Background Pre-exposure prophylaxis (PrEP) is effective for preventing HIV transmission. Studies demonstrated high sexually transmitted infection (STI) incidence among men who have sex with men (MSM) using PrEP. We aim to identify risk factors associated with Gonorrhea infection among our PrEP cohort from 2013 to 2018.

Methods This retrospective cohort study of the PrEP cohort of Clinique médicale l’Actuel (Montreal, Canada) including MSM, ages ≥18, who consulted for PrEP from January 2013 to November 2018. We defined two groups: Gonorrhea infected (during 12 months after PrEP initiation) and non-infected. Cumulative incidence of Gonorrhea during 12 months after PrEP initiation was calculated. Behavioural risks characteristics (condom use, number of partners and history of STIs before PrEP) and Gonorrhea infection odds Ratio (OD) were compared between groups. Analyses were performed by using Stata 11.

Results Among 1159 patients who consulted for PrEP, 763 (66%) had a university degree, 540 (47%) an annual revenue higher than $55000 and the median age was 36 years (IQR: 29–44); 929 (80%) patients received daily baseline regimen. The Gonorrhea cumulative incidence was 18%. There’s no significant difference between groups, infected and non-infected respectively, in condomless anal sex (95% v. 93%, p=0.20) and mean number of sexual partner (19 vs 20, p=0.74). However, infected group reported history of STIs superior than non-infected (84% vs 75%, p=0.006), translating to a Gonorrhea infection risk (OR: 1.77, 95%CI: 1.18–2.64, adjusted by age, condomless anal sex and number of sexual partner).

Conclusion We found Gonorrhea infection among PrEP users was significantly associated with history of STIs. PrEP reaches high-risk individuals with STIs. Our results indicate the need for support which takes into consideration contextual lifestyle. The 3-month follow-up of patients on PrEP is a great opportunity to test and treat them frequently and to provide adequate and regular counseling.

Disclosure No significant relationships.