Infectious Disease AdvisorHigher STI Prevalence Linked to HIV PrEP Use in MSM

ℹ️ Observational Association Only Evidence
The BRAHMS study followed HIV-negative MSM aged 18-55 across 10 German sites between 2018 and 2021. Patients underwent quarterly testing for chlamydia, M. genitalium, gonorrhea, trichomoniasis, syphilis, and HIV alongside structured counseling and condom provision.

Clinical Considerations

• PrEP use was an independent predictor of STI acquisition (OR 1.29; 95% CI, 1.05-1.58) after adjusting for sexual behavior.
• C. trachomatis was most common (40.4%), followed by M. genitalium (38.5%) and N. gonorrhoeae (36.0%); coinfections were frequent.
• Only 14.4% of positive visits involved STI-related symptoms, reinforcing that screening cannot rely on symptom presentation.
• Structured quarterly testing and counseling reduced N. gonorrhoeae by 26.2% and trended toward lower chlamydia rates over the study period.

Practice Applications:

• Integrate quarterly multi-site STI screening (oral, anal, urogenital) into PrEP follow-up visits.
• Recognize that asymptomatic infection is the norm, not the exception, in this population.
• Consider coinfection patterns when selecting empiric antibiotics to limit antimicrobial resistance.
• Counsel PrEP patients on condom use and partner notification at every visit, not just at initiation.