HIV/STI Unit, 567788Institute of Tropical Medicine, Antwerp, Belgium.
Division of Infectious Diseases and HIV Medicine, University of Cape Town, South Africa.
Int J STD AIDS. 2022 Mar;33(4):404-415. doi: 10.1177/09564624211064133. Epub 2022 Jan 4.
A large number of countries are being confronted with twin epidemics of increasing STI incidence and antimicrobial resistance (AMR). This has led to calls to intensify STI screening of high STI prevalence populations. The available evidence suggests that this will have little impact on STI prevalence but a significant deleterious effect on AMR. We suggest that this call to intensify STI screening is one of the several errors that stem from the way that the STI-field has been dominated by a biomedical individualistic conceptual framework. This framework views STIs as obligate pathogens that can and should be eradicated by intensive seek-and-destroy activities. We evaluate five types of evidence that suggest that a multi-level, socio-ecological framework would provide a more accurate portrayal of the important determinants of STI prevalence and AMR spread. By incorporating concepts such as limiting STI screening to scenarios with clear evidence of net-benefit and considering 'antimicrobial footprint' thresholds, this framework would be more likely to result in a better balance between targeting STI prevalence whilst minimizing the risk of AMR emerging.
大量国家正面临着性传播感染发病率上升和抗生素耐药性（AMR）双重流行的局面。这导致了呼吁加强高性传播感染流行人群的性传播感染筛查。现有证据表明，这对性传播感染的流行率影响甚微，但对抗生素耐药性却有显著的不利影响。我们认为，这种呼吁加强性传播感染筛查是源于性传播感染领域一直被生物医学个体化概念框架所主导的几个错误之一。该框架将性传播感染视为强制性病原体，可以并且应该通过密集的寻找和消灭活动来根除。我们评估了五类证据，这些证据表明，多层次、社会生态框架将更准确地描绘出性传播感染流行和抗生素耐药性传播的重要决定因素。通过将性传播感染筛查限制在具有明确净效益证据的情况下，并考虑“抗生素足迹”阈值等概念，该框架更有可能在针对性传播感染流行率的同时，最大限度地降低抗生素耐药性出现的风险，从而实现更好的平衡。
