Background Sexually-transmitted infections (STIs) increase the risk of infertility and HIV acquisition. Data on STIs in low and middle income countries (LMIC) are sparse because of syndromic management and lack of testing. PrEP projects which test for STIs provide key epidemiologic data, identify gaps, and should guide policies.
Methods PrEP projects are reaching populations at risk of HIV in LMIC, including adolescent girls and young women (AGYW), heterosexual HIV serodiscordant couples, and men who have sex with men. STI data from different populations and geographies will be reviewed, and research and intervention gaps will be discussed.
Results Among African AGYW in PrEP projects, the prevalence of Chlamydia trachomatis (CT) and/or Neisseria gonorrhoea (GC) is 30%, most of which is asymptomatic, syphilis is <1%, and annual incidence of CT is 30% and GC is 10%, most of which are new infections. Among African heterosexual HIV serodiscordant couples in PrEP studies, the prevalence of CT is 10%, trichomonas is 7%, GC is 6%, and syphilis is <1%. STI prevalence among African men who have sex with men (MSM) are more sparse, but indicate high prevalence of GC, CT, and syphilis.
Conclusion The prevalence of curable bacterial STIs is high in PrEP projects among diverse populations in LMIC, most of which are missed by syndromic STI management. STI services are an important reproductive sexual health intervention, are valued by clients, and increase the public health impact of PrEP. Interventions to lower the costs of STI diagnostic assays, point of care tests, and treatment of partners are needed. Innovative STI prevention strategies should be evaluated, including doxycycline post-exposure prophylaxis and vaccines. STI testing, treatment, and partner services should be integrated into PrEP, medical male circumcision, antenatal care, and HIV care and prevention programs which reach sexually-active persons in LMIC.
Disclosure No significant relationships.
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