Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men

Abstract

Background The incidence of bacterial sexually transmitted infections (STIs) in men who have sex with men (MSM) has increased substantially despite availability of effective antibiotics. The US Centers for Disease Control and Prevention (CDC) recommends annual screening for all sexually active (SA) MSM and more frequent screening for high-risk (HR) MSM. The population-level benefits of improved coverage vs increased frequency of STI screening among SA vs HR MSM are unknown. Methods We used a network transmission model of gonorrhea (NG) and chlamydia (CT) among MSM to simulate the implementation of STI screening across different scenarios, starting with the CDC guidelines at current coverage levels. Counterfactual model scenarios varied screening coverage and frequency for SA MSM and HR MSM (MSM with multiple recent partners). We estimated infections averted and the number needed to screen to prevent 1 new infection. Results Compared with current recommendations, increasing the frequency of screening to biannually for all SA MSM and adding some HR screening could avert 72% of NG and 78% of CT infections over 10 years. Biannual screening of 30% of HR MSM at empirical coverage levels for annual SA screening could avert 76% of NG and 84% of CT infections. Other scenarios, including higher coverage among SA MSM and increasing frequency for HR MSM, averted fewer infections but did so at a lower number needed to screen. Conclusions The optimal screening scenarios in this model to reduce STI incidence among MSM included more frequent screening for all sexually active MSM and higher coverage of screening for HR men with multiple partners.

Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence Among Men Who Have Sex With Men in the United States: A Modeling Analysis

“…Previous analyses have demonstrated the expected effects of increased NG/CT screening on NG/CT incidence 20 ; our analysis expands on those results to understand the effects of NG/CT screening on HIV incidence. There is strong evidence for the synergy between the HIV and STI epidemics among MSM, including shared transmission mechanisms and risk factors 3,4 .…”

Positive association between country-level screening rates for chlamydia and gonorrhea and self-reported diagnoses in MSM: an ecological analysis

“…5 Finally, modelling studies have reached various conclusions. For example, one study found that screening MSM could approximately halve the incidence of CT/NG 14 whilst another found screening would have a minimal effect on CT/NG prevalence and result in a large increase in antimicrobial consumption. 15…”

Influence of sexual risk behaviour and STI co-infection dynamics on the evolution of HIV set point viral load in MSM

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