Summary: We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEPSE) to HIV. This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE would and would not be considered. We review which agents to use for PEPSE including the potential for drug-drug interactions and make recommendations for monitoring individuals receiving PEPSE. Other areas included are the possible impact on sexual behaviour, cost-effectiveness and issues relating to service provision. Throughout the document, consideration is given to the place of PEPSE within the broader context of HIV prevention strategies and sexual health.
We present the British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis after sexual exposure (PEPSE) to HIV. This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of HIV infection after a potential exposure, and provides recommendations on when PEPSE would and would not be considered. Other areas included are the possible impact on sexual behaviour, cost-effectiveness, and issues relating to service provision. Throughout the document, consideration is given to the place of PEPSE within the broader context of HIV prevention strategies and sexual health.
c Triple-site testing (using pharyngeal, rectal, and urethral/first-void urine samples) for Neisseria gonorrhoeae and Chlamydia trachomatis using nucleic acid amplification tests detects greater numbers of infections among men who have sex with men (MSM). However, triple-site testing represents a cost pressure for services. MSM over 18 years of age were eligible if they requested testing for sexually transmitted infections (STIs), reported recent sexual contact with either C. trachomatis or N. gonorrhoeae, or had symptoms of an STI. Each patient underwent standard-of-care (SOC) triple-site testing, and swabs were taken to form a pooled sample (PS) (pharyngeal, rectal, and urine specimens). The PS was created using two methods during different periods at one clinic, but we analyzed the data in combination because the sensitivity of the two methods did not differ significantly for C. trachomatis (P ؍ 0.774) or N. gonorrhoeae (P ؍ 0.163). The sensitivity of PS testing (92%) was slightly lower than that of SOC testing (96%) for detecting C. trachomatis (P ؍ 0.167). For N. gonorrhoeae, the sensitivity of PS testing (90%) was significantly lower than that of SOC testing (99%) (P < 0.001). When pharynx-only infections were excluded, the sensitivity of PS testing to detect N. gonorrhoeae infections increased to 94%. Our findings show that pooling of self-taken samples could be an effective and cost-saving method, with high negative predictive values. (Interim results of this study were presented at the BASHH 2013 summer meeting.) I n the United States and Europe, genital Chlamydia trachomatis and Neisseria gonorrhoeae are the most prevalent bacterial sexually transmitted infections (STIs). In the United Kingdom, rates of gonorrhea and chlamydia among men who have sex with men (MSM) continue to rise (1), while studies highlight increases in the numbers of HIV-positive and HIV-negative MSM reporting high-risk sexual behavior since the advent of combination antiretroviral therapy (cART) (2-4).Coinfection with an STI and HIV has been shown to increase HIV transmission in epidemiological studies (5-7). Concomitant genital infections have been shown to increase shedding of HIV in the genital tract, in both vaginal secretions and seminal fluid (8, 9). Rectal C. trachomatis/N. gonorrhoeae infections have been associated with HIV acquisition in MSM (10), and it is plausible that they may also enhance HIV transmission.Nucleic acid amplification tests (NAATs) are being used increasingly to screen MSM for pharyngeal and rectal C. trachomatis/N. gonorrhoeae infections, in addition to the use of urethral or first-void urine (FVU) samples, and the use of NAATs is now recommended in national guidelines (11). While there are no NAATs licensed for use with extragenital specimens, several studies have demonstrated that NAATs perform well for the detection of both pharyngeal and rectal C. trachomatis/N. gonorrhoeae infections in . Studies evaluating the performance of these testing methodologies have demonstrated sensitivities and sp...
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