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THE INTERSECTION OF PrEP AND SEXUALLY TRANSMITTED INFECTIONS
Julia A. Schillinger1
1CDC, Atlanta, GA, USA
Bacterial sexually transmitted infections (STI) are increasing in the United States at the same time as increases in the awareness and utilization of biomedical advances in HIV treatment (TasP) and prevention (PrEP). In this environment, rates of reported new HIV infections have stabilized, and even declined in some areas. This presentation will examine a confluence of factors which may be contributing to observed increases in bacterial STI. Trends in chlamydia, gonorrhea, syphilis, and HIV in the years before and after the availability of PrEP will be described using national and local surveillance data. On the population level, the uptake of PrEP could contribute to increasing STI rates because the regular, biannual (at least) STI screening recommended for all people on PrEP may increase detection of asymptomatic, or recent infections. However, broad increases in STI screening and detection are likely occurring independently of PrEP, due to increased availability of extragenital (anorectal and oropharyngeal) nucleic acid amplification tests for Neisseria gonorrhoeae and Chlamydia trachomatis, improved provider adherence to longstanding national recommendations for screening all men-who-have-sex-with-men (MSM) for these largely asymptomatic pathogens, and the ease afforded by patient self-collected specimens. Changes in sexual behavior may also be expected in the context of TasP and PrEP. Sexual risk compensation related to PrEP may play a role in increasing STI transmission among people who are, and are not on PrEP. A decreased fear of HIV infection, and knowledge of the low risk of transmission from persons with an undetectable viral load may also result in changes in sexual behaviors that increase the risk of other STI.