DOI: 10.1177/09564624261476607 ISSN: 0956-4624
Screening for asymptomatic
Chlamydia trachomatis
and
Neisseria gonorrhoeae
in gay, bisexual and other men who have sex with men: A scoping review
Thomas Munday, Himani Jayasinghe, Helen Fifer, John Saunders
Background
The 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.
Methods
We 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.
Results
Fifteen 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. trachomatis
incidence 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.
Conclusions
The current evidence base provides limited support for three-monthly asymptomatic
C. trachomatis and
N. gonorrhoeae
screening 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.