Are Clinicians Open to Less Asymptomatic STI Screening for Chlamydia and Gonorrhea in Gay, Bisexual, and Other Men Who Have Sex with Men and the Possibility of Not Treating Positive Diagnoses? A Qualitative Study from Australia
Bibliographic record
Abstract
Abstract Evidence from real-world studies suggests that 3-monthly screening for asymptomatic chlamydia/gonorrhoea is not reducing incidence and is driving increased antibiotic use and antimicrobial resistance (AMR). While some countries are recommending less screening, changes to guidelines require clinician buy-in. This study explored the views of Australian sexual health clinicians to changing practices around asymptomatic screening for chlamydia/gonorrhoea in gay, bisexual and other men-who-have-sex-with-men (GBMSM) and attitudes to not automatically treating positive diagnoses. We conducted thematic analysis of 16 semi-structured interviews with clinicians working in a range of settings. Interviews covered: evidence on ‘test and treat’, perspectives on reducing screening and treatment for chlamydia/gonorrhoea in GBMSM, AMR, and managing patient conversations. Clinicians had variable knowledge about the limited effectiveness of asymptomatic screening. Many were open to reduced screening, if provided supporting evidence. Given challenges in reducing medical interventions, they recommended public education to drive changes. While some clinicians supported patient dialogue in treatment decision-making, most felt uncomfortable not treating. Concerns included: ideas about their role as doctors; onward transmission (particularly to women); and, complications/uncomfortable symptoms/patient psychological well-being. AMR considerations were less salient. While the ‘test and treat’ paradigm is engrained, clinicians were open to reduced screening, if provided with clear evidence, but were generally reluctant to not treat. A flexible approach that supports patient empowerment in decision-making about screening frequency and choices around treatment could present a way forward. Changing practice requires education to shift patient/clinician mindsets around what it means to have a positive chlamydia/gonorrhoea diagnosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.049 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.010 | 0.014 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".