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In Baltimore, less than half of MSM using PrEP screened for STDs
Despite clinical guidelines recommending they be screened biannually for STIs, less than half of men who have sex with men, or MSM, in Baltimore who were taking pre-exposure prophylaxis, or PrEP, for HIV prevention were tested for syphilis, gonorrhea and chlamydia upon PrEP initiation during a recent 30-month period, study findings showed.
Researchers said the study was developed to “provide real-world estimates of STI screening and positivity among MSM PrEP users by PrEP visit, STI, and anatomic site.”
The study population included 290 MSM who initiated PrEP as part of a demonstration project implemented by the Baltimore City Health Department between Sept. 30, 2015, and March 31, 2018. Following PrEP initiation, the researchers calculated STI screening for syphilis and gonorrhea/chlamydia at all anatomic sites and positivity at PrEP visits up to 12 months.
Just 43.1% of MSM were screened according to the PrEP clinical guidelines at initiation, the researchers reported. Among new PrEP users, 79.3% were screened for syphilis, 69.3% for urogenital gonorrhea/chlamydia, 55.9% for rectal gonorrhea/chlamydia and 69.3% for oropharyngeal gonorrhea/chlamydia.
The researchers reported that 7.8% of participants tested positive for syphilis. Participants also tested positive for rectal (11.1%), oropharyngeal (7.5%) and urogenital (5%) gonorrhea, and rectal (11.7%), urogenital (5%) and oropharyngeal (1.5%) chlamydia.
They noted that reporting anal and oral sex, as opposed to neither, was independently associated with STI screening at the PrEP initiation visit. They highlighted that STI screening rates were lower at the biannual PrEP visits, but positivity rates for syphilis and rectal gonorrhea/chlamydia were higher.
“Our results suggest that STI screening, particularly rectal gonorrhea/chlamydia screening, among MSM PrEP users is lower than estimated levels needed to reduce STI transmission, and that providers may be following disparate guidelines on STI screening,” the researchers wrote. “This underscores the need for provider training on PrEP clinical guidelines for STI screening. Future work should focus on identifying individual and provider-level barriers and facilitators to improve STI screening frequency among PrEP users.” – by Marley Ghizzone
Disclosures: Schumacher reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Although emerging evidence suggests that PrEP uptake among gay and bisexual men is associated with behavioral change and increases in individual-level STI acquisition risk, it has been hypothesized that the high frequency of STI screening resulting from widespread PrEP coverage will eventually curtail the rise in STIs, leading to population-level declines.
However, such projections depend largely on strict adherence to testing guidelines for PrEP users, which stipulate biannual or, in some countries, quarterly, asymptomatic screening of all PrEP users for all STIs at each anatomic site. It is yet to be seen whether PrEP users in the United States and internationally will adhere to these stringent testing guidelines, with a paucity of real-world data available on STI testing rates outside of clinical trials and demonstration studies.
The current study provides important insights into STI testing practices among a cohort of gay and bisexual men accessing PrEP in Baltimore, Maryland. The authors found that less than half of the cohort received comprehensive STI screening at PrEP initiation, with the figure dropping even further at the 6- and 12-month PrEP-care visits. Coupled with high positivity rates, the low testing rates among this cohort of PrEP users is cause for concern, with the authors suggesting that PrEP providers are likely following risk-based testing guidelines, rather than testing all PrEP users as recommended. For the population-level preventive effect of PrEP on STI rates to be realized, efforts to achieve and maintain high testing rates among all PrEP users must be expedited
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