Increased Risk of Sexually Transmitted Infections in Men Who Have Sex With Men Taking Preexposure Prophylaxis: A Meta-analysis

Abstract

The meta-analysis investigated the high incidence density of sexually transmitted infections of men who have sex with men taking preexposure prophylaxis for HIV prevention.

The impact of HIV preexposure prophylaxis on bacterial sexually transmitted infection occurrence in MSM: a systematic review and meta-analysis

“…In 2018, Traeger et al reported a statistically nonsignificant increase in the odds of contracting any STI (OR: 1.24; 95% CI 0.99–1.54; P = 0.059), chlamydia (OR: 1.23; 95% CI 1.00–1.51; P = 0.051), gonorrhea (OR: 1.13; 95% CI 0.78–1.64; P = 0.515) and syphilis (OR: 1.12; 95% CI 0.86–1.47; P = 0.41), while a significant increase was noted only in rectal chlamydia (OR: 1.59; 95% CI 1.19–2.13; P = 0.002) [13]. In 2022, Zhou et al [14] found a significant increase in the incidence density of chlamydia, gonorrhea and syphilis after PrEP but the aforementioned synthesis included two different sets of studies, namely one before and one after PrEP initiation to calculate the respective incidence densities, thus comparing markedly different participants.…”

“…In the past years, a few systematic reviews and metaanalyses have sought to shed light on this association, with heterogeneous methods, such as inclusion of blinded studies, comparison of PrEP to non-PrEP users and comparison of before and after STI data stemming from different studies or populations [12][13][14]. In this systematic review and meta-analysis, we explored associations between PrEP initiation and bacterial STI occurrence in MSM; we attempted to capture intraindividual changes of STI frequency to the fullest extent possible by comparing the same individuals before and after PrEP initiation, a strategy that has not been implemented by previous meta-analyses [12][13][14]. Specifically, we synthesized studies providing the necessary data for the estimation of incidence rate ratios (IRRs), prevalence ratios or cumulative incidence ratios of STIs before and after PrEP.…”