Pre-Exposure Prophylaxis
(PrEP) has shown high efficacy in preventing human immunodeficiency virus (HIV)
infection among men who have sex with men (MSM) in several large clinical
trials, and more recently in “real world” reports of clinical implementation
and a PrEP demonstration project. Those studies also demonstrated high
bacterial sexually transmitted infection (STI) incidence and raised the
discussion of how PrEP may impact STI control efforts, especially in the
setting of increasing Neisseria gonorrhoeae antimicrobial resistance and the increase in syphilis cases
among MSM. Here, we discuss STIs as a driver of HIV transmission risk among
MSM, and the potential opportunities and challenges for STI control afforded by
expanded PrEP implementation among high-risk MSM...
Increased PrEP uptake is an opportunity to increase STI
screening
Although current CDC
guidelines recommend routine and repeat screening for syphilis, and
behaviorally based screening for gonorrhea and chlamydia, the rate of screening
remains low [43, 44]. The vast
majority of STIs are asymptomatic at pharyngeal and rectal sites, and studies
suggest that more than 70 % would be missed with urogenital urine-based
screening alone [17, 44, 45]. Many patients
are not offered routine extragenital screening, even when seen at an STI
clinic, and a recent study of HIV care providers showed that despite
recommendations, routine STI screening was dismal [46]. Cited barriers
included provider time constraints, difficulty obtaining a sexual history,
language and cultural barriers, and concerns regarding patient confidentiality [46, 47]...
Purchase full article at: http://goo.gl/TxTuKE
By: 
and Jeffrey D. Klausner
and Jeffrey D. Klausner
Bridge HIV, San
Francisco Department of Public Health, San Francisco, CA USA
Division of
Infectious Diseases: Global Health, Department of Medicine, University of
California, Los Angeles, Los Angeles, CA USA
Hyman M. Scott, Email: gro.hpdfs@ttocs.namyh.
More at: https://twitter.com/hiv insight
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