Cases of syphilis among men who have sex with men continue to rise despite regular syphilis screening and contact tracing. MSM who practise receptive anal sex are almost four times more likely to present with secondary syphilis rather than primary syphilis. Three-monthly PrEP clinic appointments for syphilis screening alone have failed to detect a proportion of primary and secondary syphilis infections. Therefore, additional strategies are required for syphilis control.
About the study
The DARE Study is a cohort study of weekly self-examination of the anorectal area to detect symptoms related to syphilis in MSM. The study will follow a group of MSM over a 48-week period.
Main findings
Cases of syphilis among men who have sex with men (MSM) continue to rise despite regular syphilis screening and contact tracing. MSM who practice receptive anal sex are almost four times more likely to present with secondary syphilis rather than primary. The DARE study aimed to examine whether men who performed weekly digital anorectal examinations could detect abnormalities that may be primary anorectal syphilis.
We recruited 222 MSM into this study that engaged in receptive anal sex. Participants were asked to perform a weekly DARE for 48 weeks. Participants also answered a survey at the start of the study and every 12 weeks after until completion, on their adherence, experiences and reported abnormalities.
Six men were diagnosed with syphilis; one primary anorectal infection was detected by DARE. The other five cases of early syphilis, no primary lesion was detected. Participants performed 78% of their weekly DAREs consistently over the 48 weeks. Greater than 95% found DARE easy to perform and would continue to perform it if recommended for early syphilis detection. With a high level of adherence, this study suggests that DARE may compliment routine screening for primary anorectal syphilis, however its sensitivity may be limited.
Who we want to talk to
Our research team will contact you during your visit to Melbourne Sexual Health Centre if you:
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are 18 years or older
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have had receptive anal sex with a man in the last 12 months
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are not currently performing anorectal self-examination regularly
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are not enrolled into other research studies or trials on syphilis prevention
For the time you spend participating in this study, you will be compensated with $50 Coles Myer voucher at Week 24 and $50 Coles Myer voucher at the completion of the study
What is the DARE Study?
The DARE Study is a research study examining whether men who regularly self-examine their anus would be able to detect primary syphilis through self-identifying lesions or chancres.
The DARE Study is conducted at the Melbourne Sexual Health Centre and has been approved by the Alfred Hospital Ethics Committee. You will be reimbursed for your time participating in this study.
If you are a man who practises receptive anal sex with male partners, we would love to hear from you!
How to do an anal self-examination DARE study
This video provides details on how to do an anal self-examination.
Ethics
All research in Australia involving humans is reviewed by an independent group of people called a Human Research Ethics Committee (HREC). The ethical aspects of this research project have been approved by the Alfred Hospital HREC.
This project will be carried out according to the National Statement on Ethical Conduct in Human Research (2007). This statement has been developed to protect the interests of people who agree to participate in human research studies. Approval has been given by the Alfred Hospital HREC which reviews ethics applications for research carried out at the Melbourne Sexual Health Centre.
Researchers
Principal investigators
Associate investigator
Student investigator
Research nurses
Publications
Digital Anorectal Examination to Self-detect Primary Syphilis: A Prospective Cohort Study
Tran J, Maddaford K, Ong JJ, Aung ET, Fairley CK, Chow EPF.
(2026), The Journal of Infectious Diseases,