Department of Medicine, University of Washington, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
Nat Rev Urol. 2022 Jan;19(1):7-15. doi: 10.1038/s41585-021-00527-4. Epub 2021 Oct 25.
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.
暴露前预防 (PrEP) 彻底改变了 HIV 的预防方式，但它并不能预防其他性传播感染 (STI)。全球范围内的 STI 发病率正在上升，在高收入国家使用 PrEP 的男男性行为者中发病率尤其高；在低收入和中等收入国家，数据稀缺，但从少数针对开始使用和正在使用 PrEP 的非洲女性的研究结果来看，STI 的患病率和发病率很高。旨在大幅减少全球人群中 HIV 感染的努力包括重点关注增加 PrEP 的使用，同时改善 HIV 检测和治疗，以消除 HIV 传播。这些努力可以极大地促进全球 STI 疫情的持续扩大，但也可以为改善 STI 控制提供机会，包括制定全面的性健康方案和研究开发新的 STI 预防策略。PrEP 在全球范围内的推出具有挑战性和诸多成功，其作为减少 HIV 感染的一系列强有力策略的一部分的作用是明确的。展望未来，了解可治愈性 STI 的上升率及其与 HIV 预防的关系，并考虑 PrEP 和 STI 预防协同作用的未来方向，对于改善性健康至关重要。
