Beyond epidemiology: Community,psychosocial and public health considerations in reducing asymptomatic Chlamydia trachomatis & Neisseria gonorrhoeae screening

Abstract

Growing debate has emerged regarding the reduction of routine asymptomatic screening for gonorrhoea and chlamydia among gay, bisexual and other men who have sex with men (gbMSM), particularly within HIV pre-exposure prophylaxis (PrEP) populations. Existing evidence suggests that high-frequency screening may offer limited population-level benefit while contributing to antimicrobial exposure and resistance. Consequently, several authors and policy bodies have argued for more selective and stewardship-oriented approaches. This commentary argues that current debates remain dominated by epidemiological and microbiological framings of public health benefit, with insufficient attention to wider socioecological, psychosocial and community consequences. We highlight how asymptomatic STI screening functions not solely as a biomedical intervention, but also as a social practice embedded within community norms, healthcare engagement, reassurance and cultures of collective responsibility. Reductions in screening may therefore influence trust, stigma, healthcare-seeking behaviours and public health messaging in ways not captured through surveillance data alone. We argue that future screening policy changes should be developed through meaningful community engagement and evaluated using broader public health and socioecological frameworks alongside epidemiological evidence.