Many MSM who are taking PrEP in the U.S. are not consistently screened for STIs as recommended by Centers for Disease Control and Prevention guidelines, a study published in Clinical Infectious Diseases found.
The findings derive from an analysis of survey data from the ARTnet study, which included 3,259 HIV-negative, PrEP-eligible MSM. During the study period (2017-2019), 19% of participants said they were taking biomedical HIV prevention and 6% said they had previously taken it.
Per CDC guidelines, comprehensive STI screenings are recommended every three to six months for MSM taking PrEP. Among study participants who had ever taken PrEP, consistent screening for STIs varied widely depending on the sampling method: Screening rates were especially low for rectal swabs (57%) and pharyngeal swabs (64%), while they were higher for urine samples (78%) and blood samples (87%).
Rates were especially low among respondents living in the U.S. Southeast, where seven of 12 states have not expanded Medicaid. The study authors noted that even when the costs of PrEP itself are covered, ancillary services, such as STI screenings, may not be; thus, cost may be another barrier to STI testing.
“Infrequent extragenital screening is a public health concern because of the higher prevalence of asymptomatic chlamydia or gonorrhea infections that may remain undetected,” study authors commented. Self-collected swabs or at-home testing may improve rates, they said.
Even as this study highlights relatively poor follow-through on existing STI testing guidelines, a separate study we highlighted several weeks ago in This Week in HIV Research suggested that the guidelines themselves may not be aggressive enough: It found that screening for STIs every three months rather than the current three-to-six month recommendation could further reduce STI incidence rates.