Global Epidemiologic Characteristics of Sexually Transmitted Infections Among Individuals Using Preexposure Prophylaxis for the Prevention of HIV Infection: A Systematic Review and Meta-analysis
Open accessAbstract
Importance: Despite a global increase in sexually transmitted infections (STIs), there is limited focus and investment in STI management within HIV programs, in which risks for STIs are likely to be elevated. Objective: To estimate the prevalence of STIs at initiation of HIV preexposure prophylaxis (PrEP; emtricitabine and tenofovir disoproxil fumarate) and the incidence of STIs during PrEP use. Data Sources: Nine databases were searched up to November 20, 2018, without language restrictions. The implementers of PrEP were also approached for additional unpublished data. Study Selection: Studies reporting STI prevalence and/or incidence among PrEP users were included. Data Extraction and Synthesis: Data were extracted independently by at least 2 reviewers. The methodological quality of studies was assessed using the Joanna Briggs Institute critical assessment tool for prevalence and incidence studies. Random-effects meta-analysis was performed. Main Outcomes and Measures: Pooled STI prevalence (ie, within 3 months of PrEP initiation) and STI incidence (ie, during PrEP use, after 3 months). Results: Of the 3325 articles identified, 88 were included (71 published and 17 unpublished). Data came from 26 countries; 62 studies (70%) were from high-income countries, and 58 studies (66%) were from programs only for men who have sex with men. In studies reporting a composite outcome of chlamydia, gonorrhea, and early syphilis, the pooled prevalence was 23.9% (95% CI, 18.6%-29.6%) before starting PrEP. The prevalence of the STI pathogen by anatomical site showed that prevalence was highest in the anorectum (chlamydia, 8.5% [95% CI, 6.3%-11.0%]; gonorrhea, 9.3% [95% CI, 4.7%-15.2%]) compared with genital sites (chlamydia, 4.0% [95% CI, 2.0%-6.6%]; gonorrhea, 2.1% [95% CI, 0.9%-3.7%]) and oropharyngeal sites (chlamydia, 2.4% [95% CI, 0.9%-4.5%]; gonorrhea, 4.9% [95% CI, 1.9%-9.1%]). The pooled incidence of studies reporting the composite outcome of chlamydia, gonorrhea, and early syphilis was 72.2 per 100 person-years (95% CI, 60.5-86.2 per 100 person-years). Conclusions and Relevance: Given the high burden of STIs among individuals initiating PrEP as well as persistent users of PrEP, this study highlights the need for active integration of HIV and STI services for an at-risk and underserved population.
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These studies had limitations because of small sample size, short duration of therapy, and concerns about antibiotic resistance, specifically regarding N. gonorrhoeae.
“However, these studies had limitations because of small sample size, short duration of therapy, and concerns about antibiotic resistance, specifically regarding N. gonorrhoeae (241).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [241]
The Discussion (page unavailable) proposes monitoring antimicrobial resistance in N. gonorrhoeae, but does not describe it as a limitation of the studies in the claim. The Strengths and Limitations section (page unavailable) discusses bias and STI reporting, not small sample size or short therapy duration. Searches for those limitations and antibiotic prophylaxis found no passage establishing the attributed assessment. (LLM, conf=0.74)
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Sexually Transmitted Infections Treatment Guidelines, 2021
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- Authors
- Ong, J. J., Baggaley, R. C., Wi, T. E., Tucker, J. D., Fu, H., Smith, M. K., Rafael, S., Anglade, V., Falconer, J., Ofori-Asenso, R., Terris-Prestholt, F., Hodges-Mameletzis, I., & Mayaud, P.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- World Health Organization (CH)
- Eastern Virginia Medical School (US)
- University of Minnesota (US)
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Corresponding author
- Ong, Jason J.
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2019-12-11
- Volume
- 2
- Issue
- 12
- Pages
- e1917134
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC6991203
- OpenAlex
- W2995333784
- Cited by
- 173
- References
- 62
- Citations by year
- 2026: 15 · 2025: 22 · 2024: 23 · 2023: 30 · 2022: 32 · 2021: 24 · 2020: 24 · 2019: 2 · 2018: 1
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- Monash University Research Portal (Monash University) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- sexually transmitted infections, HIV pre-exposure prophylaxis, PrEP users, STI prevalence, STI incidence, chlamydia, gonorrhea, early syphilis, men who have sex with men, HIV prevention, emtricitabine, tenofovir disoproxil fumarate, HIV prevention programs
- MeSH terms
- Sexual and Gender Minorities, Adolescent, Adult, Female, Humans, Male, Middle Aged, Sexually Transmitted Diseases, Global Health, Cohort Studies, HIV Infections, Incidence, Young Adult, Pre-Exposure Prophylaxis
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