Purpose of Review

This article reviews current efforts to control bacterial sexually transmitted infections (STIs) among HIV pre-exposure prophylaxis (PrEP) users and outlines the opportunities and challenges to controlling STIs within HIV PrEP programs.

Recent Findings

The incidence of STIs continues to rise globally especially among HIV PrEP users, with an estimated 1 in 4 PrEP users having a curable bacterial STI. STIs and HIV comprise a syndemic needing dual interventions. The majority of STIs are asymptomatic, and when testing is available, many STIs occur in extragenital sites that are missed when relying on urine testing or genital swabs. Optimal testing and treatment, including testing for antimicrobial resistance, pose difficulties in high income countries and is essentially non-existent in most low- and middle-income countries. Novel STI primary prevention strategies, like doxycycline post-exposure prophylaxis (PEP) for STI prevention, have proven to be highly efficacious in some populations. A few jurisdictions have issued normative guidelines and position statements for doxycycline PEP; however, clinical standards for implementation and data on public health impact are limited.

Summary

STI incidence rates are high and rising in sexually active populations. Sexual health programs should leverage the expansion of HIV PrEP delivery services to integrate STI testing, surveillance, and novel STI prevention services.

中文翻译：

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HIV 和性传播感染预防时代控制性传播感染的挑战和解决方案

审查目的

本文回顾了当前在 HIV 暴露前预防 (PrEP) 使用者中控制细菌性传播感染 (STI) 的努力，并概述了在 HIV PrEP 计划中控制 STI 的机遇和挑战。

最近的发现

全球性传播感染的发病率持续上升，特别是在 HIV PrEP 使用者中，估计四分之一的 PrEP 使用者患有可治愈的细菌性性传播感染。性传播感染和艾滋病毒是一种需要双重干预的综合征。大多数性传播感染是无症状的，当可以进行检测时，许多性传播感染发生在依靠尿液检测或生殖器拭子检测时会被漏掉的生殖器外部位。最佳检测和治疗，包括抗菌素耐药性检测，在高收入国家造成困难，而在大多数低收入和中等收入国家基本上不存在。新型性传播感染一级预防策略，例如用于预防性传播感染的强力霉素暴露后预防（PEP），已被证明在某些人群中非常有效。一些司法管辖区发布了强力霉素 PEP 的规范指南和立场声明；然而，实施的临床标准和公共卫生影响的数据有限。

概括

性传播感染的发病率很高，并且在性活跃人群中呈上升趋势。性健康规划应利用扩大 HIV PrEP 提供服务的机会，整合性传播感染检测、监测和新型性传播感染预防服务。