Low use of condom and high STI incidence among men who have sex with men in PrEP programs

Abstract

Objective Since the recent introduction of preexposure prophylaxis (PrEP), several studies have reported a decrease in the use of condoms and a rise in STIs among users. This rise in risk behavior associated with the advent of PrEP is known as “risk compensation.” The aim of this study is to measure clinical and behavioral changes associated with the introduction of PrEP by analyzing condom use for anal intercourse, number of sexual partners, sexualized drug use and STI incidence. Methods We performed a retrospective descriptive study of PrEP users followed every 3months over a 2-year period spanning 2017–2019 in a referral clinic specializing in STI/HIV in Madrid, Spain. One hundred ten men who have sex with men and transgender women underwent regular screening for STIs and hepatitis C virus (HCV) infection. Sociodemographic, clinical, and behavioral data were gathered for all subjects studied. Results The risk compensation observed in this study consisted primarily of a lower rate of condom use, while the number of sexual partners and recreational drug consumption remained stable. We observed a very high incidence of STIs in this sample, particularly rectal gonorrhea and chlamydia. The factors shown to be independently associated with the presence of an STI on multivariate analysis were age below 30 years and over 10 sexual partners/month. Conclusion The incidence of STI acquisition was higher than expected, indicating a need for strategies to minimize this impact, particularly among younger individuals with a higher number of sexual partners.

Sexually Transmitted Infections Among Men and Transgender Women Using HIV Pre-exposure Prophylaxis in a Large Integrated Health System—A Cohort Study

“…In this large cohort study of men and transgender women using PrEP for HIV prevention in an integrated health care system, we found that STIs were common throughout the period of PrEP use, as observed in previous PrEP studies. [26][27][28] The observed incidence of STIs in our study population was lower compared with that reported in MSM attending an STD Clinic in Seattle & King County during the similar time period, 29 but it was higher than that among Black MSM offered daily PrEP in the HPTN 073 trial in 3 US cities (34.2 cases per 100 person-years). 30 This finding highlights the importance of routine STI screening and ongoing STI prevention education among at-risk individuals using PrEP in primary care setting.…”

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

“…Finally, 20 studies met the inclusion criteria for the final analysis. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] From these studies, we extracted 19 groups of incidence data of syphilis, 19 of gonorrhea, and 18 of chlamydia infection during the PrEP period. Five of these studies investigated the incidence data before taking PrEP.…”

“…1). Finally, 20 studies met the inclusion criteria for the final analysis 11–30 . From these studies, we extracted 19 groups of incidence data of syphilis, 19 of gonorrhea, and 18 of chlamydia infection during the PrEP period.…”

HIV, STI and renal function testing frequency and STI history among current users of self-funded HIV pre-exposure prophylaxis, a cross-sectional study, Germany, 2018 and 2019

“…Kidney function should also be monitored regularly, since TDF can impair renal function [ 9 - 11 ]. Since PrEP users might be at an increased risk of sexually transmitted infections (STI) [ 12 , 13 ], guidelines recommend testing for syphilis every 3 months and for gonorrhoea and chlamydia every 3–6 months [ 6 , 7 ]. Regular screening may increase detection of asymptomatic STI and reduce their spread across sexual networks, although direct evidence for this is still lacking [ 14 , 15 ].…”