Does Intense Sexually Transmitted Infection Screening Cause or Prevent Antimicrobial Resistance in Sexually Transmitted Infections? It Depends on One's Underlying Epistemology. A Viewpoint.

Certain authors argue that intensive sexually transmitted infection (STI) screening is a crucial way to reduce STI prevalence and prevent the emergence and spread of antimicrobial resistance (AMR) in STIs. Others argue the opposite: intense screening in high STI prevalence populations has little effect on prevalence and is likely to select for AMR. In this viewpoint, I argue that these radical differences in outlook stem, in part, from different conceptual frameworks of the determinants of STI prevalence and AMR. In the absence of strong evidence from randomized controlled trials, our brains interpret the weaker evidence from other sources in different ways, depending on our underlying epistemologies. To illustrate the argument, I contrast a predominantly biomedical individualist conceptual framework with a more ecological conceptual framework. I argue that if one's conceptual framework is based in biomedical individualism, then one is more likely to think that screening reduces STI prevalence and less likely to appreciate the connection between screening, antimicrobial exposure, and AMR than perspectives grounded in ecological frameworks.