Priya Loomba
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
STI screening in the context of PrEP
Wednesday 23rd Feb Session TD-12
It’s Complicated: Renal Function and STIs in PrEP Users.
STI Data From Community-Based PrEP: Implementation Suggest Changes to CDC Guidelines.
Presenter: Sarit A Golub (NY, USA). Oral abstract an Poster.
Main findings of a review of STI screening in the context of PrEP;
Current CDC guidelines recommend screening at 6/12 intervals or earlier only if symptomatic.
They decided to screen all PrEP attendees routinely regardless of symptoms at 3/12 intervals.
They found that 77% of STIs would have been missed if they weren’t screened at the 3/12 routinely because of reporting as asymptomatic.
STIs screened were; Gc, CT, RPR in urethral and rectal samples. Pharyngeal testing was also done but not included in this study. The majority of PrEP attendees were between 22-40yrs of age.
Test of cure was only conducted on those that were documented as not having received first line therapy at the time of initial diagnosis. Current treatment for rectal CT was 1g Azithromycin, but 7 days Doxycycline was offered if TOC was +ve.
The researchers have also proposed a theory for why there was a spike in STI detection at 6/12. Anecdotal only, but PrEP attendees reported increased sexual risk activities after the 3 month initial HIV screen had come back negative, so they could actually believe that PrEP was effective for them.
Overall they are recommending that in light of many new PrEP guidelines and protocols being developed that STI screening of MSM on PrEP should be 3/12 regardless of symptoms.
These recommendations are in fact consistent with our current STIGMA guidelines for MSM screening that suggest testing up to 4 times per year.
http://stipu.nsw.gov.au/wp-content/uploads/STIGMA_Testing_Guidelines_Final_v5.pdf
Something additional to consider is that should and if PrEP be prescribed by any clinician, without S100 authority, then there may be a need for some re-education into promoting sexual health screening especially in the community general practice setting.