Screening for asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae in gay, bisexual and other men who have sex with men: A scoping review.

Abstract

BackgroundThe balance of benefits and harms associated with frequent asymptomatic testing for Chlamydia trachomatis and Neisseria gonorrhoeae in gay, bisexual and other men who have sex with men (GBMSM) remains uncertain. While many guidelines recommend three-monthly testing for those perceived to be at higher risk, the evidence supporting this frequency is unclear. We reviewed existing evidence on testing frequency for C. trachomatis and N. gonorrhoeae in asymptomatic GBMSM and synthesised what is known about its impact on infection incidence and prevalence, symptomatic disease, and antimicrobial consumption.MethodsWe conducted a review of studies published between 2005 and 2025 across EMBASE, MEDLINE, CINAHL, Web of Science and Scopus. Quantitative, qualitative and mixed-methods studies evaluating outcomes associated with repeated asymptomatic screening in GBMSM were included.ResultsFifteen studies met eligibility criteria. More frequent screening increases detection of asymptomatic infections with limited evidence of reducing incidence, symptomatic presentations, or population-level prevalence. More frequent screening was associated with higher antimicrobial consumption. A single randomised controlled trial found modest reductions in C. trachomatisincidence with three-monthly screening but no clear benefit for N. gonorrhoeae. Frequent screening is closely tied to GBMSM's sense of responsibility, reassurance and community norms, and both GBMSM and clinicians express discomfort with reduced screening despite limited awareness of the natural clearance of C. trachomatis or N. gonorrhoeae or implications for antimicrobial resistance.ConclusionsThe current evidence base provides limited support for three-monthly asymptomatic C. trachomatis and N. gonorrhoeaescreening among GBMSM, and highlights the potential harms of increased antimicrobial use. A move to less frequent screening may offer a more balanced public health approach, but change will require careful engagement, transparent communication and attention to social and behavioural dimensions. More rigorous trials, especially in the context of emerging prevention strategies such as doxyPEP are needed to inform optimal screening intervals.