Are Clinicians Open to Less Asymptomatic STI Screening for Chlamydia and Gonorrhea in Gay, Bisexual, and Other Men Who Have Sex with Men and the Possibility of Not Treating Positive Diagnoses? A Qualitative Study from Australia.

Evidence from real-world studies suggests that 3-monthly screening for asymptomatic chlamydia/gonorrhea is not reducing incidence and is driving increased antibiotic use and antimicrobial resistance (AMR). While some countries are recommending less screening, changes to guidelines require clinician buy-in. This study explored the views of Australian sexual health clinicians on changing practices around asymptomatic screening for chlamydia/gonorrhea in gay, bisexual, and other men-who-have-sex-with-men and attitudes to not automatically treating positive diagnoses. Between September and December 2024, we conducted thematic analysis of semi-structured interviews with 12 physicians (including 8 general practitioners) and 4 nurse practitioners working in sexual health centers, hospitals, Aboriginal health services, general practice, and nongovernmental organizations. Clinicians had variable knowledge about the limited effectiveness of asymptomatic screening. Many were open to reduced screening if provided supporting evidence. Given challenges in reducing medical interventions, they recommended public education to drive changes. While some clinicians supported patient dialogue in treatment decision-making, most felt uncomfortable not treating. Key concerns included ideas about their role as doctors, onward transmission (particularly to women), and complications/uncomfortable symptoms/patient psychological well-being. AMR considerations were less salient. While the "test and treat" paradigm is engrained, clinicians were open to reduced screening if provided with clear evidence but were generally reluctant to not treat. A flexible approach that supports patient empowerment in decision-making about screening frequency and choices around treatment could present a way forward. Changing practice requires education to shift patient/clinician mindsets around what it means to have a positive chlamydia/gonorrhea diagnosis.