{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:09:03Z","timestamp":1791468543282,"version":"4.3.4"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T00:00:00Z","timestamp":1615766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000810","name":"Executive Agency for Health and Consumers","doi-asserted-by":"publisher","award":["2015 71 01"],"award-info":[{"award-number":["2015 71 01"]}],"id":[{"id":"10.13039\/501100000810","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background\/Objectives<\/jats:title>\n                    <jats:p>Many European countries reported increased numbers of syphilis, gonorrhoea and chlamydia diagnoses among men who have sex with men (MSM) in recent years. Behaviour changes and increased testing are thought to drive these increases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In 2010 and 2017, two large online surveys for MSM in Europe (EMIS-2010, EMIS-2017) collected self-reported data on STI diagnoses in the previous 12 months, diagnostic procedures, STI symptoms when testing, number of sexual partners, and sexual behaviours such as condom use during the last intercourse with a non-steady partner in 46 European countries. Multivariate regression models were used to analyse factors associated with diagnoses of syphilis, gonorrhoea\/chlamydia, and respective diagnoses classified as symptomatic and asymptomatic. If applicable, they included country-level screening rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Questions on STI diagnoses and sexual behaviours were answered by 156,018 (2010) and 125,837 (2017) participants. Between 2010 and 2017, overall diagnoses with gonorrhoea\/chlamydia and syphilis increased by 76% and 83% across countries. Increases were more pronounced for asymptomatic compared to symptomatic infections. The proportion of respondents screened and the frequency of screening grew considerably. Condomless anal intercourse with the last non-steady partner rose by 62%; self-reported partner numbers grew. Increased syphilis diagnoses were largely explained by behavioural changes (including more frequent screening). Gonorrhoea\/chlamydia increases were mainly explained by more screening and a change in testing performance. A country variable representing the proportion of men screened for asymptomatic infection was positively associated with reporting symptomatic gonorrhoea\/chlamydia, but not syphilis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion\/Conclusion<\/jats:title>\n                    <jats:p>The positive association of country-level screening rates with the proportion of symptomatic infections with gonorrhoea\/chlamydia may indicate a paradoxical effect of screening on incidence of symptomatic infections. Treatment of asymptomatic men might render them more susceptible to new infections, while spontaneous clearance may result in reduced susceptibility. Before expanding screening programmes, evidence of the effects of screening and treatment is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0248582","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T13:35:37Z","timestamp":1615815337000},"page":"e0248582","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":41,"title":["Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men\u2013is it time to re-evaluate STI-screening as a control strategy?"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3143-2717","authenticated-orcid":true,"given":"Ulrich","family":"Marcus","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2342-5867","authenticated-orcid":true,"given":"Massimo","family":"Mirandola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne B.","family":"Schink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Gios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6910-4399","authenticated-orcid":true,"given":"Axel J.","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,15]]},"reference":[{"key":"pone.0248582.ref001","volume-title":"Annual epidemiological report for 2017","author":"European Centre for Disease Prevention and Control","year":"2019"},{"key":"pone.0248582.ref002","volume-title":"Annual epidemiological report for 2017","author":"European Centre for Disease Prevention and Control","year":"2019"},{"key":"pone.0248582.ref003","volume-title":"Annual epidemiological report for 2017","author":"European Centre for Disease Prevention and Control","year":"2019"},{"issue":"7","key":"pone.0248582.ref004","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1007\/s10508-017-1107-1","article-title":"Temporal Trends in Population Level Impacts of Risk Factors for Sexually Transmitted Infections Among Men Who Have Sex with Men, Heterosexual Men, and Women: Disparities by Sexual Identity (1998\u20132013)","volume":"47","author":"H Wand","year":"2018","journal-title":"Archives of sexual behavior"},{"key":"pone.0248582.ref005","article-title":"More Screening or More Disease? 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Comparison of the performance of STI Screening Services for gay and bisexual men across 40 European cities: Results from the European MSM Internet Survey","volume":"89","author":"A Schmidt","year":"2013","journal-title":"Sexually Transmitted Infections"},{"key":"pone.0248582.ref008","article-title":"An update on the performance of STI services for gay and bisexual men across European cities- results from the 2017 European MSM Internet Survey","author":"J Doran","journal-title":"Sexually Transmitted Infections"},{"issue":"Suppl 1","key":"pone.0248582.ref009","first-page":"A1","article-title":"D01.1 Among men who have sex with men, pharyngeal infection contributes more to population levels of gonorrhea transmission than urethral infection, rectal infection, or both (for the motion)","volume":"95","author":"C Fairley","year":"2019","journal-title":"Sexually Transmitted Infections"},{"issue":"Suppl 1","key":"pone.0248582.ref010","first-page":"A2","article-title":"D01.2 Among men who have 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