Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV

Abstract

Objective:Use of preexposure prophylaxis (PrEP) for HIV raises concerns about sexually transmitted infection (STI) incidence because of decreased condom use among MSM. This study examines whether PrEP is associated with STIs in the 12 months following PrEP prescription relative to the 12 months prior to PrEP and if STI rates are higher among PrEP users relative to individuals receiving postexposure prophylaxis (PEP).Design:Retrospective cohort study including PrEP users with more than 12 months of follow-up before PrEP prescription and individuals receiving PEP from 2010 to 2015 at Clinique l’Actuel (Montréal, Canada).Methods:Incidence of chlamydia, gonorrhoea, syphilis and hepatitis C virus over 12 months was compared before and after PrEP; and for PrEP versus PEP users using Poisson models to generate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) and adjusted IRRs (aIRRs) controlling for frequency of STI-screening visits. Models comparing PrEP and PEP users were further adjusted for age and education.Results:One hundred and nine PrEP and 86 PEP users were included. Increased rates of STIs were observed in the 12 months after PrEP relative to the 12 months prior (IRR: 1.72, CI: 1.22–2.41; aIRR: 1.39, CI 0.98–1.96). PrEP users were also at higher STI risk relative to PEP users (IRR: 2.18, CI: 1.46–3.24; aIRR: 1.76, CI: 1.14–2.71).Conclusion:Increased rates of STIs among individuals after initiation of PrEP may suggest greater risk behaviours during the first year on PrEP. Further studies are needed to measure long-term trends in STI acquisition following PrEP initiation.

STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany

“…These risk factors were also found in several other studies [3,6,7,14]. Our study complements the results of a recent meta-analysis and other current cross-sectional studies that showed an association between PrEP use and STI diagnosis [30], and reported PrEP use as important risk factor for STI diagnosis [27,40,65]. A large longitudinal study from Australia could even show increasing STI incidences after initiation of PrEP [29].…”

“…Despite the license of PrEP includes the recommendation of regular condom use for PrEP users, it is probable that one of the main reasons for taking PrEP is that persons can effectively reduce their risk for acquiring a HIV infection without using condoms. Since PrEP was introduced it is under debate to what extent a concomitant reduction of condom use and a potential increase of more risky sexual behavior will lead to an increase of other STI [25][26][27][28][29][30]. In contrast, recommended regular and small meshed STI testing is discussed as an argument against an increase of STI due to PrEP, as this could lead to more efficient diagnosis and treatment of newly acquired STI as well as of so far undiagnosed reservoirs in populations with high risk such as sexually highly active MSM [31,32].…”

Evaluation of anal carcinoma screening in male and female HIV patients at an interdisciplinary HIV therapy centre

“…Recurrent syphilis infection in PLWH can be interpreted as an indicator of altered sexual risk behaviour. Recently, the increased use of pre‐exposure prophylaxis for HIV has raised concerns about greater risk behaviour among MSM and the possibility that this causes a higher incidence in STIs or HPV‐mediated malignancies . The positive correlation between syphilis, HPV infection and AIN highlights the importance of regular STD screening in PLWH and the benefit of promoting safe sex education.…”

Análise Da Profilaxia Pré-Exposição Para Hiv

“…Outra abordagem avaliou a relação entre o uso da PrEP e o aumento do risco de adquirir outras DSTs, principalmente Clamidiose, Gonorreia e Sífilis (NGUYEN et al, 2018). Apesar de haver correlações numéricas, a Truvada® (asnome comercial da associação de Emtricitabina e Tenofovir) não propicia, quimicamente, maior risco à aquisição de doenças sexualmente transmissíveis, porém, pode influenciar nos índices dessas devido mudanças de hábitos que aumentam o risco de tais infecções.…”