Background. Sexually transmitted infec- tions (STIs) such as anal/genital warts, syphilis, and genital/rectal gonorrheal/chlamydial infections compromise the health of men who have sex with men (MSM), and increase the per-contact risk of HIV infection. Early detection of asymptomatic STIs requires regular screening including physical examinations and collection of clinical specimens that allow for the detection of infections at sites common to men’s same-sex practices. Methods. From June to August 2010, the European MSM Internet Survey (EMIS) recruited 174,209 MSM from 38 European countries to an anonymous online questionnaire in 25 languages. As sexual health care for MSM in most countries is organized locally, we chose cities for comparison. Multivariable regression models were used to compare accessibility of services and applied diagnostic procedures across 1 Dutch, 1 Swiss, 1 Austrian, 3 English, and 19 German cities (N=29,962). Results. The proportion of respondents tested for STIs in the last 12 months in the absence of symptoms ranged from 13% in Magdeburg to 48% in Amsterdam. At a city level, low STI screening correlated with inaccessible services (R2=0.72). At an individual level, anal/penile inspection and anal swabbing was most common in English cities and in Amsterdam. Compared to London, MSM in German-speaking cities had an adjusted odds ratio (AOR) of 0.06–0.20 for anal/penile inspection, and of 0.05–0.17 for anal swab- bing (p<0.001). Conclusions. Anal/genital warts and rectal infections are likely to be profoundly under-diagnosed among MSM in all German-speaking cities. This has implications for the sexual health of MSM, for HIV prevention, and for comparing European surveillance data. There is an urgent need to implement or improve sexual health care tailored to MSM at risk for STIs.