PEP for men who have sex with men

[Guest guest]

[Moderators note: While we discuss about, some of the basic policy

issues related to PEP in India, it may be of interest to see some

of the global literature on this subject. Non-occupational HIV post-

exposure prophylaxis (NPEP) is routinely prescribed after high-risk

sexual exposure among men who have sex with men in Australia. Health

care providers use this chance to test and treat patients who are at

risk of concurrent sexually transmitted infections (STIs) as well.

It is intesting to note that in this seeting the health care

providers concern was NOT `to be or not to be' . But, what other

additional services could be offered as well, along with PEP]

________________

Is screening for sexually transmitted infections in men who have sex

with men who receive non-occupational HIV post-exposure prophylaxis

worthwhile?

E Hamlyn1, J McAllister1, A Winston1,2, B Sinclair1, J Amin2, A

Carr1 and D A 1,2

1 HIV, Immunology and Infectious Diseases Clinical Services Unit, St

's Hospital, Sydney, 2010, Australia. 2 National Centre for

HIV Epidemiology and Clinical Research, University for New South

Wales, Sydney, 2010, Australia. Correspondence to: Dr

Hamlyn. HIV, Immunology and Infectious Diseases Clinical Services

Unit, St 's Hospital, Street, Sydney, 2010,

Australia; liz_hamlyn@...

Background/aims: Non-occupational HIV post-exposure prophylaxis

(NPEP) is routinely prescribed after high risk sexual exposure. This

provides an opportunity to screen and treat individuals at risk of

concurrent sexually transmitted infections (STI). The aim of this

study was to assess the efficacy of an STI screening programme in

individuals receiving NPEP.

Methods: STI screens were offered to all individuals receiving NPEP

from March 2001 to May 2004. Screen results were compared to type of

sexual exposure and baseline patient characteristics.

Results: A total of 253 subjects were screened, representing 85% of

the target population. All were men who have sex with men (MSM).

Common exposure risks were receptive anal intercourse (RAI) in 61%

and insertive anal intercourse (IAI) in 33%. 32 (13%) individuals

had one or more STI. The most common STIs were rectal infections

with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in 11

(4.5%) and six (2.5%) individuals, respectively. Subjects with

rectal CT were significantly more likely to be co-infected with

rectal NG (p<0.001). There was no association between the presence

of a rectal STI and age or exposure risk. Only six (19%) individuals

with an STI were symptomatic at screening.

Conclusion: In this cohort of MSM receiving NPEP, high rates of

concomitant STIs are observed highlighting the importance of STI

screening in this setting.

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Abbreviations: CT, Chlamydia trachomatis; IAI, insertive anal

intercourse; MSM, men who have sex with men; NG, Neisseria

gonorrhoeae; NPEP, non-occupational HIV post-exposure prophylaxis;

RAI, receptive anal intercourse; RPR, rapid plasma reagent; STI,

sexually transmitted infections

Keywords: HIV post-exposure prophylaxis; sexually transmitted

infections; screening.