Does Offering PrEP Services Increase Risk for ‘Other’ Sexually Transmitted Infections?

Pre-exposure prophylaxis (PrEP) against HIV infection is controversial. Proponents hail it as a long-overdue opportunity to save lives and stem a public health crisis. Some urgent care providers are exploring whether it’s a viable opportunity both clinically and economically. Then again, some clinicians and public health officials believe offering PrEP de-incentivizes patients from using safe-sex practices and making healthy sexual decisions. A newly published article in the Journal of the American Medical Association raises another concern, however: Could PrEP be associated with increased risk of sexually transmitted infections beyond HIV in high-risk patients? With emerging evidence suggesting such a possibility, researchers sought to explore STI incidence and behavioral risk factors among a cohort of predominantly gay and bisexual men who use PrEP, and to find out if there’s any difference in STI incidence after they start taking PrEP. The primary outcome was incidence of chlamydia, gonorrhea, or syphilis. Out of  2,892 subjects (most of whom identified as a gay or bisexual male) who enrolled at final follow-up, incidence of all STIs was 91.9 per 100 person years, with 736 subjects (25%) accounting for 2,237 (76%) of cases. Among those, younger age, a greater number of partners, and group sex were associated with increased risk for STIs. Condom use was not. Looking at subjects for whom pre-enrollment testing data were available, incidence of STI increased from 69.5 per 100 person years to 98.4 per 100 person years. The authors concluded that among gay and bisexual men who take PrEP, STIs were highly concentrated among a subset, and that use of PrEP after study enrollment was associated with increased incidence of STIs vs pre-enrollment. This is not a reflection on the potential for PrEP to save lives, however, nor an indictment of the intentions of providers who offer PrEP. To explore how this plays out in the urgent care setting, read Initiating PrEP Services in Urgent Care in the JUCM archive.