Asymptomatic Screening for Neisseria gonorrhoeae Among Gay and Bisexual Men Attending Public Sexual Health Services in Australia and Associations With Patterns of Ceftriaxone Consumption: A Retrospective Observational Study.

BACKGROUND

Neisseria gonorrhoeae is a significant public health concern due to rising antimicrobial resistance. Current strategies for N gonorrhoeae among gay and bisexual men (GBM) include 3-month screening; however, high-frequency screening may increase ceftriaxone consumption, potentially contributing to antimicrobial resistance.

METHODS

We conducted a retrospective cohort study of GBM screened for N gonorrhoeae at 16 Australian public sexual health services between 2016 and 2023. We classified N gonorrhoeae tests and ceftriaxone prescriptions as screening-related (asymptomatic screening) or nonscreening-related (testing/treatment of contacts, symptomatic testing, or empirical treatment). We explored trends in annual ceftriaxone prescription rates and used multivariable Poisson regression to examine the association between individuals' annual asymptomatic screening frequency and ceftriaxone consumption, adjusted for age, year, pre-exposure prophylaxis, HIV status, injecting drug use, and syphilis and chlamydia diagnoses.

RESULTS

In total, 65 261 GBM contributed 133 846 person-years. From 2016 to 2023, the total ceftriaxone prescription rate rose from 2.92 defined daily doses per 100 person-years at risk to 5.25: screening-related ceftriaxone increased from 0.91 to 2.96 (P < .001) while nonscreening-related ceftriaxone remained stable (P = .570). When compared with having 1 screening test per year, having ≥4 tests was associated with a higher rate of screening-related ceftriaxone prescriptions (adjusted incident rate ratio, 5.47; 95% CI, 5.16-5.79).

CONCLUSIONS

Ceftriaxone consumption rose among GBM, largely driven by increased screening rather than nonscreening-related treatment. Our findings highlight the association between high-frequency screening and antibiotic consumption, providing real-world data to guide discussions on the benefits and risks of screening.