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ASSOCIATION OF PrEP USE AND PAST AND CURRENT STIs AMONG MSM IN WASHINGTON‚ DC‚ 2017
Laura M. Torres1, Anya Agopian1, Anthony Rawls1, Jenevieve Opoku2, Manya Magnus1, Matthew E. Levy1, Michael Kharfen2, Irene Kuo1
1George Washington University, Washington, DC, USA,2District of Columbia Department of Health, Washington, DC, USA
While daily, oral pre-exposure prophylaxis (PrEP) reduces HIV transmission risk, there is a growing concern of its potential association with elevated sexually transmitted infections (STIs). It is unclear whether increased STI diagnoses are a result of initial followed by regular STI testing among PrEP users or from an actual increase in risk while on PrEP. We examined the association between PrEP use and past year and current bacterial STIs among men who have sex with men (MSM) in the DC metro area.
We used data from the 2017 National HIV Behavioral Surveillance conducted in Washington, DC. MSM recruited via venue-based sampling completed a behavioral survey and HIV test and provided pharyngeal and rectal swab specimens. HIV-negative MSM who were PrEP eligible were included in the analysis (e.g., reporting condomless anal sex). Participants reported on past year PrEP use and physician diagnosis of either Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in the past year. Current STI (CT and/or GC) was assessed via lab testing of pharyngeal and rectal specimens. Multivariable logistic regression was used to assess the associations between past year PrEP use and past year STIs and also current STI status.
Of 275 eligible participants, 41% used PrEP in the past year. PrEP users were more likely to be white and have 20 partners in the past year. Overall, 25% self-reported a STI diagnosis in the past year, and 13% were currently STI-positive via lab diagnosis. After adjusting for other confounding factors, past year PrEP users were three times as likely to self-report a STI diagnosis in the past year (aPOR= 3.0, 95% CI:1.43, 5.42) compared to non-PrEP users. However, in adjusted analyses, those using PrEP in the past year were not more likely to be currently infected with an oral or rectal STI compared to those not on PrEP (aPOR=1.70, 95% CI: 0.69, 4.3).
PrEP use was strongly associated with past year STIs but not with being currently infected, suggesting that being on PrEP may play a role in earlier, active clinical STI screening, diagnosis and treatment. PrEP users regularly interface with the medical system, leading to more opportunities for screening, diagnosis, and treatment, which may have resulted in the lower prevalence of active STIs diagnosed at the time of the survey. Future studies should examine the association of PrEP use with STI diagnosis in conjunction with treatment and use of health services.