Sexually transmitted infections and sexual behaviors of men who have sex with men in an American Deep South PrEP clinic

Abstract

HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition among men who have sex with men (MSM), but PrEP uptake has been associated with sexually transmitted infections (STIs). The effect of PrEP on STIs in MSM in the Deep South of the United States is unknown. We performed a retrospective analysis of adult MSM at an American Deep South PrEP clinic to calculate the prevalence and incidence rate of bacterial STIs (chlamydia, gonorrhea, and syphilis) and identify associated risk factors by linking incident STI to patient-reported outcomes; 139 MSM accessed the clinic between 2014 and 2018 with baseline bacterial STI prevalence of 11%. Twenty-six of 81 eligible MSM on PrEP had incident STIs with an incidence rate of 33.1 cases per 100 person-years. Significantly higher proportions of high PrEP adherence, multiple sexual partners, and inconsistent condom use were seen in those with incident STI, and we identified MSM with both high PrEP adherence and multiple sexual partners as being at especially high risk for bacterial STIs (hazard ratio: 7.57, 95% confidence interval: 1.75–32.74). Bacterial STIs are common after initiating PrEP in this clinic, and MSM reporting high PrEP adherence and multiple sexual partners have a significant risk for incident STI. High-risk sexual behaviors persisted after starting PrEP, highlighting the importance of ongoing, intensive sexual health screening and interventions.

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

“…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.…”

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“…Altogether these data suggest that PrEP may be considered not only as HIV prevention but as an opportunity for intensive sexual health counseling and screening to curb the rise of STIs [21].…”

“…While the IPERGAY [2] and PROUD [3] placebocontrolled studies demonstrated that there was no increase in the number of STIs in patients under PrEP, different studies [7][8][9][10][11][12][13][14][15][16] showed a significant increase of the prevalence of bacterial STIs (including Treponema pallidum, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)). A recent meta-analysis [17] We recently conducted a multicenter, retrospective, observational study [18] The discrepancy of these results could not be explained by differences in sexual risk behaviors since PrEP use was associated with a higher number of sexual partners and an increase of condom-less sex as compared to MSM/PrEPpatients [18][19][20][21][22].…”

“…The fact that high risk sexual behaviors persist after starting PrEP, highlights the importance of ongoing, intensive sexual health screening and interventions [21]. Recent updated guidelines from the International Antiviral Society-USA (IAS-USA) group recommend STIs screening in MSM on PrEP every three months [23].…”

“…Recent updated guidelines from the International Antiviral Society-USA (IAS-USA) group recommend STIs screening in MSM on PrEP every three months [23]. Furthermore, at-risk groups of MSM reporting higher PrEP adherence, multiple sexual partners, and inconsistent condom use following PrEP initiation should be closely monitored and managed with frequent free of cost STIs testing and intensive sexual health counseling, such as dedicated, condom-affirming counseling [21]. This seems to be essential to facilitate early STIs treatment and reduce further spread.…”