Open forum infectious diseases · 2026
Sexually Transmitted Infections Among Men Who Have Sex With Men Using Daily and Event-Driven HIV Pre-Exposure Prophylaxis: A Retrospective Cohort Study.
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Wijekoon Danushi, Aung Ei T, Latt Phyu Mon, Buchanan Andrew, Soe Nyi Nyi, Chow Eric P F
Аннотация
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) has reduced HIV incidence among men who have sex with men (MSM), but bacterial sexually transmitted infections (STIs) remain common, with limited data comparing regimens.
METHODS: A retrospective cohort study was conducted at Melbourne Sexual Health Centre, Australia (2024-2025). MSM aged ≥18 reporting PrEP use (daily, event-driven, or switching) who were tested for chlamydia, gonorrhea, or syphilis were included. Positivity was assessed at first consultation (baseline); incidence was assessed among those with ≥2 tests ≥30 days apart. Logistic and Poisson regression estimated associations and incidence rate ratios.
RESULTS: Among 3229 PrEP users (median age 33, IQR 29-39), 51.0% were daily, 43.2% event-driven, and 5.8% switchers. At baseline, 33.7% (765/2268) had any STI, with lower positivity among event-driven users (29.8%) than daily users (37.0%) or switchers (37.6%; P = .001), primarily driven by differences in gonorrhea positivity. After adjustment, event-driven PrEP use was independently associated with lower odds of baseline STI positivity (aOR 0.75, 95% CI 0.62-0.90), while Medicare ineligibility and recent partners had higher odds. Over 700.6 person-years, any-STI incidence (39.4/100 person-years) did not differ across regimens.
CONCLUSIONS: Although event-driven users had lower baseline STI positivity, incidence was similar across regimens, suggesting baseline differences reflect underlying risk profiles rather than ongoing risk.
METHODS: A retrospective cohort study was conducted at Melbourne Sexual Health Centre, Australia (2024-2025). MSM aged ≥18 reporting PrEP use (daily, event-driven, or switching) who were tested for chlamydia, gonorrhea, or syphilis were included. Positivity was assessed at first consultation (baseline); incidence was assessed among those with ≥2 tests ≥30 days apart. Logistic and Poisson regression estimated associations and incidence rate ratios.
RESULTS: Among 3229 PrEP users (median age 33, IQR 29-39), 51.0% were daily, 43.2% event-driven, and 5.8% switchers. At baseline, 33.7% (765/2268) had any STI, with lower positivity among event-driven users (29.8%) than daily users (37.0%) or switchers (37.6%; P = .001), primarily driven by differences in gonorrhea positivity. After adjustment, event-driven PrEP use was independently associated with lower odds of baseline STI positivity (aOR 0.75, 95% CI 0.62-0.90), while Medicare ineligibility and recent partners had higher odds. Over 700.6 person-years, any-STI incidence (39.4/100 person-years) did not differ across regimens.
CONCLUSIONS: Although event-driven users had lower baseline STI positivity, incidence was similar across regimens, suggesting baseline differences reflect underlying risk profiles rather than ongoing risk.