Since the recent introduction of preexposure prophylaxis (PrEP), several studies have reported a decrease in the use of condoms and a rise in STIs among users. This rise in risk behavior associated ...with the advent of PrEP is known as "risk compensation." The aim of this study is to measure clinical and behavioral changes associated with the introduction of PrEP by analyzing condom use for anal intercourse, number of sexual partners, sexualized drug use and STI incidence.
We performed a retrospective descriptive study of PrEP users followed every 3months over a 2-year period spanning 2017-2019 in a referral clinic specializing in STI/HIV in Madrid, Spain. One hundred ten men who have sex with men and transgender women underwent regular screening for STIs and hepatitis C virus (HCV) infection. Sociodemographic, clinical, and behavioral data were gathered for all subjects studied.
The risk compensation observed in this study consisted primarily of a lower rate of condom use, while the number of sexual partners and recreational drug consumption remained stable. We observed a very high incidence of STIs in this sample, particularly rectal gonorrhea and chlamydia. The factors shown to be independently associated with the presence of an STI on multivariate analysis were age below 30 years and over 10 sexual partners/month.
The incidence of STI acquisition was higher than expected, indicating a need for strategies to minimize this impact, particularly among younger individuals with a higher number of sexual partners.
Existe un debate sobre la frecuencia del cribado de ITS entre los usuarios de profilaxis pre-exposición (PrEP). El objetivo de este estudio fue conocer la incidencia de ITS entre usuarios de PrEP y ...evaluar distintos modelos de cribado para optimizarlo.
Estudio descriptivo prospectivo de una cohorte de usuarios de PrEP en seguimiento desde 2017-2023 en una clínica de ITS. Se incluyeron 138 participantes, a quienes se realizó un cribado de ITS trimestralmente y visitas no programadas ante sospecha clínica o epidemiológica de ITS. Se realizó un análisis de supervivencia para eventos repetidos, calculando la incidencia acumulada (IA) y la tasa de incidencia (TI).
La IA global mediante el cribado trimestral fue de 8,3 (IC 95%: 7,6-9,1) infecciones por persona en 6 años, con una tendencia descendente. El patógeno más frecuentemente diagnosticado fue la Neisseria gonorrhoeae, TI de 0,76 (IC 95%: 0,68-0,84). En caso de reducir la frecuencia de cribado semestralmente, la TI de ITS se reduce en 0,58 (IC 95%: 0,5-0,66) infecciones por usuario y año, y a 12 meses en 0,82 (IC 95%: 0,73-0,89). En caso de no realizar cribado en localización faríngea ni uretral la TI se reduce en 0,37 (IC 95%: 0,32-0,42) infecciones por persona y año y en aquellos usuarios con más de 35 años en 0,33 (IC 95%: 0,25-0,4). Eliminando las visitas no programadas la reducción en la TI es de 0,33 (IC 95%: 0,24-0,42).
La incidencia de ITS entre los usuarios de PrEP es elevada, especialmente en el recto, pero no se incrementa con el paso del tiempo. Se podría optimizar el cribado de ITS reduciendo la frecuencia de búsqueda en localización faríngea y uretral, especialmente en mayores de 35 años. Es fundamental disponer de recursos para las visitas no programadas, que han demostrado ser un cribado con mayor rentabilidad diagnóstica.
There is discussion about the frequency of STI screening among pre-exposure prophylaxis (PrEP) users. The aim of this study was to analyze the incidence of STIs and to evaluate different screening models in order to optimize the follow-up.
A prospective study was conducted between 2017 and 2023, including 138 PrEP users in a STI clinic. Participants were tested for STIs every three months. Unscheduled visits were performed for those with STI-related symptoms or for people who were notified for an STI by a sexual partner. We performed a survival analysis of repeated events, estimating the cumulative incidence (CI) and incidence rate (IR).
The overall CI by quarterly screening was 8.3 (95% CI: 7.6–9.1) infections per person over six years, with a decreasing trend. The most frequently diagnosed pathogen was Neisseria gonorrhoeae, with a IR of 0.76 (95% CI: 0.68–0.84). If the frequency of screening is reduced to every six months, the IR of STIs is reduced by (95% CI: 0.5–0.66) infections per user per year, and at 12 months by 0.82 (95% CI: 0.73–0.89). In the case of no pharyngeal or urethral screening, IR is reduced by 0.37 (95% CI: 0.32–0.42) infections per person per year and in those over 35 years of age by 0.33 (95% CI: 0.25–0.4). Eliminating unscheduled visits, the reduction in IR is 0.33 (95% CI: 0.24–0.42).
The incidence of STIs among PrEP users is high, especially in the rectum, but it does not increase over time. STI screening could be optimized reducing the frequency of pharyngeal and urethral testing, particularly in those over 35 years of age. It is essential to redistribute health resources for unscheduled visits, which have been shown to be the most cost-effective screening.
La profilaxis pre-exposición (PrEP) frente al virus de la inmunodeficiencia humana (VIH) es una medida preventiva eficaz y segura. Sin embargo, no se ha alcanzado a todos los usuarios objetivo que ...podrían beneficiarse de la misma.
El objetivo del estudio fue conocer las características basales sociodemográficas, clínicas y conductuales de las personas al iniciar la PrEP. Como objetivo secundario, se describió el uso de medicación concomitante y el consumo de drogas.
Estudio observacional, retrospectivo y descriptivo de las características sociodemográficas, clínicas y conductuales de los usuarios que se incluyeron en el programa de PrEP de la Comunidad de Madrid durante los 2 primeros años de experiencia.
Se incluyeron 2.256 usuarios en PrEP, el 99,0% hombres, con una edad media de 36,9 años (DE: 8,68). El 33,1% presentó alguna infección de transmisión sexual (ITS) en la primera visita, destacando las clamidiasis y gonococias rectales. El 70,4% refirió consumir drogas asociadas al sexo, y el 42,4% participó en sesiones de chemsex en los últimos 3 meses. Se observó un alto porcentaje de usuarios con medicación concomitante (37,6%), destacando fármacos relacionados con salud mental y alopecia.
Se requiere un abordaje multidisciplinar para cubrir todas las necesidades de los usuarios de PrEP, incluyendo al abordaje clínico medidas de evaluación de salud mental y tratamiento de adicciones.
Pre-exposure prophylaxis (PrEP) against the human immunodeficiency virus (HIV) is an effective and safe preventive measure. However, it has not reached all target users who could benefit from it.
The study aimed to understand the sociodemographic, clinical and behavioral baseline characteristics of PrEP users. As a secondary objective, the use of concomitant medication and drug consumption were described.
Observational, retrospective and descriptive study of the sociodemographic, clinical and behavioral characteristics of the users who were included in the PrEP program of the Community of Madrid during the first two years of experience.
Two thousand two hundred fifty-six PrEP users were included, 99.0% men, with a mean age of 36.9 years (SD: 8.68). 33.1% presented a sexually transmitted infection (STI) on the first visit, highlighting chlamydiasis and rectal gonococci. 70.4% reported using drugs associated with sex, and 42.4% participated in chemsex sessions in the last 3 months. A high percentage of users with concomitant medication was observed (37.6%), highlighting drugs related to mental health and alopecia.
A multidisciplinary approach is required to cover all the needs of PrEP users, including mental health evaluation measures and addiction treatment with the clinical approach.
Serological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for ...primary syphilis.
Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR).
Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA.
DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.
Serological test for primary syphilis could be negative the first 5–15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for ...primary syphilis.
Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR).
Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA.
DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.
La serología luética en la sífilis primaria puede ser negativa los primeros 5–15 días. El objetivo de este trabajo fue evaluar los beneficios de incluir la microscopia de campo oscuro (MCO) en el algoritmo diagnóstico de la sífilis primaria.
Se incluyó a todos los pacientes que acudieron a una clínica de infecciones de transmisión sexual de la Comunidad de Madrid entre 2015 y 2019 que presentaban una úlcera genital sospechosa de sífilis primaria. Se les realizó MCO y serología (EIA/TPPA/RPR).
De las 806 muestras, el 53,2% (429) fueron positivas para MCO. De los 429, el 48% presentaba screening serológico negativo (EIA/RPR) y de ellos en el 77,6% el TPPA fue positivo.
La MCO permite un diagnóstico de sífilis primaria precoz, incluso sin confirmación serológica. Si no se dispone de técnicas directas, en primoinfección, la TPPA es de gran ayuda en el diagnóstico.
Pre-exposure prophylaxis (PrEP) against the human immunodeficiency virus (HIV) is an effective and safe preventive measure. However, it has not reached all target users who could benefit from it.
The ...study aimed to understand the sociodemographic, clinical and behavioral baseline characteristics of PrEP users. As a secondary objective, the use of concomitant medication and drug consumption were described.
Observational, retrospective and descriptive study of the sociodemographic, clinical and behavioral characteristics of the users who were included in the PrEP program of the Community of Madrid during the first two years of experience.
Two thousand two hundred fifty-six PrEP users were included, 99.0% men, with a mean age of 36.9 years (SD 8.68). 33.1% presented a sexually transmitted infection (STI) on the first visit, highlighting chlamydiasis and rectal gonococci. 70.4% reported using drugs associated with sex, and 42.4% participated in chemsex sessions in the last 3 months. A high percentage of users with concomitant medication was observed (37.6%), highlighting drugs related to mental health and alopecia.
A multidisciplinary approach is required to cover all the needs of PrEP users, including mental health evaluation measures and addiction treatment with the clinical approach.
La profilaxis pre-exposición (PrEP) frente al virus de la inmunodeficiencia humana (VIH) es una medida preventiva eficaz y segura. Sin embargo, no se ha alcanzado a todos los usuarios objetivo que podrían beneficiarse de la misma.
El objetivo del estudio fue conocer las características basales sociodemográficas, clínicas y conductuales de las personas al iniciar la PrEP. Como objetivo secundario, se describió el uso de medicación concomitante y el consumo de drogas.
Estudio observacional, retrospectivo y descriptivo de las características sociodemográficas, clínicas y conductuales de los usuarios que se incluyeron en el programa de PrEP de la Comunidad de Madrid durante los dos primeros años de experiencia.
Se incluyeron 2.256 usuarios en PrEP, 99,0% hombres, con una edad media de 36,9 años (DE 8,68). El 33,1% presentó alguna infección de transmisión sexual (ITS) en la primera visita, destacando las clamidiasis y gonococias rectales. El 70,4% refirió consumir drogas asociadas al sexo, y el 42,4% participó en sesiones dechemsex en los últimos 3 meses. Se observó un alto porcentaje de usuarios con medicación concomitante (37,6%), destacando fármacos relacionados con salud mental y alopecia.
Se requiere un abordaje multidisciplinar para cubrir todas las necesidades de los usuarios de PrEP, incluyendo al abordaje clínico medidas de evaluación de salud mental y tratamiento de adicciones.
INTRODUCTIONSerological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis ...algorythm for primary syphilis. MATERIALS/METHODSPatients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR). RESULTSOver the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA. CONCLUSIONSDFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.
Serological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for ...primary syphilis.
Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR).
Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA.
DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.
There is discussion about the frequency of STI screening among pre-exposure prophylaxis (PrEP) users. The aim of this study was to analyse the incidence of STIs and to evaluate different screening ...models in order to optimise the follow-up.
A prospective study was conducted between 2017 and 2023, including 138 PrEP users in a STI clinic. Participants were tested for STIs every three months. Unscheduled visits were performed for those with STI-related symptoms or for people who were notified for an STI by a sexual partner. We performed a survival analysis of repeated events, estimating the cumulative incidence (CI) and incidence rate (IR).
The overall CI by quarterly screening was 8.3 (95% CI: 7.6–9.1) infections per person over six years, with a decreasing trend. The most frequently diagnosed pathogen was Neisseria gonorrhoeae, with a IR of 0.76 (95% CI: 0.68–0.84). If the frequency of screening is reduced to every six months, the IR of STIs is reduced by (95% CI: 0.5–0.66) infections per user per year, and at 12 months by 0.82 (95% CI: 0.73–0.89). In the case of no pharyngeal or urethral screening, IR is reduced by 0.37 (95% CI: 0.32–0.42) infections per person per year and in those over 35 years of age by 0.33 (95% CI: 0.25–0.4). Eliminating unscheduled visits, the reduction in IR is 0.33 (95% CI: 0.24–0.42).
The incidence of STIs among PrEP users is high, especially in the rectum, but it does not increase over time. STI screening could be optimised reducing the frequency of pharyngeal and urethral testing, particularly in those over 35 years of age. It is essential to redistribute health resources for unscheduled visits, which have been shown to be the most cost-effective screening.
Existe un debate sobre la frecuencia del cribado de ITS entre los usuarios de profilaxis pre-exposición (PrEP). El objetivo de este estudio fue conocer la incidencia de ITS entre usuarios de PrEP y evaluar distintos modelos de cribado para optimizarlo.
Estudio descriptivo prospectivo de una cohorte de usuarios de PrEP en seguimiento desde 2017–2023 en una clínica de ITS. Se incluyeron 138 participantes, a quienes se realizó un cribado de ITS trimestralmente y visitas no programadas ante sospecha clínica o epidemiológica de ITS. Se realizó un análisis de supervivencia para eventos repetidos, calculando la incidencia acumulada (IA) y la tasa de incidencia (TI).
La IA global mediante el cribado trimestral fue de 8,3 (IC 95%: 7,6–9,1) infecciones por persona en 6 años, con una tendencia descendente. El patógeno más frecuentemente diagnosticado fue la Neisseria gonorrhoeae, TI de 0,76 (IC 95%: 0,68−0,84). En caso de reducir la frecuencia de cribado semestralmente, la TI de ITS se reduce en 0,58 (IC 95%: 0,5−0,66) infecciones por usuario y año, y a 12 meses en 0,82 (IC 95%: 0,73−0,89). En caso de no realizar cribado en localización faríngea ni uretral la TI se reduce en 0,37 (IC 95%: 0,32−0,42) infecciones por persona y año y en aquellos usuarios con más de 35 años en 0,33 (IC 95%: 0,25−0,4). Eliminando las visitas no programadas la reducción en la TI es de 0,33 (IC 95%: 0,24−0,42).
La incidencia de ITS entre los usuarios de PrEP es elevada, especialmente en el recto, pero no se incrementa con el paso del tiempo. Se podría optimizar el cribado de ITS reduciendo la frecuencia de búsqueda en localización faríngea y uretral, especialmente en mayores de 35 años. Es fundamental disponer de recursos para las visitas no programadas, que han demostrado ser un cribado con mayor rentabilidad diagnóstica.
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