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The authors impute a biological mechanism to the high incidence of syphilis in men who have sex with men using antiretroviral pre-exposure prophylaxis (PrEP), when empiric data do not support the biological hypothesis, and behavioural explanations (ie, increased condomless sex and selection of higher risk partners) are supported by stronger evidence. Randomised double-blind trials of PrEP for HIV prevention1 provide a rigorous test of the author's hypothesis. The …
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