Knowledge and attitudes of syphilis and syphilis pre-exposure prophylaxis (PrEP) among men who have sex with men in Vancouver, Canada: a qualitative study

Abstract

ObjectivesIn British Columbia, Canada, syphilis is at record-high rates, with over 80% of cases in 2017 seen in gay, bisexual and other men who have sex with men (GBM). The syphilis epidemic is of particular concern for those living with HIV, since syphilis may lead to more serious complications in this population. We sought to explore syphilis-related knowledge and attitudes around biomedical prevention options for syphilis, with the goal of informing effective strategies to prevent syphilis.DesignWe conducted a qualitative study consisting of in-depth, individual interviews from December 2016 to June 2017. Our interviews focused on participants’ knowledge about syphilis and perceptions regarding syphilis pre-exposure prophylaxis (PrEP). Interviews were analysed using Grounded Theory.ParticipantsTwenty-five GBM were interviewed (64% white; median age: 43 years), including men living with HIV and/or with a history of syphilis.SettingVancouver, British Columbia.ResultsFive interrelated themes emerged. First, GBM were aware of the local syphilis epidemic. Second, syphilis-related knowledge differed according to syphilis and HIV serostatus. Third, competing ideas emerged regarding men’s concerns about syphilis. While our participants expressed concern about getting syphilis, they also described the importance of sexual pleasure. Fourth, many participants said that syphilis was not perceived to be alarming; preventing HIV infection remained a primary concern for many. Finally, while syphilis PrEP was appealing to those living with HIV or a prior syphilis diagnosis, others were concerned about antibiotic resistance, cost and side effects.ConclusionsOur participants organised their safer sex strategies around HIV, not syphilis. Although syphilis-related knowledge was relatively high among GBM living with HIV and those with a prior syphilis diagnosis, this knowledge did not appear to be related with safer sexual practices, such as increased condom use. This work highlights the importance of examining other potential prevention solutions, such as syphilis PrEP.

Countering the rise of syphilis: A role for doxycycline post-exposure prophylaxis?

“…From a public health perspective, persuading a large percentage of the SMM population to take doxycycline regularly may prove to be difficult, especially with the concerns regarding antibiotic resistance and possible side effects. 41,48 These results underscore the need to emphasize routine STI screening and treatment as well as condom use as the primary strategy to prevent syphilis transmission. The use of doxycycline PEP in targeted interventions as a secondary measure in combination with other prevention strategies is possibly the more feasible public health approach given the available evidence around bacterial STI chemoprophylaxis.…”

Geosexual Archetype, Preventive Behaviors, and Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men

“…They are the ones at the highest risk for bacterial STIs according to the current analysis, but they also travel to different locations; in turn, they would be exposed to the highest number of interventions 16 . It could be beneficial to create more educational interventions for bacterial STIs across all types of neighborhoods, which are currently lacking relative to awareness of HIV 5,6 . Considering these different patterns and behaviors can allow us to consider multifaceted interventions that more holistically address the spectrum of MSM at risk for STIs.…”

“…Incident cases of HIV among men who have sex with men (MSM) have been generally decreasing worldwide, in part due to the expansion of pharmaceutical interventions such as preexposure prophylaxis (PrEP) and postexposure prophylaxis, 1,2 advances in effective antiretroviral therapy, 3 and educational campaigns 4 . Interviews with MSM from Toronto and Vancouver (2 large in cities in Canada) found that, generally, MSM were conscientious about adopting and practicing pharmacologic HIV prevention strategies 5,6 . However, these highly effective HIV prevention strategies focus primarily on the individual; strategies that focus solely on HIV may leave individuals vulnerable to bacterial sexually transmitted infections (STIs), such as syphilis 5,6 …”

A systematic review of the impacts of oral tetracycline class antibiotics on antimicrobial resistance in normal human flora

“…This concern is particularly salient given existing discourses regarding syphilis PrEP-related stigma, including within gbMSM communities themselves. 57 AMR measures warrant inclusion as secondary outcomes in all clinical trials examining the long-term use of an antibacterial drug, regardless of the primary indication.…”

“…Yet community members themselves have also voiced concerns about the potential for STI prophylaxis to drive AMR, emphasizing the importance of generating high-quality evidence on this question. 57 …”