Tuesday, January 26, 2016

Sexually Transmitted Infections & Pre-Exposure Prophylaxis: Challenges & Opportunities among Men Who Have Sex with Men in the US

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 [, ]. 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 [, , ]. 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 []. Cited barriers included provider time constraints, difficulty obtaining a sexual history, language and cultural barriers, and concerns regarding patient confidentiality [, ]... 

Purchase full article at:   http://goo.gl/TxTuKE

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.

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