Less is more: reconsidering asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae screening for gay, bisexual and other men who have sex with men in the era of doxycycline post-exposure prophylaxis (DoxyPEP)
4 affiliations
- 1Health Psychology Group, University of Aberdeen, Aberdeen, UK
- 2Gay Men’s Health Service, Health Service Executive, Dublin, Ireland
- 3Department of Infectious Diseases and Genitourinary Medicine, St James’s Hospital, Dublin, Ireland
- 4Department of Public Health, HSE Dublin and Midlands, Health Service Executive, Dublin, Ireland
Abstract
Routine high-frequency screening for asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae among cisgender gay, bisexual and other men who have sex with men (gbMSM) is established despite limited evidence that it reduces population-level incidence or harm. Recent studies support reconsideration but do not settle the balance of benefits and harms. Reducing screening could delay diagnosis and affect transmission or partner notification; continuing screening may increase antimicrobial exposure, possible overdiagnosis, anxiety and stigma. The demonstrated benefits and unresolved long-term stewardship implications of doxycycline post-exposure prophylaxis (DoxyPEP) illustrate why antimicrobial use should be differentiated. We argue for cautious, co-produced, evaluated and reversible de-implementation while maintaining symptomatic, contact-based and otherwise clinically indicated testing, HIV and syphilis screening and HIV pre-exposure prophylaxis (PrEP) care. With transparent communication and community partnership, less screening need not mean less care.
Related
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BibTeX
@article{field2026less,
title = {{Less is more: reconsidering asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae screening for gay, bisexual and other men who have sex with men in the era of doxycycline post-exposure prophylaxis (DoxyPEP)}},
author = {David James Field and Johnny Boylan and Fiona Lyons and Ralph Hurley O’Dwyer and Chantal Den Daas},
journal = {International Journal of STD \& AIDS},
year = {2026},
month = aug,
doi = {10.1177/09564624261481866},
url = {https://doi.org/10.1177/09564624261481866},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Less is more: reconsidering asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae screening for gay, bisexual and other men who have sex with men in the era of doxycycline post-exposure prophylaxis (DoxyPEP)
AU - David James Field
AU - Johnny Boylan
AU - Fiona Lyons
AU - Ralph Hurley O’Dwyer
AU - Chantal Den Daas
PY - 2026
DA - 2026/08/26
JO - International Journal of STD & AIDS
DO - 10.1177/09564624261481866
UR - https://doi.org/10.1177/09564624261481866
AB - Routine high-frequency screening for asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae among cisgender gay, bisexual and other men who have sex with men (gbMSM) is established despite limited evidence that it reduces population-level incidence or harm. Recent studies support reconsideration but do not settle the balance of benefits and harms. Reducing screening could delay diagnosis and affect transmission or partner notification; continuing screening may increase antimicrobial exposure, possible overdiagnosis, anxiety and stigma. The demonstrated benefits and unresolved long-term stewardship implications of doxycycline post-exposure prophylaxis (DoxyPEP) illustrate why antimicrobial use should be differentiated. We argue for cautious, co-produced, evaluated and reversible de-implementation while maintaining symptomatic, contact-based and otherwise clinically indicated testing, HIV and syphilis screening and HIV pre-exposure prophylaxis (PrEP) care. With transparent communication and community partnership, less screening need not mean less care.
SN - 0956-4624
SN - 1758-1052
ER -