Rates of chlamydia and gonorrhea, but not syphilis, increased among men who have sex with men after they started pre-exposure prophylaxis (PrEP) to prevent HIV, a meta-analysis of relevant studies showed.
About This Study
“The impact of HIV pre-exposure prophylaxis on bacterial sexually transmitted infection occurrence in MSM: A Systematic Review and Meta-analysis” was published online on Jan. 12, 2024, in AIDS. The lead authors are Nikolaos Georgiadis, M.D., M.P.H., and Dimitrios Papamichail, M.Sc., M.P.H., Ph.D., both of the Department of Public Health Policy at the School of Public Health of the University of West Attica in Athens, Greece.
Key Research Findings
This systematic review and meta-analysis of 23 studies evaluated the bacterial sexually transmitted infection rates (chlamydia, gonorrhea, and syphilis) before and after men who have sex with men initiated PrEP. The studies included a total of 11,776 adult participants (18-71 years old). The majority of the studies were cohort studies (22) and one was a randomized controlled trial. Median follow-up was 12 months. Most studies had been conducted in high-income countries; their results were published between 2015 and 2022.
Starting PrEP was associated with more sexually transmitted infections overall (pooled effect size 1.15), as well as higher rates specifically of gonorrhea (effect size 1.17) and chlamydia (effect size 1.31), but not syphilis (effect size 0.99), which showed almost no change after PrEP initiation.
Site-specific infections increased significantly for rectal and slightly for urethral chlamydia. Changes were not statistically significant for other chlamydia sites or other site-specific infections.
Discussion Highlights and Implications for Practice
Analysis limitations reported included the diversity in study design, screening frequency and populations, and high drop-out rates in the studies. Safer sex and other behavioral counseling was included in some, but not all, studies. Most research was conducted in high-income countries, and men volunteering for such studies may engage in different behaviors from the general population of men who have sex with men. Potential publication bias is another limiting factor.
The researchers suggested that findings may be partly related to men not using condoms when taking PrEP to prevent HIV acquisition. However, other research has shown little impact of condom use levels on overall sexually transmitted infection rates. Bacterial infections also may be transmitted during oral sex when few people use condoms, they pointed out. Other explanations offered for the observed findings included changes in sexual networks or sexual behaviors once the risk of HIV seroconversion is minimized.
Results show the need for comprehensive, accessible sexually transmitted infection testing in people taking PrEP, the authors concluded.
By Barbara Jungwirth
Source : TheBodyPro
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