Background:
The Centers for Disease Control and Prevention recommends annual rectal and pharyngeal gonorrhea screening and rectal chlamydia screening for men who have sex with men (MSM) with sexual exposures that put them at risk for these infections. However, these tests are not available in many traditional medical settings. In San Francisco, four annual street fairs in the gay community provide an opportunity for expanding the accessibility of rectal and pharyngeal screening to high-risk populations.

Objective:
To assess the feasibility and yield of chlamydia (CT) and gonorrhea (GC) screening of pharyngeal and self collected rectal specimens obtained at street fairs targeting MSM.

Method:
STD screening booths were set up at four street fairs. Health workers and volunteers registered patients, collected pharyngeal specimens and provided verbal instructions to patients on how to collect their own rectal specimens. Patients self-collected rectal specimens behind a screen in the booth to assure privacy. Rectal and pharyngeal specimens were tested using a previously validated assay (Genprobe APTIMA) by the local public health laboratory.


Result:
167 males at the four street fairs were screened for rectal and/or pharyngeal CT and GC. 2.4% (3/124) of self-collected rectal and 0% (0/167) of pharyngeal specimens were unsatisfactory. 10.7% (13/121) of males had rectal infections and 3% (5/167) had pharyngeal infections (8.3% rectal CT, 2.5% rectal GC, 1.7% pharyngeal CT, 1.7% pharyngeal GC). No men were dually infected at an anatomic site.

Conclusion:
Self-collected rectal and pharyngeal screening was acceptable to MSM in an outdoor community event setting. Screening MSM for STDs at street fairs is both feasible and effective at detecting infections. The high prevalence of rectal infections is comparable to the local STD clinic.

Implications:
Community based STD screening of MSM using pharyngeal and self-collected rectal specimens will be expanded to additional venues.