Screening is not associated with reduced incidence of gonorrhoea or chlamydia in men who have sex with men (MSM); an ecological study of 23 European countries

Abstract

Background: Increasing rates of antimicrobial resistance has motivated a reassessment of if intensive screening for gonorrhoea and chlamydia is associated with a reduction in the prevalence of these infections in men who have sex with men (MSM). Methods: Spearman's correlation was used to evaluate the country-level correlation between the intensity of self-reported sexual transmitted infection (STI) screening in MSM (both anal and urethral screening, taken from a large internet survey of MSM) and the incidence (taken from ECDC surveillance figures) and prevalence (taken from a literature review of studies estimating prevalence in MSM attending STI clinics) of gonorrhoea and chlamydia. Results: The intensity of both anal and genital screening was found to be positively associated with country level gonorrhoea incidence rates (rho 0.74; p=0.0004; rho=0.73; p=0.0004, respectively) and Ct incidence rates (rho 0.71; p=0.001; rho=0.78; p=0.0001, respectively). No associations were found between anal or genital screening intensity and Ng prevalence in clinic populations (Table 2). Conclusions: We found no evidence of a negative association between screening intensity and the prevalence of gonorrhoea or chlamydia in MSM. Randomized controlled trials are urgently required to evaluate if the high antimicrobial exposure resulting from intensive screening programmes is justified.

Keywords: Gonorrhoea; MSM; PrEP; STI screening; antimicrobial resistance; chlamydia.

Figure 1.. Scatter plots of country-level association between self-reported anal and urethral sexual transmitted infection (STI) screening intensity in men who have sex with men (MSM) and incidence of Chlamydia trachomatis and Neisseria gonorrhoeae in men in European countries in 2010.

Country designations: AT, Austria; BE, Belgium; CZ, Czech Republic; DE, Germany; DK, Denmark; EL, Greece; ES, Spain; FI, Finland; FR, France; HR, Croatia; HU, Hungary; IE, Ireland; IT, Italy; LU, Luxembourg; LV, Latvia; NL, the Netherlands; PT, Portugal; SE, Sweden; SI, Slovenia; SK, Slovakia; UK, United Kingdom.