Confronting Rising STIs in the Era of PrEP and Treatment as Prevention

Abstract

Purpose of Review:To review the epidemiology of sexually transmitted infections (STIs) among men who have sex with men (MSM) and suggest control measures.Recent findings: Despite declines in new HIV diagnosis, bacterial STIs among MSM have dramatically risen since the late 1990s. This increase occurred concurrent with introduction of effective antiretroviral therapy, the advent of electronic mechanisms for meeting sex partners and population-level changes in sexual behavior, including decreased condom use. HIV pre-exposure prophylaxis (PrEP) is now further diminishing condom use, though its impact on STIs is uncertain. A plan to confront the MSM STI epidemic should include increased HIV/STI testing promoted through expanded public health clinical infrastructure, health care system reform to improve the care of gender and sexual minorities and promote low-barrier care, re-invigorated condom promotion, and scientific innovation. Summary:There is an urgent need to implement new STI control measures while continuing to expand PrEP use.

Comparison of Trends in Rates of Sexually Transmitted Infections Before vs After Initiation of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men

“…Although the reasons for this are not well established, they have been correlated with increases in condomless anal intercourse and numbers of sexual partners 6 , 8 , 21 and associated with HIV biomedical strategies, such as treatment used as prevention. 22 , 23 The main difference between our studies and others is that we found that the STI test positivity rate after commencing PrEP stabilized. These findings are consistent with those of an international meta-analysis 24 of PrEP use that found no change in the proportion of MSM reporting condomless sex from baseline to follow-up while taking PrEP, which suggests that groups of study participants use condoms inconsistently and regardless of PrEP use.…”

The past, present and future impact of HIV prevention and control on HPV and cervical disease in Tanzania: A modelling study

“…may facilitate an increase in risky sexual practices to the order of up to 21% [49][50][51][52][53][54]. A Latin Hypercube Sampling (LHS) analysis over 6,000 possible parameter sets was utilised, the values of which are described in Table 5.…”

“…A range of studies reported that availability of HIV control interventions ART and PrEP can facilitate behavioural disinhibition where risk behaviours are increased in a population [49][50][51][52][53][54].…”

“…This analysis was limited by the inherent uncertainty surrounding input parameter assumptions, in particular, sexual behaviour assumptions including condom usage. In many settings which have implemented such HIV controls, a reduction in safe sex practices and an increase in other sexually transmitted infections is often observed [49][50][51][52][53][54]. A recent study into the sexual behaviour of PrEP users in Amsterdam found that daily PrEP use among HIV negative men who have sex with men (MSM) was associated with a 2-9% increase in condomless sex acts [50]; whereas another study has reported a 21% increase in risky sexual practice, and an increase in HIV incidence, among the San Franciscan MSM population since the advent of ART [53].…”

Factors Predicting Uptake of Sexually Transmitted Infections Testing among Men Who Have Sex with Men Who Are “Pre-Exposure Prophylaxis Tourists”—An Observational Prospective Cohort Study

“…A recent meta-analysis suggested that PrEP use was associated with a 24% increase in the prevalence of STI and a 59% increase in the risk of rectal STI among users [ 15 ]. Although STI among MSM are seldom life-threatening, they are morbid and associated with increasing medical cost, and likely to increase risk of HIV transmission [ 20 ]. Therefore, the PrEP clinical practice guideline issued by the United States Centers for Disease Control and Prevention (CDC) highlights the importance of regular STI testing for PrEP users [ 21 ].…”