• DRUG MISUSE
• POSTEXPOSURE PROPHYLAXIS (HIV)
• MEN

Sexualised recreational drug use or chemsex is associated with an increase in sexual risk-taking behaviours in men who have sex with men (MSM).1 Chemsex is associated with group sex and multiple sexual partners, serodiscordant condomless sex and STI transmission.1–3 Chemsex is, therefore, an important public health issue among MSM and may result in an increase in HIV-negative men attending for postexposure prophylaxis for sexual exposure (PEPSE). As part of a local audit into recreational drug history taking in MSM PESPE attendees, we evaluated self-reported sexualised recreational drug use in 2013/2014 as compared with 2015. Local standards are to take detailed recreational drug histories from all (100%) of MSM accessing PEPSE.

We reviewed anonymised electronic case notes of MSM attending for PEPSE at the sexual health service in Brighton during two 4-month periods: November 2013 to February 2014 and March 2015 to June 2015. One hundred and fifty-two MSM attended for PEPSE: 51 in the 2013–2014 period and 101 in the 2015 period. The median age of attendees was 31 years (IQR 25–41 years). Documentation of recreational drug use during the PEPSE episodes increased significantly from 27/51(53%) in the 2013–2014 period to 100/101(99%) during the 2015 period (p<0.001). Reported drug use during PEPSE episode increased significantly from 9/51(18%) in the 2013–2015 period to 41/101(41%) in the 2015 period (OR 3.19, p<0.005). There were no significant changes in the types of drugs being used: gamma-butyrolactone (GBL), Mephedrone and Crystal Meth being the most frequent reported.

Episodes of condomless anal sex in MSM leading to increased attendances for PEPSE appear to be increasingly associated with the use of GBL, Mephedrone and crystal meth. Incident HIV infection and other STIs in MSM are increasing in the UK, and it is vital that we identify high-risk MSM to enable interventions to reduce STI transmission in this group.4 New PEPSE consultations are an ideal opportunity to identify those at risk. It is imperative to take a detailed drug history including chemsex and offer evidence-based interventions to reduce transmission of STIs and other associated poor health outcomes.