Less is more: reconsidering asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae screening for gay, bisexual and other men who have sex with men in the era of doxycycline post-exposure prophylaxis (DoxyPEP)

among cisgender gay, bisexual and other men who have sex with men (gbMSM) is established despite limited evidence that it reduces population-level incidence or harm. Recent studies support reconsideration but do not settle the balance of benefits and harms. Reducing screening could delay diagnosis and affect transmission or partner notification; continuing screening may increase antimicrobial exposure, possible overdiagnosis, anxiety and stigma. The demonstrated benefits and unresolved long-term stewardship implications of doxycycline post-exposure prophylaxis (DoxyPEP) illustrate why antimicrobial use should be differentiated. We argue for cautious, co-produced, evaluated and reversible de-implementation while maintaining symptomatic, contact-based and otherwise clinically indicated testing, HIV and syphilis screening and HIV pre-exposure prophylaxis (PrEP) care. With transparent communication and community partnership, less screening need not mean less care.