STAR-trial: STI-TESTING IN ASYMPTOMATIC MEN: IS MORE THAN TWO PARTNERS PER YEAR SUFFICIENTLY SELECTIVE? - BAG
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STAR-trial: STI-TESTING IN ASYMPTOMATIC MEN: IS MORE THAN TWO PARTNERS PER YEAR SUFFICIENTLY SELECTIVE? Axel J. Schmidt 1,10, Manuela Rasi 1, Vanessa Christinet 2, Michael Ritzler 3, Christoph Hauser 4, Marcel Stoeckle 5, Cate Esson6, Michael Kluschke 7, Florent Jouinot 2, Wuddri Rim8, Torsten Konrad 4, Dirk Letsch 9, Markus Stratmann 7, Steven Derendinger 10, Andreas Lehner 11, Lorenz Risch 3, Pietro Vernazza 1 1. Division of Infectious Diseases and Infection Control, Cantonal Hospital St.Gallen, Switzerland; 2. Checkpoint Vaud, Lausanne, Switzerland; 3. Laboratory Risch, Buchs, Switzerland; 4. Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; 5. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University Basel, Switzerland; 6. Profa, Consultations in Sexual Health, Renens, Switzerland; 7. Checkpoint Zürich, Switzerland; 8. Checkpoint Bern, Switzerland; 9. Checkpoint Basel, Switzerland; 10. Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland; 11. Swiss AIDS Federation, Zurich, Switzerland Schweizer HIV & STI-Forum, Bern, 8. März 2018
Introduction:
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
• In Switzerland routine STI-testing is not covered by health
insurance, even in individuals at high risk.
• It is further aggravated by lack of multi-site, particularly
anal, swabbing.
• This leads to under- diagnosis and non-treatment of
notifiable infections.
• STAR is the first study to systematically evaluate
prevalence of the “Big-5” and some more bacterial STIs
in two vulnerable groups in Switzerland
• This presentation will focus on men-who-have-sex-with-
men.
Methods Don’t confuse with:
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
• STAR trial (STI Testing of Asymptomatics at Risk)
5 dimenstions of sexual health
• Multi-centre, country-wide Big 5 / 3
• Free HIV, Hepatitis, and STI-testing
• Seegene®STI-7 multiplex PCR
(N.gonorrhoeae, C.trachomatis, T.vaginalis, M. genitalium)
• Pooled swabs (“frottis combinés”)
(pharyngeal, vaginal, rectal)
About pooled swabs
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
Abb: Levy, 2012
• The oropharynx is probably the most
important source for gonorrhoea.
• Ideally (scientifically more interesting)
are three separate swabs.
• This would imply a dramatic cost increase
• Most practitioners don’t know three-site swabbing can be
combined. This information needs to be spread.
Results: Recruitment
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
Recruitment STAR (Baseline) CPVD, CPBS,
200 CPBE, CPZH
180
ISLA, AHbB, KANO,
160
140 CSS, INSE, KSSG
120 Outreach work
100
(M Rasi @KSSG:
80
gay saunas;
60
brothels,
40
20
Northeastern CH)
0
01
02
03
04
05
06
07
08
09
10
11
12
01
02
03
04
05
06
07
16
16
16
16
16
16
16
16
16
16
16
16
17
17
17
17
17
17
17
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
CPV D CPBS AHbB CPBE ISLA INSE KSSG CSS CPZH
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
2017 in Helsinki.
For all other results,
see poster for IUSTI-Condom effectiveness
When using condoms for penetrative anal or vaginal intercourse,
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
the overall risk for acquisition of bacterial STIs is reduced by approximately 50%.
Prevention interventions aiming at 100% condom-effectiveness for «Big-3»
(Syphilis, gonorrhoea, chlamydiosis) would need to include recommendations to use condoms
and other latex-based (etc.) barrier methods also for
• oro-penile,
• oro-anal
• oro-vaginal
• digito-anal
• digito-vaginal
• digito-penile
• digito-oral
• vagino-vaginal
• brachio-rectal
• brachio-vaginal
• and, last but not least: oro-oral («deep kissing»)
sexual contacts.
This would imply a massive and highly unwanted change in people’s sexuality.Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
sexual health
5-edged star:
dimensions of
ExplanationsSexual Diversity
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
(«Und weil’s jede(r) anders liebt / Et parce que chacun(e) l’aime à sa façon»)
100%
Inser ve oral
90%
Recep ve oral
80%
Mutual masturba on
70%
Inser ve anal
60%
Recep ve anilingus
50%
Recep ve anal
40%
Inser ve anilingus
30%
Inser ve brachioproctal
20%
STI test
10%
Recep ve brachioproctal
0%
24 h 7 days 4 weeks 6 months 12 months 5 years ever EMIS-2010
The EMIS Network. EMIS 2010: The European Men-Who-Have-Sex-With-Men Internet Survey.
Findings from 38 countries. Stockholm: European Centre for Disease Prevention and Control, 2013Sexual Diversity
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
(«Und weil’s jede(r) anders liebt / Et parce que chacun(e) l’aime à sa façon»)
Up to 10 non-steady partners More than 10 non-steady partners
Self-reported newly diagnosed STIs (last 12 months)
30%
25%
20%
15%
10%
5%
0%
1 2 3 4 5 6 7 8 9
Score: Sexual diversity with non-steady partners (1 point for engaging in any sexual practice
from the list in the previous slide)
The EMIS Network. EMIS 2010: The European Men-Who-Have-Sex-With-Men Internet Survey.
Findings from 38 countries. Stockholm: European Centre for Disease Prevention and Control, 2013Conclusions
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
• Among MSM, but not among other multi-partner men,
bacterial STIs, mostly asymptomatic, are common.
• Switzerland has existing structures for low-threshold STI-testing for
MSM, but costs are too high.
• Existing structures need too be maintained.
• Given the high risk of onward transmission, low-cost or free routine
Big 3 of MSM is a public health priority.
screening (Big-3)Merci * Danke * Thank you
Axel J. Schmidt, Dr. med. M.D. MPH - Schweizer HIV & STI-Forum, Bern, 8. März 2018
Overall Primary Investigator: P. Vernazza
Overall Coordination: A.J. Schmidt, M. Rasi
Data cleaning and analyses: A.J. Schmidt
Data aggregation: K. Keckeis
Local PIs: K. Aebi-Popp, V. Cristinet, F. Dost, C. Esson, C.V. Hauser, M. Kluschke, M. Stöckle
Recruitment and counselling: B. Aebersold, G. Aurora, C. Bischof, A. Christen, R.J. Fontana, F. Jouinot,
T. Konrad, K. Lange, D. Letsch, B. Leutwyler, W. Rim, M. Stoffel, S. Stölzl, M. Stratmann, B. Zahno,
and many others
Outreach work: M. Rasi, J. Bläuer, C. Bischof, R. Fontana, S. Gresser, R. Zbinden
Laboratory: I. Goegele, F. Imeri, T. Lung, L. Risch, M. Ritzler, N. Wohlwendt
Further Support: S. Derendinger, A. Lehner, N. Low
Contact: star-trial@infekt.ch
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