Less is more: reconsidering asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae screening for gay, bisexual and other men who have sex with men in the era of doxycycline post-exposure prophylaxis (DoxyPEP)

Routine high-frequency screening for asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae among cisgender gay, bisexual and other men who have sex with men (gbMSM) is established despite limited evidence that it reduces population-level incidence or harm. Recent studies support reconsideration but do not settle the balance of benefits and harms. Reducing screening could delay diagnosis and affect transmission or partner notification; continuing screening may increase antimicrobial exposure, possible overdiagnosis, anxiety and stigma. The demonstrated benefits and unresolved long-term stewardship implications of doxycycline post-exposure prophylaxis (DoxyPEP) illustrate why antimicrobial use should be differentiated. We argue for cautious, co-produced, evaluated and reversible de-implementation while maintaining symptomatic, contact-based and otherwise clinically indicated testing, HIV and syphilis screening and HIV pre-exposure prophylaxis (PrEP) care. With transparent communication and community partnership, less screening need not mean less care.