Reviewing PrEP’s Effect on STI Incidence Among Men Who Have sex with Men—Balancing Increased STI Screening and Potential Behavioral Sexual Risk Compensation

• DOI: 10.1007/s10461-020-03110-x
• Publication Date: 2020-11-26T06:38:19Z
• Authors: Sagar Kumar; Laura T. Haderxhanaj; Ian H. Spicknall
• Keywords: Male; Sexual and Gender Minorities; 03 medical and health sciences; 0302 clinical medicine; Incidence; Sexually Transmitted Diseases; Humans; HIV Infections; Pre-Exposure Prophylaxis; Homosexuality, Male; 3. Good health

Though pre-exposure prophylaxis (PrEP) can prevent HIV acquisition, it provides no protection against bacterial sexually transmitted infections (STIs). PrEP use may increase STI acquisition due to sexual risk compensation, but that could be counterbalanced by increased STI screening at regular PrEP visits. We conducted a literature search of studies with quantitative data published prior to March 2020, assessing sexual risk compensation or STI screening among men who have sex with men (MSM) before and after PrEP initiation. We identified 16 relevant publications. Changes in condom use were inconsistent across studies. Partner acquisition following PrEP initiation decreased in most studies, likely due to behavioral counseling. In publications comparing a PrEP arm to a non-PrEP arm, serodiscordance increased in the PrEP arm and decreased in the non-PrEP arm. STI screening among MSM was low within a month of PrEP initiation. Monitoring trends in sexual risk compensation and STI screening will be critical to understand PrEP's effects on STI burden.