Would men who have sex with men support less frequent screening for asymptomatic chlamydia and gonorrhoea to improve antibiotic stewardship? A qualitative study. 2023

Amelia Margaret Wardley, and Henrietta Williams, and Jacqueline Coombe, and Cassandra Caddy, and Christopher Kincaid Fairley, and Jane Simone Hocking
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.

Men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) are recommended to have screening for asymptomatic chlamydia and gonorrhoea every 3months 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. Individual semi-structured interviews were conducted with MSM living in Victoria, Australia. Participants were aged 20-62years and had been taking PrEP for at least 6months. Interviews were audio-recorded and transcribed, and these data were investigated through reflexive thematic analysis. 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. 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.

UI MeSH Term Description Entries
D008297 Male Males
D002689 Chlamydia A genus of the family CHLAMYDIACEAE whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is CHLAMYDIA TRACHOMATIS.
D002690 Chlamydia Infections Infections with bacteria of the genus CHLAMYDIA. Infections, Chlamydia,Chlamydia Infection,Infection, Chlamydia
D006069 Gonorrhea Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, NEISSERIA GONORRHOEAE, was isolated by Neisser in 1879. Neisseria gonorrhoeae Infection
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000072339 Sexual and Gender Minorities Individuals including lesbian, gay, bisexual, transgender, queer, intersex, gender non-conforming people, and other populations whose sexual orientation or GENDER IDENTITY and reproductive development is considered outside cultural, societal, or physiological norms. Gays,Gender Diverse,LGBTQ,LGBTQIA,Bisexuals,GLBT Persons,Gender Minorities,Homosexuals,LBG Persons,LGBT Persons,LGBTQ Persons,Lesbians,Lesbigay Persons,Men Who Have Sex With Men,Non-Heterosexual Persons,Non-Heterosexuals,Queers,Sexual Dissidents,Sexual Minorities,Women Who Have Sex With Women,Bisexual,Dissident, Sexual,Dissidents, Sexual,Diverse, Gender,GLBT Person,Gay,Gender Minority,Homosexual,LBG Person,LGBT Person,LGBTQ Person,Lesbian,Lesbigay Person,Minorities, Gender,Minorities, Sexual,Minority, Gender,Minority, Sexual,Non Heterosexual Persons,Non Heterosexuals,Non-Heterosexual,Non-Heterosexual Person,Person, GLBT,Person, LBG,Person, LGBT,Person, LGBTQ,Person, Lesbigay,Person, Non-Heterosexual,Persons, GLBT,Persons, LBG,Persons, LGBT,Persons, LGBTQ,Persons, Lesbigay,Queer,Sexual Dissident,Sexual Minority
D000073602 Antimicrobial Stewardship Programs and guidelines for selecting optimal ANTI-INFECTIVE AGENTS regimens in an effort to maintain antibiotic efficacy, reduce CROSS INFECTION related to ANTIBIOTIC RESISTANCE while managing satisfactory clinical and economic outcomes. Antibiotic Stewardship,Stewardship, Antibiotic,Stewardship, Antimicrobial
D000890 Anti-Infective Agents Substances that prevent infectious agents or organisms from spreading or kill infectious agents in order to prevent the spread of infection. Anti-Infective Agent,Anti-Microbial Agent,Antimicrobial Agent,Microbicide,Microbicides,Anti-Microbial Agents,Antiinfective Agents,Antimicrobial Agents,Agent, Anti-Infective,Agent, Anti-Microbial,Agent, Antimicrobial,Agents, Anti-Infective,Agents, Anti-Microbial,Agents, Antiinfective,Agents, Antimicrobial,Anti Infective Agent,Anti Infective Agents,Anti Microbial Agent,Anti Microbial Agents
D012725 Sexual Behavior Sexual activities of humans. Anal Sex,Oral Sex,Sexual Activity,Sexual Orientation,Premarital Sex Behavior,Sex Behavior,Sex Orientation,Sexual Activities,Activities, Sexual,Activity, Sexual,Behavior, Premarital Sex,Behavior, Sex,Behavior, Sexual,Orientation, Sexual,Sex, Anal,Sex, Oral
D014739 Victoria A state in southeastern Australia, the southernmost state. Its capital is Melbourne. It was discovered in 1770 by Captain Cook and first settled by immigrants from Tasmania. In 1851 it was separated from New South Wales as a separate colony. Self-government was introduced in 1851; it became a state in 1901. It was named for Queen Victoria in 1851. (From Webster's New Geographical Dictionary, 1988, p1295 & Room, Brewer's Dictionary of Names, p574)

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