Would men who have sex with men support less frequent screening for asymptomatic chlamydia and gonorrhoea to improve antibiotic stewardship? A qualitative study.

BACKGROUND: Men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) are recommended to have screening for asymptomatic chlamydia and gonorrhoea every 3months with high rates of asymptomatic chlamydia and gonorrhoea detected. However, there is little evidence about the effectiveness of this screening interval and there is increasing concern about antibiotic consumption and its impact on antimicrobial resistance. There have been calls to reconsider this frequent screening for chlamydia and gonorrhoea. We conducted interviews with MSM to assess their attitudes to 3-monthly chlamydia and gonorrhoea screening. METHODS: Individual semi-structured interviews were conducted with MSM living in Victoria, Australia. Participants were aged 20-62years and had been taking PrEP for at least 6months. Interviews were audio-recorded and transcribed, and these data were investigated through reflexive thematic analysis. RESULTS: Thirteen interviews were conducted in August 2021. Participants were hesitant about reducing the screening frequency and reported that testing gave them a sense of security. While MSM recognised antimicrobial resistance was a concern, it did not impact their sexual behaviour, with many participants stating they would rather continue to take antibiotics to treat infections rather than adopt preventative measures such as condom use. Positive attitudes towards screening interval changes are more likely when PrEP patients are informed about the risks and benefits of sexual healthcare recommendations. CONCLUSION: While MSM on PrEP were initially hesitant to changes in screening frequency, changes may be acceptable if transparent communication, presenting the benefits and harms of screening and treatment, was delivered by a trusted healthcare professional.

High rates of chlamydia found among 12- to 16-year-olds attending a rural sexual health clinic: implications for practice.

UNLABELLED: Background Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) and is asymptomatic in ~80% of women. If untreated, potential consequences include pelvic inflammatory disease, ectopic pregnancy and infertility. METHODS: In 2014, a retrospective audit was undertaken at a rural service to determine what proportion of patients were aged 12-16 years, infected with chlamydia and their reasons for attending the clinic. RESULTS: There were 111 patients aged 12-16 years attending during 2011-2014; 104 (95%) were female. One hundred and ninety-four chlamydia tests were conducted, with the proportion of patients having at least one test annually being 100% in 2011, 81% in 2012, 72% in 2013 and 78% in 2014. There was no difference in the proportion tested by age during the study (P=0.59). Forty-six tests were positive for chlamydia (23.7%; 95%CI: 17.8%, 30.9%) with proportions decreasing with increasing age from 46.7% (95%CI: 16.4%, 79.5%) in 12- or 13-year-olds to 15.5% (95%CI: 9.4%, 24.2%) in 16-year-olds (P=0.02). The reasons for attending when a chlamydia test was ordered included: (i) fear of pregnancy (18.3%, 34/185); (ii) symptoms (16.7%, 31/185); (iii) STI test/treatment (32.4%, 60/185); and (iv) contraception (32.4%, 60/185). Only 29.7% (33/111) would have been tested if symptoms or requesting a test were impetus. CONCLUSION: Sexually active 12- to 16-year-olds should be tested for chlamydia, and establishing their sexual history is crucial. Amending the current Australian guidelines to annual testing of any sexually active person under the age of 30 years should be considered.

Treatment challenges for urogenital and anorectal Chlamydia trachomatis.

While true antimicrobial resistance to Chlamydia trachomatis is a rare occurrence, repeat chlamydia infections continue to be reported following treatment with a single 1 g dose of azithromycin or week long doxycycline - with considerable more concern about azithromycin treatment failure. While most repeat positive cases are likely to be reinfections, emerging evidence indicates treatment failure may play a role. Current data suggests that there may are differences in the efficacy of the drugs between rectal and non-rectal sites of infection and factors such as immune response, drug pharmacokinetics, organism load, auto-inoculation from rectum to cervix in women and the genital microbiome may play a role in treatment failure. Other possible reasons for repeat infection include the low discriminatory power of NAAT tests to differentiate between viable and nonviable organisms and failure to detect LGV infection. This review will present the current evidence regarding the management challenges for urogenital and anorectal chlamydia infections and provide some suggestions for where future research efforts are needed to address important knowledge gaps in this area and provide stronger evidence for the development of robust treatment guidelines.