Incidence of gonorrhea and chlamydia following human immunodeficiency virus preexposure prophylaxis among men who have sex with men: a modeling study.
Open accessAbstract
Background: Preexposure prophylaxis (PrEP) is highly effective for preventing human immunodeficiency virus (HIV) infection, but risk compensation (RC) in men who have sex with men (MSM) raises concerns about increased sexually transmitted infections (STIs). The Center for Disease Control and Prevention's (CDC's) PrEP guidelines recommend biannual STI screening, which may reduce incidence by treating STIs that would otherwise remain undiagnosed. We investigated these two counteracting phenomena. Methods: With a network-based mathematical model of HIV, Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) transmission dynamics among MSM in the United States, we simulated PrEP uptake following the prescription indications and HIV/STI screening recommendations in the CDC guidelines. Scenarios varied PrEP coverage (the proportion of MSM indicated for PrEP who received it), RC (a reduction in the per-act probability of condom use), and the STI screening interval. Results: In our reference scenario (40% coverage, 40% RC), 42% of NG and 40% of CT infections would be averted over the next decade. A doubling of RC would still result in net STI prevention relative to no PrEP. STIs declined because PrEP-related STI screening resulted in a 17% and 16% absolute increase in the treatment of asymptomatic and rectal STIs, respectively. Screening and timely treatment at quarterly vs biannual intervals would reduce STI incidence an additional 50%. Conclusions: Implementation of the CDC PrEP guidelines while scaling up PrEP coverage could result in a significant decline in STI incidence among MSM. Our study highlights the design of PrEP not only as antiretroviral medication but as combination HIV/STI prevention incorporating STI screening.
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In an MSM transmission model that explored the impact of HIV PrEP use on STI prevalence, quarterly chlamydia and gonorrhea screening was associated with an 83% reduction in incidence.
“In an MSM transmission model that explored the impact of HIV PrEP use on STI prevalence, quarterly chlamydia and gonorrhea screening was associated with an 83% reduction in incidence (205).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [205]
Studies have reported that MSM taking PrEP have high rates of STIs, and frequent screening is warranted.
“Studies have reported that MSM taking PrEP have high rates of STIs, and frequent screening is warranted (204–206).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [205]
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- Authors
- Jenness, S. M., Weiss, K. M., Goodreau, S. M., Gift, T., Chesson, H., Hoover, K. W., Smith, D. K., Liu, A. Y., Sullivan, P. S., & Rosenberg, E. S.
- Affiliations
- Emory University (US)
- University of Washington (US)
- Division of STD Prevention, and
- Centers for Disease Control and Prevention (US)
- San Francisco Department of Public Health (US)
- Corresponding author
- Jenness, Samuel M
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-05-13
- Volume
- 65
- Issue
- 5
- Pages
- 712-718
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC5848234
- OpenAlex
- W2612576926
- Cited by
- 224
- References
- 38
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 20 · 2023: 30 · 2022: 20 · 2021: 21 · 2020: 32 · 2019: 43 · 2018: 31 · 2017: 7
- FWCI
- 23.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (R21 MH112449, R21 HD075662)
- CDC (U38 PS004646)
- University of Washington (P30 AI027757)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Keywords
- HIV pre-exposure prophylaxis, men who have sex with men, gonorrhea, chlamydia, risk compensation, STI screening, condom use, STI incidence, PrEP coverage, HIV transmission dynamics
- MeSH terms
- Chlamydia Infections, Gonorrhea, Humans, Male, Models, Statistical, Cohort Studies, HIV Infections, Homosexuality, Male, Pre-Exposure Prophylaxis
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