In a new study analyzing a large group of people (most of whom were same-sex-attracted men) using Truvada as part of an HIV-prevention regimen, the rates of gonorrhea and chlamydia increased steadily, almost doubling in one year. The data was gathered from July 2012 through June 2015. Even though the study participants were taking preventative medications (there was a 92% take rate among those who had at least one refill) and had no new HIV transmission, these bisexual and gay men were getting other sexually transmitted infections (STIs) frequently.
There are several different ways to explain the rising STI rates among bisexual and gay men, including the frequency of STI testing in a pre-exposure prophylaxis (PreP) program (participants are tested quarterly) and the increased risk of STIs among those taking PrEP. The higher rates of gonorrhea and chlamydia may also be due to increased sexual risk-taking as a function of peace of mind when taking PrEP.
As Condom Use Decreases, STI Rates Increase
The findings were published in the Journal of Acquired Immune Deficiency Syndromes and included 972 members of Kaiser Permanente Northern California (KNPC). Throughout the study, the researchers saw no new HIV infections among the men who maintained the PrEP regimen.
A September 2015 analysis of Kaiser Permanente’s San Francisco clinic, the largest PrEP site, researchers found many men who have sex with men (MSM) were using condoms less since starting PrEP. These mainly bisexual and gay men had contracted one or more STIs by the end of the study.
When starting PrEP, 15.9 percent of participants had an STI, with 34.2 percent having one during the previous two years. At the end of the study, out of 972 PrEP users, 342 (35.2 percent) were diagnosed with at least one STI during follow-up. 173 of them had multiple diagnoses, between two and 19 STIs, for 771 STIs diagnosed.
 |
| Gay and bisexual men face higher rates of syphilis infections. Source: cdc.gov |
What Does This Mean?
Although PrEP protects patients who take it from many of the risks of HIV/AIDS, it doesn’t protect them from other STIs. STI rates were much higher in many participants taking this study, which could be caused by a variety of factors.
However, what this does tell us is that the current CDC recommendation for STI testing every six months while taking Truvada or other PrEP is insufficient. Quarterly or more frequent testing is required to keep abreast of STIs. Additional caution is required when testing for STDs in PrEP-adhering bisexual or gay men.
While PrEP is incredibly helpful is reducing and in some cases, altogether eliminating new transmissions of HIV, it doesn’t remove the risk of other STIs for gay men. More frequent STI testing and sexual safety are necessary for MSM and other users of PrEP.
