HIV PrEP in Men Who Have Sex with Men Increases STI Acquisition Risk

Concern has been raised in trials that PrEP use might lead to a higher incidence of STIs
Concern has been raised in trials that PrEP use might lead to a higher incidence of STIs

NEW ORLEANS, LA—Among men who have sex with men (MSM), pre-exposure prophylaxis (PrEP) to prevent HIV infection is associated with an increased risk of acquiring sexually transmitted infections (STIs), “which could lead to increased transmission of STIs and antibiotic resistant STIs,” accordig to authors of a meta-analysis presented at IDWeek 2016.

“Our results support updating current Centers for Disease Control and Prevention guidelines to recommend that MSM given PrEP receive quarterly STI screenings, an increase from their current guidelines that recommend biannual to quarterly screenings," said lead study author Noah Kojima, BS, a medical student at the David Geffen School of Medicine at UCLA, Los Angeles, CA.

Even if PrEP is associated with an increased STI incidence, the benefits of HIV prevention might still outweigh that impact, Kojima suggested. 

"Physicians must provide their patients on PrEP with a sexual health prevention package that includes quarterly STI screenings, timely treatment of infection, expedited partner treatment, and rescreening if positive," he said.

In PrEP studies, a high incidence of STIs raised concern that PrEP use might lead to a higher incidence of STIs—including antibiotic-resistant STIs—due to increased sexual risk behavior. Therefore, the investigators conducted a literature review of 18 English-language studies that included a cohort of MSM and STI incidence rates reported with nucleic acid amplification testing. Together, the reviewed studies represented more than 70,000 person-years of follow-up.

MSM administered PrEP were markedly more likely than MSM not given PrEP to acquire syphilis, chlamydia, or Neisseria gonorrhoeae infections, the meta-analysis showed. (Incidence rate ratio [IRR]s for PrEP vs. no-PrEP were 44.6, 11.2, and 25.3, respectively (all P values <0.001).

More research is needed to confirm that PrEP causes higher incidences of STIs among MSM, Kojima cautioned.

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