Are higher STD rates among MSM an unavoidable consequence of increased PrEP use?
Click here to read the Cover Story, “Ending STD epidemic in MSM requires ‘the action of many’.”
Rates of sexually transmitted diseases in the United States continue to rise year after year, a trend that has disproportionately affected men who have sex with men.
Infectious Disease News asked its Chief Medical Editor Paul A. Volberding, MD, a professor of medicine and director of the AIDS Research Institute at the University of California, San Francisco, if higher STD rates are an unavoidable consequence of increased PrEP use.
The rate of STDs among men who have sex with men (MSM) has increased substantially in recent years. One common concern is that this may somehow be associated with the increase in PrEP use over the same time frame. Although PrEP use is not closely linked to increases in sexual contacts among MSM, it does seem reasonable to speculate that condom use may be reduced among PrEP users and that this may be, at least partly responsible, for the trend.
As the cover story in this issue of Infectious Disease News outlines, the question of PrEP and increases in STDs in this group is a complex one — and understanding it in its complexity is vital because interventions may vary widely as a result. Better epidemiological studies could tell us, for example, if we are simply finding more cases of STDs among PrEP users because they are linked to the health care system, where STD screening is increased. If the association is due to decreased condom use, however, the most effective response might be to double down on educational approaches that increase awareness of the benefits of barrier protection and of the adverse consequences of these infections, which is especially important as drug resistance to STDs continues to rise.
We have powerful tools to decrease HIV transmission, including treatment as prevention as well as PrEP. It is important in considering this issue to keep promoting awareness and use of these tools. We absolutely have to work much harder to better understand the challenges in STD prevention, but at least one STD, HIV infection itself, has come under much more effective control in recent years.
Even with all the other huge challenges we face in a world dominated by the SARS-CoV-2 pandemic, we need to remain attentive to our broader public health responsibilities. Those certainly include improving our efforts to reduce STDs in the heavily affected community of MSM.
Disclosure: Volberding reports serving on a data and safety monitoring board for Merck.