Would men who have sex with men support less frequent screening for asymptomatic chlamydia and gonorrhoea to improve antibiotic stewardship? A qualitative study

Abstract

Background. Men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) are recommended to have screening for asymptomatic chlamydia and gonorrhoea every 3 months with high rates of asymptomatic chlamydia and gonorrhoea detected. However, there is little evidence about the effectiveness of this screening interval and there is increasing concern about antibiotic consumption and its impact on antimicrobial resistance. There have been calls to reconsider this frequent screening for chlamydia and gonorrhoea. We conducted interviews with MSM to assess their attitudes to 3-monthly chlamydia and gonorrhoea screening. Methods. Individual semi-structured interviews were conducted with MSM living in Victoria, Australia. Participants were aged 20-62 years and had been taking PrEP for at least 6 months. Interviews were audio-recorded and transcribed, and these data were investigated through reflexive thematic analysis. Results. Thirteen interviews were conducted in August 2021. Participants were hesitant about reducing the screening frequency and reported that testing gave them a sense of security. While MSM recognised antimicrobial resistance was a concern, it did not impact their sexual behaviour, with many participants stating they would rather continue to take antibiotics to treat infections rather than adopt preventative measures such as condom use. Positive attitudes towards screening interval changes are more likely when PrEP patients are informed about the risks and benefits of sexual healthcare recommendations. Conclusion. While MSM on PrEP were initially hesitant to changes in screening frequency, changes may be acceptable if transparent communication, presenting the benefits and harms of screening and treatment, was delivered by a trusted healthcare professional.

Non-pathogenic Neisseria species of the oropharynx as a reservoir of antimicrobial resistance: a cross-sectional study

“…MSM are often exposed to an excess of antimicrobials, including macrolide, fluoroquinolones, cephalosporins and tetracyclines (Kenyon and Schwartz, 2018). An explanation of the large drug consumption among MSM is the practice of screening for gonorrhea and chlamydia, with high rates of asymptomatic infections detected and treated (Kenyon et al, 2020;Wardley et al, 2023). In this context, it has been observed that the pharyngeal environment of MSM using pre-exposure prophylaxis (PrEP) for HIV prevention is enriched with antibiotic resistance genes (Van Dijck et al, 2023).…”

Sexual health clinic attendees’ views on antibiotic post-exposure prophylaxis and vaccinations for sexually transmitted infections prevention: A qualitative study

“…Prophylactic use of doxycycline after potential exposures (i.e., DoxyPEP), has been found to be effective in reducing the likelihood of acquiring an STI in men who have sex with men (MSM) ( Luetkemeyer et al, 2023 ). However, frequent use of antibiotics has been correlated with antimicrobial resistance causing public health concerns, particularly for groups who screen frequently ( Kenyon, 2018 , Wardley et al, 2023 ). Vaccinations to reduce the incidence of bacterial STIs are still under investigation but may offer an alternative ( Gottlieb et al, 2019 ).…”