While screening younger women and men who have sex with men for STIs could help prevent more serious health problems down the line, the potential health benefits for heterosexual men are not as clear.
“Data are insufficient to draw definitive conclusions about the effectiveness of screening heterosexual men at low risk for gonorrhea and chlamydia,” Laura Bachmann, MD, chief medical officer for the CDC’s Division of STD Prevention, writes in an email. “More research is needed.”
And with the low risk of long-term complications in heterosexual men, there is little momentum to get that research funded, says Jeffrey Klausner, MD, an STI specialist with the Keck School of Medicine at the University of Southern California in Los Angeles.
“No one has said, ‘Well, this is a 20 million-dollar question,’” he notes.
And while it makes sense that by screening heterosexual men and detecting and treating more STIs, you could lower STI rates in the general population and in women, he says, studies have not found that to be the case.
Given the direct health benefits of screening in women and lack of evidence for screening heterosexual men, universal testing efforts are just not cost-effective, Dionne-Odom says.
“At $70 a test, if you test everyone in your community, that’s a lot of dollars that could be going towards HIV prevention. It could be going towards making sure pregnant women have access to penicillin for syphilis,” she says. “You can imagine all the other places you could argue where those dollars could be spent.”
While these STI screening recommendations focus more on MSM and women, they are not “prescriptive standards,” Bachmann says. “The guidelines advise health care providers to always consider the clinical circumstances of each person in the context of local disease prevalence.”
Park would ultimately support expanding testing guidelines to include heterosexual men, but that would also need to accompany expanded access to STI tests, she says. Men — especially younger men — do not always have a primary care provider or regularly see a doctor. And with the closing of STI clinics, it has become harder for people to easily get tested, Dionne-Odom says. At-home STI testing kits could be one solution, but these kits can also be expensive.
“It would be wonderful in terms of reducing stigma if we normalize STI testing and said everybody has to do it,” Park says. “We’re just not there yet.”