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. In this Review, Stewart and Baeten discuss the successes and challenges of pre-exposure prophylaxis to date, its place as part of robust strategies to reduce HIV infections, the rising rates of curable sexually transmitted diseases and their relationship with HIV prevention, and future directions for synergies in pre-exposure prophylaxis and sexually transmitted disease prevention. 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. 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.