Should we screen less frequently for chlamydia and gonorrhoea in gay and bisexual men who have sex with men? Findings from a global crowdsourcing exercise with experts
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Objectives
Many countries recommend 3-monthly chlamydia/gonorrhoea screening for men-who-have-sex-with-men (MSM). New evidence about the limited impact of frequent, asymptomatic gonorrhoea/chlamydia screening on population prevalence, coupled with concerns about overburdened health services and antimicrobial resistance (from over-treatment), calls into question current approaches to asymptomatic screening. We explored sexual health professionals/experts’ arguments in favour/against reducing asymptomatic screening using Polis ( www.Pol.is ), an online, crowdsourcing tool for understanding what large groups think.
Methods
Recruited via global peak bodies/networks, 99 sexual health professionals/experts (43.4.% clinicians, 35.4% researchers) primarily from Oceania (41.4%), UK/Europe (29.4%) and North America (22.2%) submitted 83 statements in favour/against reduced screening for men-who-have-sex-with-men (e.g. ‘Bisexual men who don’t test regularly risk putting women at risk’). Participants voted on submitted statements (agree/disagree/pass). We considered statements with ≥ 80 agreement as strong support, 70-79% moderate support, ≤ 69% mixed support. We used content analysis to group clusters of related statements, and examined associations between participant demographics and votes for/against.
Results
There was ‘mixed support’ for statements on :1) the impact of screening in reducing prevalence; 2) whether asymptomatic infections pose clinical harm/necessitate treatment; and risk of antimicrobial resistance. Statements advocating for 6-monthly screening received ‘moderate support’, with arguments centering on resource use. Participants ‘strongly supported’ the need for community engagement and maintaining frequent HIV/syphilis screening. UK/Europe participants were more likely to favour reduced chlamydia/gonorrhoea screening.
Conclusions
While there were mixed opinions about relative utility, risks, and harms of reducing chlamydia/gonorrhoea screening for MSM, arguments relating to resource use may provide common ground for policy changes.
