PrEP use and risk of sexually transmitted infections among U.S. college students.

OBJECTIVES

To examine how HIV pre-exposure prophylaxis (PrEP) relates to sexually transmitted infection (STI) diagnoses and sexual behaviors among U.S. college students.

METHODS

We analyzed four waves (2021-2023) of the National College Health Assessment (N = 164,577). Outcomes were self-reported diagnoses of multiple STIs, and sexual behavior measures included the number of sexual partners and condomless sex while drinking. Multivariable regressions adjusted for demographics, campus size, region, and survey wave.

RESULTS

PrEP users reported a higher prevalence of multiple STIs than nonusers, along with more condomless sex and more sexual partners. Associations appeared among both heterosexual and LGBTQ+ students, with larger differences in the latter group.

CONCLUSION

PrEP use was associated with higher STI prevalence and behavioral patterns that increase exposure risk. Integrating PrEP delivery with routine STI screening, safer sex counseling, and condom access is essential to maximize its preventive benefits while minimizing unintended harms.