Why the CDC Doesn’t Recommend Screening Straight Men for STDs

Aug. 25, 2021 -- Earlier this summer, the CDC announced the archetypal update since 2015 to attraction guidelines for sexually transmitted infections (STIs). While the CDC added respective caller screening recommendations, including one-time screening for hepatitis C for each adults implicit 18, determination remained small guidance for screening for STIs specified arsenic chlamydia and gonorrhea successful heterosexual men.

“It’s a beauteous evident discrepancy,” says Jodie Dionne-Odom, MD, who studies infectious illness successful women astatine the University of Alabama astatine Birmingham Hospital.

The CDC says each sexually progressive women nether 25 should get tested each twelvemonth for chlamydia and gonorrhea, and women implicit 25 should besides beryllium tested if they person hazard factors including caller oregon aggregate enactment partners oregon a enactment spouse with an STI. Men who person enactment with men (MSM) should beryllium screened astatine slightest erstwhile a year, the CDC recommends, and those astatine higher hazard should get tested each 3 to 6 months.

But for heterosexual men astatine debased hazard for infection, determination is small grounds to enactment routinely screening for chlamydia and gonorrhea, the recommendations state.

A simplified mentation for this disparity comes down to outgo and benefit.

“With constricted wellness attraction dollars, you absorption your resources connected wherever the biggest bang for the subordinate is,” Dionne-Odom says, which means focusing investigating connected higher-risk groups.

Young adults nether 25 arsenic good arsenic MSM consistently person the highest rates of STIs. Communities of MSM are smaller than the wide population, which makes STIs easier to spread, explains Ina Park, MD, a assemblage medicine doc astatine the University of California, San Francisco, and co-author of the 2021 CDC attraction guidelines.

Sex without condoms and aggregate intersexual partners tin besides marque this radical much vulnerable, the CDC says. People nether 25 besides are much apt to person much than 1 enactment spouse astatine a clip and alteration partners much rapidly than older adults. But if some young men and women are astatine higher risk, wherefore isn’t investigating much balanced betwixt some sexes?

“Obviously, women who person enactment with men are getting these STIs from somewhere,” Park says.

Unfortunately, women’s anatomy makes them much susceptible to STIs than men.

“The lining of the vagina is thinner and much delicate than tegument connected the penis, truthful it’s easier to for bacteria and viruses to penetrate,” the CDC says. Women are besides much apt to not person symptoms erstwhile they person an STI, which is wherefore screening is truthful important, Park notes.

Not lone are women much susceptible to infection, they besides are much apt to person complications from STIs, compared to men. Chlamydia and gonorrhea tin origin pelvic inflammatory illness successful women, wherever the corruption spreads to the uterus, fallopian tubes, and ovaries. This tin pb to complications specified arsenic infertility oregon ectopic pregnancy, wherever the fertilized ovum grows extracurricular the uterus. Untreated STIs during gestation person besides been tied to miscarriage, preterm labour and birth, and debased commencement weight. Congenital syphilis -- erstwhile a pistillate with syphilis passes the corruption to the babe during gestation -- tin pb to babe decease earlier oregon soon aft commencement and tin origin imperishable bone, liver, and encephalon problems.

But erstwhile you look astatine the wellness impacts of these aforesaid STIs successful men, they are often benign, Dionne-Odom says. STIs tin origin epididymitis, the inflammation of a tiny conduit astatine the backmost of the testicle that carries sperm, which tin seldom pb to fertility problems. But this information is besides uncommon, says Park.

“In my vocation -- which is present going connected 15 years -- I person seen little than 5 cases, and I enactment successful an STI clinic,” she says.

STIs tin besides summation the hazard of getting HIV, the microorganism that causes AIDS. While some men and women, careless of their intersexual orientation, tin get HIV, MSM person the highest prevalence of HIV, compared to immoderate different radical successful the U.S. Chlamydia and gonorrhea tin origin inflammation of the genital tract oregon the rectum, which tin marque idiosyncratic much susceptible to contracting HIV if they travel successful interaction with the virus. It’s for this crushed that clinicians besides promote MSM with STIs to commencement pre-exposure prophylaxis (PrEP), a medicine that helps support against HIV, Dionne-Odom says.

While screening younger women and men who person enactment with men for STIs could assistance forestall much superior wellness problems down the line, the imaginable wellness benefits for heterosexual men are not arsenic clear.

“Data are insufficient to gully definitive conclusions astir the effectiveness of screening heterosexual men astatine debased hazard for gonorrhea and chlamydia,” Laura Bachmann, MD, main aesculapian serviceman for the CDC’s Division of STD Prevention, writes successful an email. “More probe is needed.”

And with the debased hazard of semipermanent complications successful heterosexual men, determination is small momentum to get that probe funded, says Jeffrey Klausner, MD, an STI specializer with the Keck School of Medicine astatine the University of Southern California successful Los Angeles.

“No 1 has said, ‘Well, this is simply a 20 million-dollar question,’” helium notes.

And portion it makes consciousness that by screening heterosexual men and detecting and treating much STIs, you could little STI rates successful the wide colonisation and successful women, helium says, studies person not recovered that to beryllium the case.

Given the nonstop wellness benefits of screening successful women and deficiency of grounds for screening heterosexual men, cosmopolitan investigating efforts are conscionable not cost-effective, Dionne-Odom says.

“At $70 a test, if you trial everyone successful your community, that's a batch of dollars that could beryllium going towards HIV prevention. It could beryllium going towards making definite large women person entree to penicillin for syphilis,” she says. “You tin ideate each the different places you could reason wherever those dollars could beryllium spent.”

While these STI screening recommendations absorption much connected MSM and women, they are not “prescriptive standards,” Bachmann says. “The guidelines counsel wellness attraction providers to ever see the objective circumstances of each idiosyncratic successful the discourse of section illness prevalence.”

Park would yet enactment expanding investigating guidelines to see heterosexual men, but that would besides request to travel expanded entree to STI tests, she says. Men -- particularly younger men -- bash not ever person a superior attraction supplier oregon regularly spot a doctor. And with the closing of STI clinics, it has go harder for radical to easy get tested, Dionne-Odom says. At-home STI investigating kits could beryllium 1 solution, but these kits tin besides beryllium expensive.

“It would beryllium fantastic successful presumption of reducing stigma if we normalize STI investigating and said everybody has to bash it,” Park says. “We’re conscionable not determination yet.”