Chemsex questions: what are we actually asking?

Among men who have sex with men (MSM), sexualised drug use (SDU) is related to high risk sexual behaviour and a higher chance of contracting STIs. Chemsex, a subset of SDU, has a particularly high risk factor for STIs. We describe the implementation of a new question about Chemsex for first time clients attending Sydney Sexual Health Centre through a retrospective review of electronic medical records. Between 1 December 2018 and 30 November 2019, 227 MSM reported engaging in 'Chemsex'. 74 respondents (33%) had a specific drug used during sex noted. Of these, the majority (52, 70%; 95% CI 60-81) used a drug commonly associated with Chemsex (crystal methamphetamine, gamma-hydroxybutyrate, or mephedrone), however, a sizeable minority (22, 30%; 95% CI 19-40) only described a drug not commonly associated with Chemsex. The question asked appeared to be more broadly interpreted as SDU. Broad SDU questions, not just questions on Chemsex, may be more appropriate for identifying risk behaviours in MSM in clinical contexts.