Background:
Syphilis and HIV have increased significantly in men who have sex with other men in recent years. Accordingly, in 2002, Denver Public Health re-instituted HIV and STD screening in commercial sex venues serving MSM in Denver. In 2004, rapid HIV tests were introduced in these venues. We describe a decline in syphilis tests correlating with the uptake of rapid HIV testing.

Objective:
To compare rates of syphilis testing in commercial sex venues before and after the introduction of rapid HIV testing.

Method:
Screening for syphilis, HIV, gonorrhea, and chlamydia began in May 2002 at three urban bathhouses in Denver. Rapid HIV testing, with the option of finger stick for specimen acquisition, was implemented in sequential baths from May to September 2004. Data was collected to determine the relative percentage of bathhouse clients screened for HIV and syphilis pre- and post rapid HIV testing.

Result:
In 2002, 94% (280/298) of all men screened for HIV were tested for syphilis. The transition to rapid testing was completed in September 2004. In 2005, only 36% (236/653) of men screened for HIV were tested for syphilis. Prior to September 2004, pre-rapid testing, 74% (841/1143) of all men screened were tested for syphilis. After September 2004, post-rapid testing, only 38% (352/907) of men screened were tested for syphilis.

Conclusion:
Though bathhouse clients are offered a spectrum of STD screening services, HIV continues to be their main concern. With the advent of rapid HIV testing using a finger stick it has become more difficult to screen for other STDs that require veni-puncture, as clients frequently opt out of these tests.

Implications:
Programs instituting full STD and HIV screening services at bathhouses need to be conscious of possible repercussions related to the introduction of new technologies.