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High sexually transmitted infection rates among men on PrEP supports more frequent monitoring
Liz Highleyman, 2016-03-16 07:50:00
Participants taking tenofovir/emtricitabine
(Truvada) for pre-exposure
prophylaxis (PrEP) continued to have high rates of sexually transmitted
infections (STIs) in two US PrEP demonstration projects, according to a pair of
reports at the Conference on Retroviruses and Opportunistic
Infections (CROI 2016) last month in Boston. Semi-annual
STI testing missed many cases, leading researchers to suggest that gay men on
PrEP could benefit from screening every three months.
One of the most common concerns
surrounding PrEP is the high rate of STIs seen among users. There is little
evidence that PrEP actually causes an
increase in STIs, but gay and bisexual men at risk for HIV already have high
STI rates, and many PrEP users are likely to be already having, or wish to have, sex
As Sheena McCormack, lead
investigator for the English PROUD study,
explained at a CROI symposium on innovations in PrEP, "the pre-existing trajectory of rising
STIs [among men who have sex with men] is carrying on, but PrEP means HIV
doesn't have to rise too."
On the other hand, the regular STI screening
recommended for people on PrEP encourages prompt diagnosis and treatment, which
reduces onward transmission and could potentially contribute to lowering STI
rates among PrEP users compared to non-users.
Scheduled screening of at-risk asymptomatic
individuals is important because some STIs do not cause symptoms and can be
transmitted by people who are unaware they are infected and show no visible
signs such as sores or discharge.
The US Centers for Disease
Control and Prevention (CDC) PrEP guidelines recommend STI testing
at least every six months for asymptomatic individuals, though PrEP users should
be seen every three months for HIV testing and Truvada prescription renewal,
and some clinics do screen for STIs at every visit. CDC's 2015 sexually
transmitted disease treatment guidelines recommend
screening every three to six months for men who have sex with men (MSM), especially those with
a past history of STIs. The British Association for Sexual Health and HIV recommends
that all sexually active MSM should be tested for STIs at least annually, with
those at high risk being tested every three months.