Department for Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany.
Checkpoint BLN, Berlin, Germany.
BMC Public Health. 2023 Apr 7;23(1):661. doi: 10.1186/s12889-023-15570-6.
BACKGROUND: The impact of starting HIV pre-exposure prophylaxis (PrEP) on diagnoses of sexually transmitted infections (STI) remains unclear. We used data from German HIV/STI Checkpoints collected from 01/2019 to 08/2021 to determine the impact of PrEP use on syphilis, gonorrhoea and chlamydia diagnoses. METHODS: We used self-reported data on demographics, sexual behaviour, testing and PrEP use, as well as lab-confirmed diagnoses from visits to HIV/STI Checkpoints in Germany. PrEP use was categorized as (1) never used; (2) intention to use; (3) former use; (4) current on-demand use; (5) daily use. In multivariate regression analyses (MRA) with gonorrhoea, chlamydia, and syphilis diagnoses as outcomes, we controlled for age, number of sexual partners, number of condomless anal intercourse (CAI) partners in the last six months, and testing recency. RESULTS: For the analysis, we included 9,219 visits for gonorrhoea and chlamydia testing and 11,199 visits for syphilis testing conducted at checkpoints from 01/2019 to 08/2021. MRA identified age (aOR 0.98; 95%CI 0.97-0.99), number of sexual partners in the past six months (aOR 4.90; 95%CI 2.53-9.52 for 11 + partners), and use of chemsex substances (aOR 1.62; 95%CI 1.32-2.00) as risk factors for gonorrhoea, while age (aOR 0.99; 95%CI 0.98-1.00), number of CAI partners (aOR 3.19; 95%CI 2.32-4.41 for 5 + partners), partner sorting (aOR 1.30; 95%CI 1.09-1.54), and use of chemsex substances (aOR 1.29; 95%CI 1.05-1.59) were risk factors for chlamydia infections. For syphilis, the number of CAI partners (aOR 3.19; 95%CI 1.60-6.34 for 5 + partners) was found to be the only significant risk factor. There was a strong association between PrEP use and the number of sexual partners (≤ 5 vs.>5: aOR 3.58; 95%CI 2.15-5.97 for daily PrEP use), the number of CAI partners in the past six months (≤ 1 vs.>1: aOR 3.70; 95%CI 2.15-6.37 for daily PrEP use), and the number of STI tests performed (suggesting higher testing frequency). Both outcomes were also related to partner sorting, chemsex, and selling sex. CONCLUSIONS: Checkpoint visits reporting current PrEP use or intention to start PrEP correlated with eligibility criteria for PrEP, i.e. high partner numbers, inconsistent condom use during anal intercourse, and use of chemsex drugs. Use of HIV-specific prevention methods such as HIV serosorting, PrEP sorting, and viral load sorting was reported more frequently. (Daily) PrEP use was an independent risk factor for a chlamydia diagnosis only.
背景：开始使用 HIV 暴露前预防 (PrEP) 对性传播感染 (STI) 的诊断的影响仍不清楚。我们使用了德国 HIV/STI 检测点从 2019 年 1 月至 2021 年 8 月收集的数据，以确定 PrEP 使用对梅毒、淋病和衣原体诊断的影响。
方法：我们使用了自我报告的数据，包括人口统计学、性行为、检测和 PrEP 使用情况，以及德国 HIV/STI 检测点就诊时的实验室确诊诊断。PrEP 使用情况分为 (1) 从未使用；(2) 打算使用；(3) 曾经使用；(4) 按需使用；(5) 每日使用。在以淋病、衣原体和梅毒诊断为结果的多变量回归分析 (MRA) 中，我们控制了年龄、性伴侣数量、过去六个月无保护肛交 (CAI) 伴侣数量和检测时间。
结果：在分析中，我们包括了 2019 年 1 月至 2021 年 8 月期间在检测点进行的淋病和衣原体检测的 9219 次就诊，以及梅毒检测的 11199 次就诊。MRA 确定了年龄 (aOR 0.98；95%CI 0.97-0.99)、过去六个月的性伴侣数量 (aOR 4.90；95%CI 2.53-9.52，伴侣数量≥11) 和使用化学性行为物质 (aOR 1.62；95%CI 1.32-2.00) 是淋病的危险因素，而年龄 (aOR 0.99；95%CI 0.98-1.00)、CAI 伴侣数量 (aOR 3.19；95%CI 2.32-4.41，伴侣数量≥5)、伴侣排序 (aOR 1.30；95%CI 1.09-1.54) 和使用化学性行为物质 (aOR 1.29；95%CI 1.05-1.59) 是衣原体感染的危险因素。对于梅毒，CAI 伴侣数量 (aOR 3.19；95%CI 1.60-6.34，伴侣数量≥5) 是唯一显著的危险因素。PrEP 使用与性伴侣数量 (≤5 vs. >5：每日 PrEP 使用的 aOR 3.58；95%CI 2.15-5.97)、过去六个月 CAI 伴侣数量 (≤1 vs. >1：每日 PrEP 使用的 aOR 3.70；95%CI 2.15-6.37) 和进行的性传播感染检测数量 (表明检测频率更高) 之间存在很强的关联。这两个结果也与伴侣排序、化学性行为和卖性有关。
结论：报告当前 PrEP 使用或打算开始 PrEP 使用的检测点就诊与 PrEP 的资格标准相关，即性伴侣数量高、肛交时不经常使用安全套和使用化学性行为药物。更频繁地报告使用艾滋病毒特定预防方法，如艾滋病毒血清学排序、PrEP 排序和病毒载量排序。(每日)PrEP 使用仅是衣原体诊断的一个独立危险因素。
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