The results of a new analysis, published at the end of last year in the journal, have confirmed the high incidence of sexually transmitted infections recorded in studies on pre-exposure prophylaxis against HIV (PrEP) among groups of gay, bisexual and other men who have sex with men, concentrate more than half of the new diagnoses of HIV infection, so the implementation of pre-exposure prophylaxis programs against HIV, along with the rest of preventive strategies, can be crucial to reduce the transmission of HIV among these people. Despite this, different studies have linked the use of PrEP with an increase in STI rates among its users.
A team of researchers from the Berlin Health Institute wanted to evaluate through a meta-analysis the rates of STIs throughout the different PrEP studies and implementation studies. All the studies included a total of 11,918 gay men, bisexuals and other MSM.
Of the most common bacterial infections (syphilis, gonorrhea and chlamydia), syphilis is the only one in which the increase in its screening has the least impact on the number of diagnoses. This is because their detection can be done through a blood test and, therefore, it takes time to perform more consistently. However, to detect gonorrhea and chlamydia, it is necessary to perform a rectal and / or throat swab and perform them in a less consistent manner, at least in some countries. Gonorrhea and chlamydia were also classified by location in the body. In the most rigorous analyzes, 4% presented urethral gonorrhea and 9% urethral chlamydia. Rectal infections were more common with rates of 17% and 33%, respectively. In the five studies that reported on the Hepatitis C virus, data were also observed that show a higher rate compared to the rest of the population on foot.
One of the reasons why STI rates were higher in the more robust trials is because STI rates tended to be higher in the cohort studies and in the implementation programs compared to randomized studies where Participants did not necessarily know if they were receiving PrEP or not.
The results of the present study show, despite the heterogeneity of some results, the high rates of STI among gay men, bisexuals and other MSM who use PrEP. However, it remains unclear whether this is due to risk compensation (the condom is no longer used as a result of being protected from HIV by antiretroviral medication) or to an increase in STIs during periodic follow-up of the antiretroviral drugs. PrEP programs.
The authors of this study point out that STIs are concentrated in subgroups that are particularly at risk, such as those who have unprotected sex with casual partners. They also emphasize that PrEP not only reduces the incidence of HIV but also decreases the rate of STIs by including their regular screening and early treatment of them.