Sexually Transmitted Infections in the PReP Era. Are Family Doctors Ready to Give Advice?

Carmen Rodríguez Cerdeira,Sánchez Blanco E,Sánchez Blanco B,Carnero Gregorio M

doi:10.2174/1874372201711010035

Abstract

Background:Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) as a method of HIV prevention is not without controversy, and there has been concern that it may lead its users to think that they no longer need other preventive measures such as condoms. Thus, healthcare providers are convinced that PrEP decreases condom use and increases sexually transmitted infections (STIs). This treatment has been studied in men who have sex with men, men and women in heterosexual HIV-discordant couples, and heterosexual men and women.Objective:The objective of this study was to review the current state of evidence on the association of PrEP with condom use, the incidence of STIs, and the change in sexual behaviours in populations with risky practices.Materials and Methods:PubMed (National Center for Biotechnology Information, Bethesda, MD, USA), Science Direct (Elsevier Ltd., Oxford, UK), and Google Scholar (Google Inc., Mountain View, CA, USA) search engines were used during the study. We used the terms HIV, PrEP, sexually transmitted infections (STIs), MSM, condom, heterosexual men / women to search the databases.Results:Here, we present evidence that daily oral treatment is safe and effective in these populations studied, especially when medication adherence is high. STI testing should include extra-genital testing regardless of PrEP use to prevent health deficits and onward transmission.Conclusion:Despite this safety and efficacy, we strongly advise that patients continue to use condoms as a prophylactic measure against other sexually transmitted diseases. This update addresses the benefits and precautions that must be taken when establishing PrEP treatment, focusing mainly on family doctorswho are best positioned to provide follow-up and advice to patients and their relatives.

Highlights

Infection with the human immunodeficiency virus (HIV) continues to be a major sanitary, social, economic, and human health problem in the world
MATERIAL AND METHODS We carried out a comprehensive search of the Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), and Embase databases for articles published from March 2010 to March 2016, using the following search terms: VIH, pre-exposure prophylaxis (PrEP), sexually transmitted infections, syphilis, gonorrhea, chlamydia, and vulvovaginitis
Clinical trials and observational studies have shown that Pre-exposure prophylaxis (PrEP) with FTC/TDF has great benefitin preventing HIV transmission, though the efficacy is highly dependent on adherence to the prescribed regimen

Summary

Introduction

Infection with the human immunodeficiency virus (HIV) continues to be a major sanitary, social, economic, and human health problem in the world. The use of antiretroviral drugs to prevent HIV infection in at-risk, uninfected individuals was initially based on efficacy demonstrated in animal models. The implementation of this strategy must be based on the scientific evidence provided by controlled clinical trials. In these trials, it is essential to pay attention to both the efficacy and the safety of a preventive intervention directed at a healthy population [2].The FDA recently approved the HIV antiretroviral drug emtricitabine/tenofovirdisoproxilfumarate as PrEP therapy for adults at high risk for sexually-acquired HIV infection [2]. This treatment has been studied in men who have sex with men, men and women in heterosexual HIV-discordant couples, and heterosexual men and women

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Results

Conclusion