National Infection Service, Public Health England, London, UK
National Infection Service, Public Health England, London, UK.
Sex Transm Infect. 2021 Sep;97(6):429-433. doi: 10.1136/sextrans-2020-054592. Epub 2020 Oct 20.
The use of antibiotics as pre-exposure or postexposure prophylaxis for sexually transmitted infection (STI) prevention (STI prophylaxis) is not currently recommended in the UK, but there is evidence that self-prescribing occurs among those at greatest risk. We present the prevalence and factors associated with STI prophylaxis among a community sample of HIV pre-exposure prophylaxis (PrEP) users.
The 2019 online PrEP User Survey ran between 17 May and 1 July. Eligible participants included UK residents reporting HIV PrEP use or having tried to obtain HIV PrEP since January 2017. STI prophylaxis use was defined as reporting buying antibiotics to prevent STIs, either privately or through the internet; this question was only asked to HIV PrEP users. Factors associated with STI prophylaxis use were assessed using univariable and multivariable logistic regression.
Overall, 9% (167/1856) of HIV PrEP users reported STI prophylaxis use; 97% were gay or bisexual men, 84% reported white ethnicity, 55% resided in London and 69% were aged ≥35 years. Factors associated with STI prophylaxis included: reporting ≥5 compared with 1-4 condomless sex partners in the past 6 months (12% vs 5.6%, adjusted odds ratio (aOR)=1.80; 95% CI 1.22 to 2.64), reporting chemsex drug use compared with no sexualised drug use in the past 12 months (13% vs 6.0%, aOR=1.88; 95% CI 1.20 to 2.93) and reporting an STI diagnosis in the past 12 months (12% vs 6.6%, aOR=1.54; 95% CI 1.08 to 2.18). Variables not significant in multivariable analyses included: ethnicity, age, residence and HIV PrEP sourcing.
Approximately 1 in 10 HIV PrEP users from this community sample reported self-prescribed STI prophylaxis. STI prophylaxis was associated with sexual behaviour known to facilitate STI transmission and with a history of recent STIs acquisition. Given the potential risk of antimicrobial resistance, sexual health clinicians should consider asking attendees, especially HIV PrEP users, about the use of antibiotics as STI prophylaxis, to inform appropriate counselling, testing and management.
在英国，不建议将抗生素作为性传播感染（STI）预防的暴露前或暴露后预防（STI 预防），但有证据表明，高危人群存在自行开药的情况。我们在社区人群 HIV 暴露前预防（PrEP）使用者中报告了 STI 预防的流行情况和相关因素。
2019 年在线 PrEP 用户调查于 5 月 17 日至 7 月 1 日进行。符合条件的参与者包括报告自 2017 年 1 月以来使用 HIV PrEP 或试图获得 HIV PrEP 的英国居民。STI 预防用药的定义为报告购买抗生素预防 STIs，无论是私人购买还是通过互联网购买；这个问题只询问了 HIV PrEP 用户。使用单变量和多变量逻辑回归评估了 STI 预防用药相关因素。
总体而言，9%（167/1856）的 HIV PrEP 用户报告使用了 STI 预防用药；97%为男同性恋或双性恋男性，84%报告为白人，55%居住在伦敦，69%年龄≥35 岁。与 STI 预防用药相关的因素包括：报告过去 6 个月内有≥5 次而不是 1-4 次无保护性行为的性伴侣（12%比 5.6%，调整后的优势比（aOR）=1.80；95%CI 1.22 至 2.64），报告过去 12 个月内有化学性交药物使用而不是没有性药物使用（13%比 6.0%，aOR=1.88；95%CI 1.20 至 2.93）和报告过去 12 个月内有性传播感染（STI）诊断（12%比 6.6%，aOR=1.54；95%CI 1.08 至 2.18）。多变量分析中无统计学意义的变量包括：种族、年龄、居住地和 HIV PrEP 来源。
从这个社区样本中，约有 10%的 HIV PrEP 用户报告自行开具 STI 预防药物。STI 预防用药与已知促进 STI 传播的性行为以及最近获得性传播感染的病史有关。鉴于抗生素耐药性的潜在风险，性健康临床医生应考虑询问患者，尤其是 HIV PrEP 用户，是否使用抗生素作为 STI 预防用药，以提供适当的咨询、检测和管理。
