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HIV pre-exposure prophylaxis and sexually transmitted infections: intersection and opportunity

Abstract

Pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention, but PrEP does not protect against other sexually transmitted infections (STIs). Rates of STIs are rising worldwide, with notably high incidences among PrEP-using men who have sex with men in high-income countries; in low-income and middle-income countries, data are sparse, but results from a limited number of studies among African women initiating and taking PrEP have shown high STI prevalence and incidence. Efforts aimed at markedly reducing HIV in populations worldwide include a major focus on increasing PrEP use, along with improving HIV testing and treatment in order to eliminate HIV transmission. Together, these efforts could augment continued expansion of the global STI epidemic, but they could alternatively create an opportunity to improve STI control, including the development of comprehensive sexual health programmes and research to develop new STI prevention strategies. The introduction of PrEP globally has been characterized by challenges and many successes, and its role as part of a range of robust strategies to reduce HIV infections is clear. Looking ahead, understanding rising rates of curable STIs and their relationship to HIV prevention, and considering the future directions for synergies in PrEP and STI prevention will be integral to improving sexual health.

Key points

  • Pre-exposure prophylaxis (PrEP) prevents sexual acquisition of HIV and is a part of comprehensive, evidence-informed primary and specialty care. Expanding access to and initiation of PrEP is a key part of global efforts to reverse the HIV epidemic.

  • Sexually transmitted infection (STI) rates are rising worldwide and integration of STI prevention and care with PrEP care is an important opportunity for leveraging resources and synergizing interventions.

  • Strategies to simplify PrEP care and STI testing and treatment, including self-care approaches, could increase the number of individuals receiving effective HIV and STI prevention.

  • Research into new STI prevention strategies is still needed.

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Fig. 1: HIV infection and PrEP mechanism of action.

References

  1. Blackwell, C. W. Preventing HIV infection in high-risk adolescents using preexposure prophylaxis (PrEP). J. Assoc. Nurses AIDS Care 29, 770–774 (2018).

    Article  PubMed  Google Scholar 

  2. Hosek, S. G. et al. An HIV preexposure prophylaxis demonstration project and safety study for young MSM. J. Acquir. Immune Defic. Syndr. 74, 21–29 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Centers for Disease Control. Preexposure prophylaxis for the prevention of HIV infection in the United States — 2017 Update: a clinical practice guideline (CDC, 2017).

  4. WHO. Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV (WHO, 2015).

  5. Owens, D. K. et al. Preexposure prophylaxis for the prevention of HIV infection: US preventive services task force recommendation statement. JAMA 321, 2203–2213 (2019).

    Article  PubMed  Google Scholar 

  6. Cairns, G., McCormack, S. & Molina, J. M. The European preexposure prophylaxis revolution. Curr. Opin. HIV AIDS 11, 74–79 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wright, E. et al. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. Update April 2018. J. Virus Erad. 4, 143–159 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sax, P. E. et al. Tenofovir alafenamide vs. tenofovir disoproxil fumarate in single tablet regimens for initial HIV-1 therapy: a randomized phase 2 study. J. Acquir. Immune Defic. Syndr. 67, 52–58 (2014).

    Article  CAS  PubMed  Google Scholar 

  9. Gupta, S. K. et al. Renal safety of tenofovir alafenamide vs. tenofovir disoproxil fumarate: a pooled analysis of 26 clinical trials. AIDS 33, 1455–1465 (2019).

    Article  CAS  PubMed  Google Scholar 

  10. Hare, C. B. et al. The Phase 3 Discover Study: Daily F/TAF or F/TDF for HIV PrEP (CROI, 2019).

  11. Anderson, P. L. et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci. Transl Med. 4, 151ra125 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Baeten, J. M. et al. Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial. Lancet Infect. Dis. 14, 1055–1064 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Baeten, J. M. et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N. Engl. J. Med. 367, 399–410 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Nguyen, V. K. et al. Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV. AIDS 32, 523–530 (2018).

    Article  PubMed  Google Scholar 

  15. Traeger, M. W. et al. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA 321, 1380–1390 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Morton, J. et al. High prevalence of curable STIs among young women initiating PrEP in Kenya and South Africa. in AIDS 2018: 22nd International AIDS Conference (Abstract WEPEC224) (AIDS, 2019).

  17. Garrett, N. et al. Diagnostic accuracy of the Xpert CT/NG and OSOM Trichomonas Rapid assays for point-of-care STI testing among young women in South Africa: a cross-sectional study. BMJ Open 9, e026888 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Stewart, J., Bukusi, E., Celum, C., Delany-Moretlwe, S. & Baeten, J. M. Sexually transmitted infections among African women: an opportunity for combination sexually transmitted infection/HIV prevention. AIDS 34, 651–658 (2020).

    Article  PubMed  Google Scholar 

  19. Eisinger, R. W., Erbelding, E. & Fauci, A. S. Refocusing research on sexually transmitted infections. J. Infect. Dis. 222, 1432–1432 (2019).

    Article  PubMed Central  Google Scholar 

  20. Stack, L. Sexually transmitted disease cases reach a record high (The New York Times, 2019).

  21. Ryom, L. et al. 2019 update of the European AIDS Clinical Society Guidelines for treatment of people living with HIV version 10.0. HIV Med. 21, 617–624 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Günthard, H. F. et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 Recommendations of the International Antiviral Society-USA Panel. JAMA 316, 191–210 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  23. FDA. FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic (FDA News Release, 2019).

  24. Grant, R. M. et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N. Engl. J. Med. 363, 2587–2599 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Donnell, D. et al. HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. J. Acquir. Immune Defic. Syndr. 66, 340–348 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Haberer, J. E. et al. Adherence to antiretroviral prophylaxis for HIV prevention: a substudy cohort within a clinical trial of serodiscordant couples in East Africa. PLoS Med. 10, e1001511 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Colby, D. J. et al. Acquisition of multidrug-resistant human immunodeficiency virus type 1 infection in a patient taking preexposure prophylaxis. Clin. Infect. Dis. 67, 962–964 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Markowitz, M. et al. Newly acquired infection with multidrug-resistant HIV-1 in a patient adherent to preexposure prophylaxis. J. Acquir. Immune Defic. Syndr. 76, e104–e106 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Peterson, L. et al. Tenofovir disoproxil fumarate for prevention of HIV infection in women: a phase 2, double-blind, randomized, placebo-controlled trial. PLoS Clin. Trials 2, e27 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  30. WHO. WHO Implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection (World Health Organization, 2017).

  31. Seifert, S. M. et al. Dose response for starting and stopping HIV preexposure prophylaxis for men who have sex with men. Clin. Infect. Dis. 60, 804–810 (2015).

    Article  CAS  PubMed  Google Scholar 

  32. Saag, M. S. et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA 320, 379–396 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Molina, J. M. et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV 4, e402–e410 (2017).

    Article  PubMed  Google Scholar 

  34. Molina, J. M. et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 Infection. N. Engl. J. Med. 373, 2237–2246 (2015).

    Article  CAS  PubMed  Google Scholar 

  35. DeJesus, E. et al. Superior efficacy and improved renal and bone safety after switching from a tenofovir disoproxil fumarate- to a tenofovir alafenamide-based regimen through 96 weeks of treatment. AIDS Res. Hum. Retroviruses 34, 337–342 (2018).

    Article  CAS  PubMed  Google Scholar 

  36. Daar, E. S. et al. Efficacy and safety of switching to fixed-dose bictegravir, emtricitabine, and tenofovir alafenamide from boosted protease inhibitor-based regimens in virologically suppressed adults with HIV-1: 48 week results of a randomised, open-label, multicentre, phase 3, non-inferiority trial. Lancet HIV 5, e347–e356 (2018).

    Article  PubMed  Google Scholar 

  37. WHO. What’s the 2+1+1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: Update to WHO’s recommendation on oral PrEP (WHO, 2019).

  38. Thompson, C. G., Cohen, M. S. & Kashuba, A. D. Antiretroviral pharmacology in mucosal tissues. J. Acquir. Immune Defic. Syndr. 63 (Suppl. 2), S240–S247 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Karim, S. S., Kashuba, A. D., Werner, L. & Karim, Q. A. Drug concentrations after topical and oral antiretroviral pre-exposure prophylaxis: implications for HIV prevention in women. Lancet 378, 279–281 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Pyra, M. et al. Patterns of oral PrEP adherence and HIV risk among eastern African Women in HIV serodiscordant partnerships. AIDS Behav. 22, 3718–3725 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mullins, T. L. K. & Lehmann, C. E. Oral pre-exposure prophylaxis (PrEP) for HIV prevention in adolescents and young adults. Curr. Pediatr. Rep. 6, 114–122 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Were, E. O. et al. Pre-exposure prophylaxis does not affect the fertility of HIV-1-uninfected men. AIDS 28, 1977–1982 (2014).

    Article  PubMed  Google Scholar 

  43. Fonner, V. A. et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS 30, 1973–1983 (2016).

    Article  PubMed  Google Scholar 

  44. Arribas, J. R. et al. Tenofovir disoproxil fumarate, emtricitabine, and efavirenz compared with zidovudine/lamivudine and efavirenz in treatment-naive patients: 144-week analysis. J. Acquir. Immune Defic. Syndr. 47, 74–78 (2008).

    Article  CAS  PubMed  Google Scholar 

  45. Mugwanya, K. et al. Low risk of proximal tubular dysfunction associated with emtricitabine-tenofovir disoproxil fumarate preexposure prophylaxis in men and women. J. Infect. Dis. 214, 1050–1057 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Mulligan, K. et al. Effects of emtricitabine/tenofovir on bone mineral density in HIV-negative persons in a randomized, double-blind, placebo-controlled trial. Clin. Infect. Dis. 61, 572–580 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Grohskopf, L. A. et al. Randomized trial of clinical safety of daily oral tenofovir disoproxil fumarate among HIV-uninfected men who have sex with men in the United States. J. Acquir. Immune Defic. Syndr. 64, 79–86 (2013).

    Article  CAS  PubMed  Google Scholar 

  48. Pilkington, V., Hill, A., Hughes, S., Nwokolo, N. & Pozniak, A. How safe is TDF/FTC as PrEP? A systematic review and meta-analysis of the risk of adverse events in 13 randomised trials of PrEP. J. Virus Erad. 4, 215–224 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  49. AVAC. Global PrEP Tracker. AVAC https://www.prepwatch.org/resource/global-prep-tracker/ (2019).

  50. County of Santa Clara Public Health Department. HIV Epidemiology Annual Report: County of Santa Clara, 2018. County of Santa Clara https://publichealth.sccgov.org/sites/g/files/exjcpb916/files/hiv-annual-report-2018.PDF (2019).

  51. Grulich, A. E. et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV 5, e629–e637 (2018).

    Article  PubMed  Google Scholar 

  52. Finlayson, T. et al. Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men — 20 urban areas, 2014 and 2017. MMWR 68, 597–603 (2019).

    PubMed  PubMed Central  Google Scholar 

  53. Calabrese, S. K. et al. Current US guidelines for prescribing HIV pre-exposure prophylaxis (PrEP) disqualify many women who are at risk and motivated to use PrEP. J. Acquir. Immune Defic. Syndr. 81, 395–405 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  54. Siegler, A. J. et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann. Epidemiol. 28, 841–849 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  55. Poteat, T. et al. A gap between willingness and uptake: findings from mixed methods research on HIV prevention among Black and Latina transgender women. J. Acquir. Immune Defic. Syndr. 82, 131140 (2019).

    Article  Google Scholar 

  56. Huang, Y. A., Zhu, W., Smith, D. K., Harris, N. & Hoover, K. W. HIV preexposure prophylaxis, by race and ethnicity — United States, 2014–2016. MMWR 67, 1147–1150 (2018).

    PubMed  PubMed Central  Google Scholar 

  57. Hoots, B. E., Finlayson, T., Nerlander, L. & Paz-Bailey, G., National HIV Behavioral Surveillance Study Group. Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men — 20 US Cities, 2014. Clin. Infect. Dis. 63, 672–677 (2016).

    Article  PubMed  Google Scholar 

  58. Hess, K. L., Hu, X., Lansky, A., Mermin, J. & Hall, H. I. Lifetime risk of a diagnosis of HIV infection in the United States. Ann. Epidemiol. 27, 238–243 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  59. Sullivan, P. S. et al. Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Ann. Epidemiol. 25, 445–454 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  60. Raifman, J. R. et al. Brief report: pre-exposure prophylaxis awareness and use among cisgender women at a sexually transmitted disease clinic. J. Acquir. Immune Defic. Syndr. 80, 36–39 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  61. AVAC. Country Updates — PrEPWatch. AVAC https://www.prepwatch.org/in-practice/country-updates/ (2018).

  62. UNAIDS. Trend of New HIV Infections. UNAIDS https://aidsinfo.unaids.org (2019).

  63. Celum, C. L. et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J. Int. AIDS Soc. 22 (Suppl. 4), e25298 (2019).

    PubMed  PubMed Central  Google Scholar 

  64. UNAIDS. The Gap Report. UNAIDS https://www.unaids.org/en/resources/campaigns/2014gapreport (2015).

  65. UNAIDS. UNAIDS Data 2018. UNAIDS https://www.unaids.org/en/resources/documents/2018/unaids-data-2018 (2018).

  66. PrEP Watch. PrEP-it Pilot User Guide. Version 1.0. prepwatch.org https://www.prepwatch.org/wp-content/uploads/2019/09/PrEP-it_UserGuide_Sept2019.pdf (2019).

  67. Vandepitte, J. et al. Estimates of the number of female sex workers in different regions of the world. Sex. Transm. Infect. 82 (Suppl. 3), iii18–iii25 (2006).

    PubMed  PubMed Central  Google Scholar 

  68. Golub, S. A., Gamarel, K. E., Rendina, H. J., Surace, A. & Lelutiu-Weinberger, C. L. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS 27, 248–254 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  69. Hosek, S. G. et al. Safety and feasibility of antiretroviral preexposure prophylaxis for adolescent men who have sex with men aged 15 to 17 years in the United States. JAMA Pediatr. 171, 1063–1071 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  70. Kapadia, S. N. et al. HIV virologic response better with single-tablet once daily regimens compared to multiple-tablet daily regimens. SAGE Open Med. 6, 2050312118816919 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  71. Hanna, D. B. et al. Increase in single-tablet regimen use and associated improvements in adherence-related outcomes in HIV-infected women. J. Acquir. Immune Defic. Syndr. 65, 587–596 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Rodger, A. J. et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 316, 171–181 (2016).

    Article  PubMed  Google Scholar 

  73. Rodger, A. J. et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 393, 2428–2438 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  74. Closson, E. F. et al. Intimacy versus isolation: a qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia. PLoS ONE 10, e0120957 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  75. Bearinger, L. H., Sieving, R. E., Ferguson, J. & Sharma, V. Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. Lancet 369, 1220–1231 (2007).

    Article  PubMed  Google Scholar 

  76. Hoornenborg, E. et al. Change in sexual risk behaviour after 6 months of pre-exposure prophylaxis use: results from the Amsterdam pre-exposure prophylaxis demonstration project. AIDS 32, 1527–1532 (2018).

    Article  PubMed  Google Scholar 

  77. Newcomb, M. E., Mongrella, M. C., Weis, B., McMillen, S. J. & Mustanski, B. Partner disclosure of PrEP use and undetectable viral load on geosocial networking apps: frequency of disclosure and decisions about condomless sex. J. Acquir. Immune Defic. Syndr. 71, 200–206 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  78. Cohen, M. S. et al. Prevention of HIV-1 infection with early antiretroviral therapy. N. Engl. J. Med. 365, 493–505 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Koester, K. et al. Risk, safety and sex among male PrEP users: time for a new understanding. Cult. Health Sex. 19, 1301–1313 (2017).

    Article  PubMed  Google Scholar 

  80. Centers for Disease Control. HIV Incidence: Estimated Annual Infections in the U.S., 2010–2016. CDC https://www.cdc.gov/nchhstp/newsroom/2019/HIV-incidence.html (2019).

  81. Brown, A. E. et al. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Eur. Surveill. 22, 30553 (2017).

    Article  Google Scholar 

  82. Carlo Hojilla, J. et al. Sexual behavior, risk compensation, and HIV prevention strategies among participants in the San Francisco PrEP demonstration project: a qualitative analysis of counseling notes. AIDS Behav. 20, 1461–1469 (2016).

    Article  CAS  PubMed  Google Scholar 

  83. Grant, R. M. & Koester, K. A. What people want from sex and preexposure prophylaxis. Curr. Opin. HIV AIDS 11, 3–9 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  84. Lal, L. et al. Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users. AIDS 31, 1709–1714 (2017).

    Article  PubMed  Google Scholar 

  85. Montano, M. A. et al. Changes in sexual behavior and STI diagnoses among MSM initiating PrEP in a clinic setting. AIDS Behav. 23, 548–555 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  86. Liu, A. Y. et al. Preexposure prophylaxis for HIV infection integrated with municipal- and community-based sexual health services. JAMA Intern. Med. 176, 75–84 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  87. Heffron, R. et al. Objective measurement of inaccurate condom use reporting among women using depot medroxyprogesterone acetate for contraception. AIDS Behav. 21, 2173–2179 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  88. Sander, P. M., Raymond, E. G. & Weaver, M. A. Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection. Am. J. Obstet. Gynecol. 201, 146.e1–6 (2009).

    Article  Google Scholar 

  89. Kasaie, P. et al. The impact of preexposure prophylaxis among men who have sex with men: an individual-based model. J. Acquir. Immune Defic. Syndr. 75, 175–183 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  90. Eisinger, R. W. & Fauci, A. S. Ending the HIV/AIDS Pandemic(1). Emerg. Infect. Dis. 24, 413–416 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  91. McManus, H. et al. STI trends following PrEP uptake in men who have sex with men in a population-based implementation project. JAMA Netw. Open 3, e2030806 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Centers for Disease Control. New CDC analysis shows steep and sustained increases in STDs in recent years. CDC https://www.cdc.gov/media/releases/2018/p0828-increases-in-stds.html (2018).

  93. Newman, L. et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS ONE 10, e0143304 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  94. Katz, D. A., Dombrowski, J. C., Bell, T. R., Kerani, R. P. & Golden, M. R. HIV incidence among men who have sex with men after diagnosis with sexually transmitted infections. Sex. Transm. Dis. 43, 249–254 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  95. Tilchin, C. et al. Human immunodeficiency virus diagnosis after a syphilis, gonorrhea, or repeat diagnosis among males including non-men who have sex with men: what is the incidence? Sex. Transm. Dis. 46, 271–277 (2019).

    Article  PubMed  Google Scholar 

  96. Fleming, D. T. & Wasserheit, J. N. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex. Transm. Infect. 75, 3–17 (1999).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. Ong, J. J. et al. Global epidemiologic characteristics of sexually transmitted infections among individuals using preexposure prophylaxis for the prevention of HIV infection: a systematic review and meta-analysis. JAMA Netw. Open 2, e1917134 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  98. Ramchandani, M. S. & Golden, M. R. Confronting rising STIs in the Era of PrEP and treatment as prevention. Curr. HIV/AIDS Rep. 16, 244–256 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  99. Comninos, N. B. et al. Increases in pharyngeal Neisseria gonorrhoeae positivity in men who have sex with men, 2011–2015: observational study. Sex. Transm. Infect. 96, 432–435 (2020).

    Article  PubMed  Google Scholar 

  100. Martin-Sanchez, M. et al. Trends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study in Melbourne, Australia. BMJ Open 10, e037608 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  101. Pagkas-Bather, J., Khosropour, C. M., Golden, M. R., Thibault, C. & Dombrowski, J. C. Population-level effectiveness of HIV pre-exposure prophylaxis among MSM and transgender persons with bacterial sexually transmitted infections. J. Acquir. Immune Defic. Syndr. 87, 769–775 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  102. Rolle, C. P. et al. Willingness to use pre-exposure prophylaxis among Black and White men who have sex with men in Atlanta, Georgia. Int. J. STD AIDS 28, 849–857 (2017).

    Article  PubMed  Google Scholar 

  103. Rojas Castro, D., Delabre, R. M. & Molina, J. M. Give PrEP a chance: moving on from the “risk compensation” concept. J. Int. AIDS Soc. 22 (Suppl. 6), e25351 (2019).

    PubMed  PubMed Central  Google Scholar 

  104. Atkins, D. N. & Bradford, W. D. Association between increased emergency contraception availability and risky sexual practices. Health Serv. Res. 50, 809–829 (2015).

    Article  CAS  PubMed  Google Scholar 

  105. Schuster, M. A., Bell, R. M., Berry, S. H. & Kanouse, D. E. Impact of a high school condom availability program on sexual attitudes and behaviors. Fam. Plann. Perspect. 30, 67–72, 88 (1998).

    Article  CAS  PubMed  Google Scholar 

  106. Traeger, M. W. et al. Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection on sexual risk behavior in men who have sex with men: a systematic review and meta-analysis. Clin. Infect. Dis. 67, 676–686 (2018).

    Article  PubMed  Google Scholar 

  107. Montano, M. A. et al. Differences in sexually transmitted infection risk comparing preexposure prophylaxis users and propensity score matched historical controls in a clinic setting. AIDS 33, 1773–1780 (2019).

    Article  PubMed  Google Scholar 

  108. Holt, M. et al. Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013–17. Lancet HIV 5, e448–e456 (2018).

    Article  PubMed  Google Scholar 

  109. World Health Organization, Department of Reproductive Health and Research. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. WHO https://www.who.int/reproductivehealth/publications/rtis/9789241503501/en/ (2012).

  110. Moore, M. S., Golden, M. R., Scholes, D. & Kerani, R. P. Assessing trends in chlamydia positivity and gonorrhea incidence and their associations with the incidence of pelvic inflammatory disease and ectopic pregnancy in Washington state, 1988–2010. Sex. Transm. Dis. 43, 2–8 (2016).

    Article  PubMed  Google Scholar 

  111. Brill, J. R. Diagnosis and treatment of urethritis in men. Am. Fam. Physician 81, 873–878 (2010).

    PubMed  Google Scholar 

  112. Centers for Disease Control. Sexually Transmitted Disease Surveillance 2019. CDC https://www.cdc.gov/std/statistics/2019/default.htm (2021).

  113. Centers for Disease Control. Sexually Transmitted Disease Surveillance 2018: Syphilis. CDC https://www.cdc.gov/std/stats18/STDSurveillance2018-full-report.pdf (2019).

  114. Bradley, H., Markowitz, L. E., Gibson, T. & McQuillan, G. M. Seroprevalence of herpes simplex virus types 1 and 2 — United States, 1999–2010. J. Infect. Dis. 209, 325–333 (2014).

    Article  PubMed  Google Scholar 

  115. Celum, C. et al. Daily oral tenofovir and emtricitabine-tenofovir preexposure prophylaxis reduces herpes simplex virus type 2 acquisition among heterosexual HIV-1-uninfected men and women: a subgroup analysis of a randomized trial. Ann. Intern. Med. 161, 11–19 (2014).

    Article  PubMed  Google Scholar 

  116. Zemouri, C. et al. The performance of the vaginal discharge syndromic management in treating vaginal and cervical infection: a systematic review and meta-analysis. PLoS ONE 11, e0163365 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  117. Stewart, J. & Stekler, J. D. How to incorporate HIV PrEP into your practice. J. Fam. Pract. 68, 254–261 (2019).

    PubMed  Google Scholar 

  118. Wood, B. R. et al. Knowledge, practices, and barriers to HIV preexposure prophylaxis prescribing among Washington state medical providers. Sex. Transm. Dis. 45, 452–458 (2018).

    Article  PubMed  Google Scholar 

  119. Siegler, A. J. et al. Developing and assessing the feasibility of a home-based preexposure prophylaxis monitoring and support program. Clin. Infect. Dis. 68, 501–504 (2019).

    Article  PubMed  Google Scholar 

  120. Gichangi, A. et al. Impact of HIV self-test distribution to male partners of ANC clients: results of a randomized controlled trial in Kenya. J. Acquir. Immune Defic. Syndr. 79, 467–473 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  121. Mulubwa, C. et al. Community based distribution of oral HIV self-testing kits in Zambia: a cluster-randomised trial nested in four HPTN 071 (PopART) intervention communities. Lancet HIV 6, e81–e92 (2019).

    Article  PubMed  Google Scholar 

  122. Ogale, Y., Yeh, P. T., Kennedy, C. E., Toskin, I. & Narasimhan, M. Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Glob. Health 4, e001349 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  123. Widdice, L. E. et al. Performance of the atlas genetics rapid test for chlamydia trachomatis and women’s attitudes toward point-of-care testing. Sex. Transm. Dis. 45, 723–727 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  124. WHO. Global health sector strategy on sexually transmitted infections 2016–2021 towards ending STIs. WHO Bulletin https://www.who.int/reproductivehealth/publications/rtis/ghss-stis/en/ (2021).

  125. Kissinger, P. et al. Effectiveness of patient delivered partner medication for preventing recurrent Chlamydia trachomatis. Sex. Transm. Infect. 74, 331–333 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  126. Golden, M. R. et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N. Engl. J. Med. 352, 676–685 (2005).

    Article  CAS  PubMed  Google Scholar 

  127. Otieno, F. O. et al. Evaluation of syndromic management of sexually transmitted infections within the Kisumu Incidence Cohort Study. Int. J. STD AIDS 25, 851–859 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  128. Verwijs, M. C. et al. Targeted point-of-care testing compared with syndromic management of urogenital infections in women (WISH): a cross-sectional screening and diagnostic accuracy study. Lancet Infect. Dis. 19, 658–669 (2019).

    Article  PubMed  Google Scholar 

  129. National AIDS & STI Control Program, Ministry of Health Kenya. Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV in Kenya. National AIDS & STI Control Program https://faces.ucsf.edu/sites/g/files/tkssra4711/f/Kenya-ARV-Guidelines-2018-Final_20thAug2018.pdf (2018).

  130. Van Der Pol, B. et al. Evaluation of the performance of a point-of-care test for chlamydia and gonorrhea. JAMA Netw. Open 3, e204819 (2020).

    Article  Google Scholar 

  131. Juneja, S., Gupta, A., Moon, S. & Resch, S. Projected savings through public health voluntary licences of HIV drugs negotiated by the Medicines Patent Pool (MPP). PLoS ONE 12, e0177770 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  132. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02720094 (2020).

  133. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03164564 (2020).

  134. Landovitz, R. J. et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N. Engl. J. Med. 385, 595–608 (2021).

    Article  CAS  PubMed  Google Scholar 

  135. National Institutes of Health. NIH study finds Long-Acting Injectable Drug Prevents HIV Acquisition in Cisgender Women. NIH https://www.nih.gov/news-events/news-releases/nih-study-finds-long-acting-injectable-drug-prevents-hiv-acquisition-cisgender-women (2020).

  136. WHO. WHO recommends the dapivirine vaginal ring as a new choice for HIV prevention for women at substantial risk of HIV infection. WHO https://www.who.int/news/item/26-01-2021-who-recommends-the-dapivirine-vaginal-ring-as-a-new-choice-for-hiv-prevention-for-women-at-substantial-risk-of-hiv-infection (2021).

  137. Sitruk-Ware, R., Nath, A. & Mishell, D. R. Jr Contraception technology: past, present and future. Contraception 87, 319–330 (2013).

    Article  PubMed  Google Scholar 

  138. Gottlieb, S. L. et al. Gonococcal vaccines: public health value and preferred product characteristics; report of a WHO global stakeholder consultation, January 2019. Vaccine 38, 4362–4373 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  139. Kenyon, C., Van Dijck, C. & Florence, E. Facing increased sexually transmitted infection incidence in HIV preexposure prophylaxis cohorts: what are the underlying determinants and what can be done? Curr. Opin. Infect. Dis. 33, 51–58 (2020).

    Article  PubMed  Google Scholar 

  140. Molina, J. M. et al. Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial. Lancet Infect. Dis. 18, 308–317 (2018).

    Article  CAS  PubMed  Google Scholar 

  141. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03980223 (2021).

  142. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT04050540 (2021).

  143. Petousis-Harris, H. et al. Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case-control study. Lancet 390, 1603–1610 (2017).

    Article  CAS  PubMed  Google Scholar 

  144. US National Library of Medicine ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03926728 (2021).

  145. Brenchley, J. M., Price, D. A. & Douek, D. C. HIV disease: fallout from a mucosal catastrophe? Nat. Immunol. 7, 235–239 (2006).

    Article  CAS  PubMed  Google Scholar 

  146. Deeks, S. et al. HIV infection. Nat. Rev. Dis. Prim. 1, 15035 (2015).

    Article  PubMed  Google Scholar 

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Acknowledgements

US National Institutes of Health (grants R01AI145971, P30AI027757, K23MH124466 and T32AI007044).

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Stewart, J., Baeten, J.M. HIV pre-exposure prophylaxis and sexually transmitted infections: intersection and opportunity. Nat Rev Urol 19, 7–15 (2022). https://doi.org/10.1038/s41585-021-00527-4

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