4.3 Article

Reviewing PrEP's Effect on STI Incidence Among Men Who Have sex with Men-Balancing Increased STI Screening and Potential Behavioral Sexual Risk Compensation

Journal

AIDS AND BEHAVIOR
Volume 25, Issue 6, Pages 1810-1818

Publisher

SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s10461-020-03110-x

Keywords

Sexually transmitted infections; PrEP; HIV; Men who have sex with men; Sexual risk compensation; STI screening

Funding

  1. US Department of Energy
  2. CDC

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While PrEP can prevent HIV acquisition, it does not offer protection against bacterial sexually transmitted infections. Use of PrEP may increase the risk of STI acquisition, but this can be mitigated by regular STI screening. Studies show varied changes in condom use post-PrEP initiation, with partner acquisition decreasing in most cases and serodiscordance increasing in the PrEP group compared to non-PrEP group. STI screening among MSM was found to be low within a month of PrEP initiation. Monitoring trends in sexual risk compensation and STI screening will be crucial in understanding the impact of PrEP on STI burden.
Though pre-exposure prophylaxis (PrEP) can prevent HIV acquisition, it provides no protection against bacterial sexually transmitted infections (STIs). PrEP use may increase STI acquisition due to sexual risk compensation, but that could be counterbalanced by increased STI screening at regular PrEP visits. We conducted a literature search of studies with quantitative data published prior to March 2020, assessing sexual risk compensation or STI screening among men who have sex with men (MSM) before and after PrEP initiation. We identified 16 relevant publications. Changes in condom use were inconsistent across studies. Partner acquisition following PrEP initiation decreased in most studies, likely due to behavioral counseling. In publications comparing a PrEP arm to a non-PrEP arm, serodiscordance increased in the PrEP arm and decreased in the non-PrEP arm. STI screening among MSM was low within a month of PrEP initiation. Monitoring trends in sexual risk compensation and STI screening will be critical to understand PrEP's effects on STI burden.

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