Routine STI Testing Critical for PrEP Users?

Are the Centers for Disease Control and Prevention's current guidelines — which recommend testing patients for sexually transmitted infections only if they show symptoms — missing over 75 percent of those STIs? 

That's what a new study by Sarit Golub, Director at Hunter HIV/AIDS Research Team (HART) in New York, suggests.  

The results were announced at the annual Conference on Retroviruses and Opportunistic Infections (CROI). The HART study examined STI data from users of PrEP who participated in the SPARK program. Funded by the National Institutes of Health (NIH), SPARK was developed to help people decide if PrEP is right for them, and to provide care for those who want it.

The study of STI rates among SPARK participants found that 21 percent of those who chose PrEP had experienced STIs within the six months prior to starting PrEP. After being on PrEP, 13 percent were found to have a new STI at their three-month follow up appointment and 15 percent had new STIs at at their nine-month follow up.

The decrease in the number of new STIs following their uptake of PrEP was noteworthy, but two other findings from the study may have greater consequences.  The first was that over 75 percent of those who were found to have a new STI at nine months had also tested positive for an STI at three months; the STI was treated each time.

More importantly, 77 percent of the STIs found at three months, and 68 percent of the STIs found at nine months would have been missed if health care providers had followed the CDC's current recommended guidelines on when to test. That's because the majority of these STIs were found during routine screening rather than after the patient noticed he or she had symptoms.

Golub urged the CDC to update its guidelines and make screening for STIs a routine part of PrEP care.  She noted the importance of doing so now, in the inital phase of PrEP roll out, rather than trying to change behaviors after most clinicians and healthcare providers have begun widely prescribing and monitoring PrEP usage.