Can we screen less frequently for STI among PrEP users? Assessing the effect of biannual STI screening on timing of diagnosis and transmission risk in the AMPrEP Study

• Published in: Sexually transmitted infections Vol. 99; no. 3; pp. 149 - 155
• Main Authors: Jongen, Vita W., Zimmermann, Hanne M.L., Goedhart, Marit, Bogaards, Johannes A., Davidovich, Udi, Coyer, Liza, de Vries, Henry J.C., Prins, Maria, Hoornenborg, Elske, Schim van der Loeff, Maarten F.
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.05.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Antibiotics; Asymptomatic; Chlamydia; Chlamydia Infections; Condoms; Disease prevention; Drug use; Gonorrhea; Gonorrhea - diagnosis; Gonorrhea - epidemiology; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - prevention & control; Homosexuality, Male; Human immunodeficiency virus; Humans; Infections; Male; NEISSERIA GONORRHOEAE; Original Research; Pre-Exposure Prophylaxis; PREP; Questionnaires; Severe acute respiratory syndrome coronavirus 2; Sexual and Gender Minorities; Sexual Behavior; Sexually transmitted diseases; Sexually Transmitted Diseases - diagnosis; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - prevention & control; STD; SYPHILIS; Transgender persons; Variables; United States > US; Netherlands; PREP; SYPHILIS; NEISSERIA GONORRHOEAE; Chlamydia Infections; Pre-Exposure Prophylaxis
• ISSN: 1368-4973; 1472-3263
• DOI: 10.1136/sextrans-2022-055439

BackgroundIn many countries, HIV pre-exposure prophylaxis (PrEP) users are screened quarterly for STIs. We assessed the consequences of less frequent STI testing. We also assessed determinants of asymptomatic STI and potential for onward transmission.MethodsUsing data from the AMPrEP study, we assessed the proportion of syphilis, and genital, anal, and pharyngeal chlamydia and gonorrhoea diagnoses which would have been delayed with biannual versus quarterly screening. We assessed the potential for onward transmission by examining reported condomless anal sex (CAS) in periods after to-be-omitted visits when screening biannually. We assessed determinants of incident asymptomatic STIs using Poisson regression and calculated individual risk scores on the basis of the coefficients from this model.ResultsWe included 366 participants. Median follow-up was 47 months (IQR 43–50). 1,183STIs were diagnosed, of which 932(79%) asymptomatic. With biannual screening, 483 asymptomatic STIs (52%) diagnoses would have been delayed at 364 study visits. Of these visits, 129 (35%), 240 (66%) and 265 (73%) were followed by periods of CAS with steady, known casual or unknown casual partners, respectively. Older participants had a lower risk of asymptomatic STI (incidence rate ratio (IRR) 0.86/10-year increase, 95% CI 0.80 to 0.92), while CAS with known (IRR 1.36, 95% CI 1.10 to 1.68) and unknown (IRR 1.86, 95% CI 1.48 to 2.34) casual partners and chemsex (IRR 1.51, 95% CI 1.28 to 1.78) increased the risk. The individual risk scores had limited predictive value (sensitivity=0.70 (95% CI 0.66 to 0.74), specificity=0.50 (95% CI 0.48 to 0.51)).ConclusionReducing the STI screening frequency to biannually among PrEP users will likely result in delayed diagnoses, potentially driving onward transmission. Although determinants for asymptomatic STIs were identified, predictive power was low.