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High Asymptomatic STI Prevalence and Incidence in French MSM Starting PrEP
  IDWeek2017/IDSA, October 4-8, 2017, San Diego

Mark Mascolini
Among 170 men who have sex with men (MSM) starting preexposure prophylaxis (PrEP) at a French center, 74% had a history of bacterial sexually transmitted infection (STI), 16% had an STI when they started PrEP, and STI incidence (the new-detection rate) measured 87 per 100 person-years [1]. All prevalent and most incident STIs were asymptomatic.
Researchers from Lyon University noted that decreased condom use because of PrEP may raise the risk of other STIs [2]. CDC guidelines recommend twice-yearly STI screening for MSM after PrEP begins [3]. Because routine STI screening during PrEP clinical trials may amplify asymptomatic STI detection rates, the Lyon investigators analyzed STIs in their population of MSM starting PrEP.
The researchers enrolled over 200 MSM from January to September 2016. The group had a median age of 36.4 years and 50% reported using condoms. While 53% of men practiced chemsex, 46% participated in sex parties, and 6% were escorts or sex workers. When they started PrEP then every 3 months, men got screened for syphilis, HAV, HBV, HCV, N gonorrheae, and C trachomatis (the last two in urine and on anal and pharyngeal swabs).
Nine men did not start PrEP, including 3 diagnosed with HIV at the baseline visit. Another 32 men stopped returning for study visits. The 170 men left in this analysis had a median of 6.3 months of follow-up. No men picked up HIV during follow-up but 3 had acute HCV infection.
Before the study, 37.9% of men reported a history of syphilis, 48.2% gonorrhea, 40.5% chlamydia, and 74.2% any bacterial STI. At the baseline visit, prevalence rates were 3.8% for syphilis, 7.6% for gonorrhea, 7.6% for chlamydia, and 16.3% for any bacterial STI. During follow-up, the researchers recorded incidence rates of 14.8 per 100 person-years for syphilis, 58.7 per 100 for gonorrhea, 47.6 per 100 for chlamydia, and 86.9 per 100 for any bacterial STI. All prevalent STIs and 80.3% of incident STIs were asymptomatic, meaning they would not have been detected without routine screening.
The researchers recommended "frequent screening and treatment of asymptomatic STIs" in MSM on PrEP. They stressed that "PrEP must be considered a combination HIV/STI prevention package that incorporates STI screening and treatment."
1. La Fata L, Cotte L, Godinot M, et al. High rate of asymptomatic bacterial sexually transmitted infections (STIs) in men who have sex with men on pre exposure prophylaxis (PrEP). IDWeek2017/IDSA. October 4-8, 2017. San Diego. Abstract 2259.
2. Volk JE, Marcus JL, Phengrasamy T, et al. No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clin Infect Dis. 2015;61:1601-1603. https://www.ncbi.nlm.nih.gov/pubmed/26334052
3. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States--2014. A Clinical Practice Guideline. https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf


High Rate of Asymptomatic Bacterial Sexually Transmitted Infections (STIs) in Men who Have Sex with Men (MSM) on Pre Exposure Prophylaxis (PrEP)


  L La Fata, MD1, L Cotte, MD2, M Godinot, MD2, A Pansu, MD2, C Groslafeige, MD2, D Makhloufi, MD2, A Boibieux, MD2, T Ferry, MD1, 2 and Christian Chidiac, MD1,2; (1) University Claude Bernard Lyon1, Lyon, France, (2) Department of Infectious and Tropical Diseases & AIDS Referral Center, Lyon Teaching Hospitals, HCL GHN Croix Rousse, Lyon, France