriptive approach

Participants and eligibility

Findings

Reasons and preferred resources

Attitudes toward partner examination

Acceptability and willingness to adopt the practice

Implications

􀂦 Melbourne Sexual Health Centre [https://orcid.org/0000-0002-2560-3233](https://orcid.org/0000-0002-2560-3233) MSHC: Melbourne Sexual Health Centre MSHC: Melbourne Sexual Health Centre University of Melbourne MSHC: Melbourne Sexual Health Centre MSHC: Melbourne Sexual Health Centre MSHC: Melbourne Sexual Health Centre Anal self-examination, anal syphilis, screening for anal syphilis, syphilis in MSM April 5th, 2021 [https://doi.org/10.21203/rs.3.rs-377857/v1](https://doi.org/10.21203/rs.3.rs-377857/v1) 􀁱 􀅏 This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Studies show men who have sex with men (MSM) practising receptive anal sex are more likely to present with secondary syphilis, suggesting anorectal primary lesions are being missed. Regular anal self-examination might be able to detect anorectal syphilis lesions, hence potentially reducing transmission. This study aimed to explore the attitudes of MSM on performing anal self-examination to detect primary syphilis. In this qualitative study, 20 MSM over 18 years of age were purposively sampled from a sexual health clinic to participate in semi-structured interviews. Interviews were recorded, transcribed verbatim and data analysed thematically. Four major themes and 12 sub-themes emerged from the study: (1) reasons for performing anal selfexamination, (2) preferred resources for anal self-examination, (3) attitudes towards partner anal examination, and (4) acceptability of anal self-examination. Most participants had performed some form of anal self-examination in the past, and, just over half performed regularly for mostly health-related concerns. Most participants who infrequently or never performed anal selfexamination were agreeable to perform regularly if it was recommended by health professionals with appropriate guidance. Participants preferred education on anal self-examination from health professionals and trusted online learning resources. Our study showed MSM were agreeable to anal self-examination however would like to receive education and training to gain more con¦dence in conducting anal self-examination as a screening tool. Further studies are required to explore the adherence and acceptability of anal self-examination for syphilis prior to studies examining e¨cacy. The study provides foundation for any future policy aiming at utilising anal self-examination as a screening tool for syphilis among MSM. The noti¦cation rate of syphilis in Australia increased between 2014 and 2018, from 9 to 20.8 noti¦cations per 100,000 people (1) . Increases have also been seen in other high-income countries, mainly among key populations including men who have sex with men (MSM), and transgender individuals (2–4) . Over the last decades, there have been numerous public health interventions aimed at improving syphilis prevention and control, including regular testing (5,6), improvements in contact tracing (5), and interventions to increase condom use(7), yet the noti¦cation rate of syphilis continues to increase. Novel strategies for syphilis control are required. One of the main strategies underpinning interventions for controlling syphilis is to reduce the duration of infectiousness. Primary syphilis classically presents as a painless chancre at the point of inoculation that results in in§ammation and local swelling (8) . However, primary syphilis might not present as a typical chancre in some cases, instead presenting as super¦cial ulcers (8) . Cornelisse et al reported that MSM who practised receptive penile-anal sex were four times more likely to have secondary syphilis than those who practised insertive penile-anal sex, (9) suggesting primary anorectal lesions are often missed, leading to progression to secondary syphilis (9–11) . If men examine their anus regularly, they might be able to detect primary anorectal lesions and present for treatment before progressing to the sec

FAQs

What problem does the study address regarding syphilis?

The study addresses the possibility that anorectal primary syphilis lesions are often missed, contributing to progression to secondary syphilis.

How was the study conducted?

A qualitative descriptive framework was used, with semi-structured interviews of 20 MSM who met eligibility criteria. Interviews were transcribed verbatim and analyzed thematically.

What did participants prefer for learning anal self-examination?

Participants preferred education provided by health professionals and trusted online learning resources.

Sep 27, 2026

Uploaded by jayni