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

ObjectivesMany 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. MethodsRecruited 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 dont 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. ResultsThere 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. ConclusionsWhile 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.