PrEP tied to more sexually transmitted infections in gay, bisexual men

  • Traeger MW et al
  • JAMA
  • 9 Apr 2019

  • International Clinical Digest
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  • Increases in sexually transmitted infections (STIs) appear to be associated with use of HIV pre-exposure prophylaxis (PrEP) among gay, bisexual high-risk men.
  • Related editorial warns that findings should not be interpreted in isolation, and that "Concerns about behavioral change after starting PrEP should not decrease the willingness of clinicians to offer PrEP."

Why this matters

  • Increased PrEP prescribing should go hand-in-hand with frequent STI testing; timely diagnosis, treatment reduce infection duration, transmission potential.
  • Consider STI home testing to reduce stigma.

Key results

  • 2981 participants; 97% (2892 enrolled at final follow-up).
  • 2928 STI diagnoses in 48% (1427).
  • Multiple infections observed in 25% (736).
  • Any STI incidence was 91.9/100 person-years (PY), and greatest among 25-34 years; STI incidence was 45.0, 39.0, 8.0 per 100 PY for chlamydia, gonorrhea, syphilis, respectively.
  • Multivariate analysis in 2058 showed younger age, preenrollment rectal STI, greater number of anal sex partners, group sex participation significantly associated with STI risk.
  • Any STI incidence in 1378 participants with before/after data increased from 69.5 to 98.4/100 PY, 1 year prior, during follow-up (incidence rate ratio, 1.41; 95% CI, 1.29-1.56).

Study design

  • Secondary evaluation of an open-label population intervention study assessing association between HIV PrEP and STI risk in a cohort of gay/bisexual Australian high-risk men.
  • Funding: Victoria Department of Health and Human Services, others.


  • Nongeneralizable.
  • Selection bias.
  • Recall, sociability bias.
  • Missing STI treatment data.
  • On-demand PrEP data not included.

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