First figures on PrEP and STIs study in Germany

HIV-negative men who have sex with men (MSM), who use PrEP, are significantly more likely to have other sexually transmitted diseases.

72% of MSM under PrEP engage in unprotected anal intercourse

HIV-negative men who have sex with men (MSM), who use PrEP, are significantly more likely to have other sexually transmitted diseases.

Pre-exposure prophylaxis (PrEP) to prevent HIV infection has already been approved in Germany for three years. Although the use of condoms as additional protection to PrEP use is still recommended, experts already assumed when the PrEp was introduced that PrEP users would diminish the frequency of condom use. Could this make PrEP as a risk factor for other sexually transmitted infections? A recent study has now provided the first figures for Germany.

Between February 2018 and July 2018, a total of 2,303 men who have sex with men (MSM) were examined in the context of the "MSM Screening Study". All men in the study received routine STI screening for Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae and Trichomonas vaginalis in their respective study centers.

Half of the volunteers between the ages of 18 and 71 were HIV positive. Statements on sexual behavior were also asked by all during consultation at the study center. During the course of the study, the men belonged to one of the following three groups: HIV-positive MSM, HIV-negative MSM under PrEP and HIV-negative MSM without PrEP.

Finally, the results essentially confirm the assumptions of the experts since the introduction of the PrEP in Germany. In the median, the subjects had five sexual partners within the last six months, with about one-third of the HIV-negative MSM using PrEP. Around 72% of the participants also stated that they had practiced anal intercourse without condoms under PrEP. Almost 43% had “chemsex” and used different "party drugs".

More than three-quarters of the men surveyed (78.9%) had already suffered from an STI. A third (32.1%) of STI-positive subjects also reported having experienced STI-specific symptoms before the infection was finally detected in this study.

In 30.1% of the study participants, the researchers found at least one STI, while 16.7% of the STI-positive men had co-infections with several pathogens:

In the overall prevalence of STI, however, there were no significant differences in HIV status. Interestingly, however, 40.2% of HIV-negative MSM with PrEP suffered from STI, while the figure for HIV-negative MSM without PrEP was only 25%.

The current guidelines recommend a syphilis test every three months and a test for chlamydia and gonococcus every 3-6 months. In addition, the present study showed very clearly that the PrEP is also a sufficient indication for the STI test.

However, the necessity and indication for a test are currently still hampered by the problem that the health insurance funds only cover the costs incurred for STI diagnostics if symptoms occur or if there are reasonable grounds to suspect the presence of an STI. As long as "precautionary" STI screenings still have to be paid for privately in many cases, it will certainly not be possible to establish the necessary comprehensive tests.

Jansen K & Steffen G, STI in times of PrEP. Current data from the MSM screening study. HIV&more 1/2019 (Original study title in German: STI in Zeiten von PrEP. Aktuelle Daten aus der MSM-Screening-Study.)