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Health: STIs on the Rise among PrEP Users 

(Photo Credits: NIAID, CC BY 2.0)

A recent study confirmed that pre-exposure prophylaxis (PrEP)—when taken daily—reduces HIV transmission risk up to 99%. However, it also revealed that participants are “72% more likely to acquire a sexually transmitted infection (STI) than they were before starting PrEP,” HIV Equal Online Magazine reports.

The 12-month long study was conducted in an LGBTQ health clinic in Montreal, Canada to determine the incidence of STIs such as “chlamydia, gonorrhea, syphilis, and hepatitis C virus before and after PrEP; and for PrEP versus (postexposure prophylaxis ) PEP users.” A total of 195 gay and bisexual men participated in the study, 109 of them were on PrEP while the rest (86) were PEP users.

Results showed that after starting PrEP, the incidence rate of anal chlamydia infection alone had “more than doubled” during the time of study as compared to “before PrEP.” Increased rates of gonorrhea and syphilis were observed as well, but to a “less significant degree.” Morever, during the course of study, 30% of PrEP users were found to have acquired one STI, 12% contracted two STIs, and 9% were infected with three or more STIs.” Lastly, the study also found that PrEP users were significantly more likely to contract an STI as compared to those taking PEP.

Why does this happen?

Experts theorized that PrEP users, because of the decrease on perceived risk of acquiring HIV, may have engaged in “riskier sexual practices” which therefore increased their chances of contracting STIs. Risky sexual behavior means engaging in unprotected sex, having multiple sex partners, drug use, having a high-risk partner to name a few.

Adam4Adam users who think they may have engaged in risky sex this Pride season may find free, fast, and confidential testing centers in your area for STIs (chlamydia, gonorrhea, syphilis, hepatitis C, etc.) through this website.

Thoughts? Share it with us in the comments section below.

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    • catsmeow

      what would you like them to say? there was a topic solely on undetectable recently.
      this subject doesnt need to discuss undetectable

  1. Dylan

    CDC should have never released the fact PrEP worked so well. The condoms came off quickly and the rest of the diseases not effected by PrEP still remained. You didn’t need to be a doc to figure this one out. I’ve met ppl who were will to go get a shot from the doc and stay on PrEP and rush all of the other viruses/diseases out there.

  2. FL

    I’m SO FUCKING TIRED of reading posts on this blog that cite statistical data and writes in a way that sounds like it’s causation rather than correlation!!!

    It’s reasonable to believe that many readers of this and other posts believe that people who take PrEP are more likely to catch an STI simply BECAUSE of the fact that they’re on PrEP. And it’s ethically wrong to misuse the researcher(s)’s data and mislead the reader.

    Just because another, (possibly) more credible source says it doesn’t make it true. In the case of the line quoted here by HIV Equal Online Magazine, that sounds exactly like PrEP users are more likely to catch an STI. And while they may sound accurate at first read, it’s illogical!!!

    In actually, what’s happening is that among the increased rates of STIs, a high portion of those people are on PrEP. That is vastly different than leading the reader to believe that taking PrEP leaves them with an increased risk of catching an STI.

    Yes, it may be splitting hairs. But the average reader is going to have neither the knowledge of the difference between causation and correlation nor the ability to recognize when someone has cited data in a way that confuses the two. Thus, it leads to misinformation and that’s a problem that the A4A blog shouldn’t be contributing to.

    • Dave

      FL, show this article to your STIs/HIV doctor (I specify because some “regular doctor don’t even have a clue what prEP is) and ask him what he thinks of the article. You are right, not ALL PrEP users catch other STIs, but many infections have increased tenfold and more. It’s a fact, not an opinion that A4A blog has.

    • DR.H

      You can never prove causation from a single factor because there will ALWAYS be the Null Hypothesis! That is why we say SMOKING MAY cause cancer, even though we KNOW smoking CAN cause cancer in many people, though there are probably some who happen to be resistant to cancer … either way it is a counter-intuitive argument as it doesn’t take a genius to figure out it is better to NOT play the odds of getting cancer, and therefore WISE NOT TO SMOKE. So PrEP DOESN’T make you more likely to get an STI, however, if you use PrEP, and believe that it alone WILL stave off HIV infection, that is just as FALSE as those who believe that there is no need to protect themselves from OTHER STIs because they ARE ON PrEP, and THERE [this scenario] is the increased potential. To even discuss such a proposition IS silly because it is saying to those who believe PrEP makes them invincible: it is okay to do as you please because THIS drug lowers your risk of infection (for ONE particular STI) when there is TREMENDOUS correlative data that PrEP users who DO NOT use further protections have 10 times the rate of other STIs than those using additional methodologies. So, YEP, my seat belt doesn’t make me MORE LIKELY to get in an accident, however, the use of my seat belt in MOST accidents makes it MORE LIKELY I will SURVIVE the accident, (EVEN MORE LIKELY if I don’t drive drunk AND follow speed and traffic guidelines AND have an AIRBAG), however, in some cases I guess I could be injured or killed by the airbag and the seat belt, but come on, even in this vignette, isn’t the best scenario evident here?

  3. Ivan

    ‍♂️‍♂️ people feel like bc you got the flu shot you can hang out with other virus/bacteria and think you won’t get sick, numbness! I heard the expression “ sexual freedom” that PrEP gives some guys/girls who don’t fear the rapid rate of gonorreha medication resistance and I am sure soon some people on PrEP will develop resistant to these medications.
    All I can say is some people deserve what they get

  4. Mark

    Co-infections have existed with HIV positive people. However; HIV infected patients don’t have a false sense of security, and are more aware of reinfections ,drug resistant strains ,and suffering that comes along with the HIV virus and drug side effects. Those on prep may be aware of the effectiveness of the HIV prophylaxis, but for some reason don’t think of other STI as contagious or dangerous due to the curative treatments available. They are not aware of organ damage and increased incidence of cancers that can result from these STI s . Common sense is not so common when you don’t have the total picture. Remember a little bit of knowledge can be a dangerous thing.

    • Fred

      Jesus, where do I even start! Your post is so full of errors it would take me twice the space to correct all of your misrepresentation.

      Reinfection superinfection are a myth.

      Modern cART has very few side effects and most people can achieve undetectable status.

      Cancer from STI. I presume you are referring to HPV or HSV. Condoms do practically nothing to prevent exposure to those two viruses.

      There are hundreds of thousands of HIV poz guys that live healthy happy undetectable lives and are not traumatized by having to take a pill or even several pills every morning.

      Face it HIV is no big deal anymore. It is functionally cured. Life expectancy is practically normal. Go find something else to nuerotically obsess about

      • NotNelly

        Fred, your ignorance and *arrogance* are astounding. The cytotoxic (toxins do not always kill a cell, but altering a cell’s processes can have a deleterious effect upon that cell’s function) drugs which prevent the entry, replication, and release of the HIV also affect cells which play no purpose in the proliferation of the HIV, resulting in widespread damage to entire tissue structures and organs. In effect, the treatment can be as damaging as the pathogen, but sustainable for a longer period of time. In a nutshell, IT IS STILL A BIG DEAL, MORON. Reliance on drugs, alone, to prevent HIV infection is having a *horrendous* effect upon the population who subscribe to the misinformation proliferating in the “slut drug culture.” Gonorrhea is now mutating into untreatable strains. Syphilis and chlamydia are *rampant,* all because of a peer-pressure and fetish-driven subculture, bent upon self-gratification, waving self-righteous flags woven from hedonism and lack of accountability. Those bacterial diseases are fatal, if untreated. If treated too often, they are capable of adapting to the antibiotics which once treated them. Grow up, and stop providing gasoline for the inferno.

  5. JL

    As expected… People are using PrEP as a license to make real their most wild fantasies. But HIV is not the only monster around. Even though many STIs have treatment, is quite challenging due to new variants on the rise. What about the gonorrhea resistant to antibiotics, HPV which may lead to cancer. Hep C as well. PrEP is good but not perfect. Protects you only 97%. And if you dont know it HIV resistant to PrEP is already hanging around the communities. Dont engage in high risk behaviors. And if you do then be responsible letting your partner know.

  6. Migs

    The silver lining, PrEP users are routinely in care and get test/treated for infections. I prefer not stigmatizing a group or people who are proactive in their sexual health then someone who “claims” they negative but havent been tested for an STI in years. If every sexually active man, on PrEP or not would get into care, we wouldnt keep on transmitting these infections.

  7. Father Hennepin

    Yeah, the rapidly spreading outbreak of barebacking would inevitably lead to spreading disease. So much for the selfish assholes who claim that because they are “undetectable” and on Prep they are safe for barebacking and all that shit. Why are gay men so immature, so self-centered, so wanton? Do they even get vaccinations? This is part of the price of separating sex from love. The more you separate it and turn into a physical act alone, the more the devil gets in you and drives you down, down, down. Love is one of, if not the most powerful force we know in life, and when you work against it, there is bound to be some kind of payback. I think it is pretty miserable to see middle-aged guys and older who have no interest in relationships, on NSA, and the same for young guys just starting out. Setting a bad example for the young ‘uns is not a good thing. A 22-year-old should not have the idea that it is normal to hook up with a total stranger, let alone bareback and breeding and all that.
    The gay community has got to grow up, grow some spine, and stop being pushed around by porn vendors, sex clubs, bars and others who exploit us to make a fortune. Try going to church or temple to meet someone. That’s my sermon and I’m sticking to it. Sermon, not semen.

    • PostGayGrandDad

      I would love to see a post asking members to define love. Every time I ask no one can. “Oh, everyone knows what it is.” OK, if you know, define it. I have a definition, but would love hear others’.

  8. willie spates III

    First off these dumb ass faggots been online offering up raw ass like its a flyer at the mall …Then yall telling these dudes that its safe to have raw sex if u on prep …Simple fact is most men have no control over themselves sexually, mom used to say if u give a man a inch he gonna try to take a mile everytime . …most of us are like dogs that see eachother on the street …”Take a sniff , if the pussy in heat fuck it ” That irresponsible as hell …Then we got our younger generation following yall dumb nasty disease having asses thinking it cool to degrade themselves all in thr name of fun ….The bible said in the last days men would be lovers of themselves instead of lovers of God …These people out here spreading these nastiness around just for something that feels food at the moment . I think gay men show the raw nasty uninhibited side of the male species . Gay men feral like wild animals..I pray everyday that this will end or get better …but everyone is complaining but not putting forth any effort to change it …..well im not for it ….”I am Resist “

  9. PostGayGrandDad

    Well, duh. Who woulda thunk?

    When I hear someone say he’s on PrEP I immdiately think to stay away, as he’s probably catching all kinds of other weird shit. And here’s the proof: they’re catching all kinds of other weird shit.

    You have only two choices, CONDOMS or abstinence.

  10. nyfreerider

    Shocking that the people who panned Prep for just these reasons the past few years and were mocked and scorned are now proven right. Just like in the ‘old’ days when no status was to be inferred as barebacking and/or hiv+, Prep with no mention of condoms gets barebacking and stds, avoid at all costs treatment.

  11. gtownbottom

    You’d Better Make Him Use A Flavored Condom If He Wants Oral, I Noticed A Lot Of People Yap About No Raw/ Bareback Sex But Unprotected Oral, Rimming Is Just As Dangerous. Just Saying….

  12. Hunter0500

    Does this mean on profiles there’ll be a shift away from “On PrEP” because it’ll be perceived as more of a negative than a benefit?

      • Hunter0500

        Well it’ll mean A4A is off the hook. After all, they gave members the oportunity to declare their status and of course members would be truthful. Right?

        And if a guy got tested this morning and got his results on the spot, he’d be safe. Right?

        • Dave

          No, that doesn’t mean that, but some guys can use this feature to inform others about their last results. Of course some users will lie, but hey, A4A is not the police, we always let people decide what’s good for them, but we put the tools out there, to help.

  13. JK

    It may not necessarily mean a rise in STIs/STDs. People on PrEP are required to get tested more frequently and for stuff other than just HIV. If you didn’t get tested or test infrequently for other sexually transmitted diseases, they will show up while you’re on PrEP and getting tested making it look like rates of new STDs are increasing when it’s really screening that’s increasing.

  14. Neil

    I think it’s time that we practice monogamy and serious relationship. Just because we use prep does not prevent you from getting other STDs. Last of prolong use of prep also lead to kidney failure and HIV resistance. virus can change it’s strand and continue to replicate through time.

  15. Randy

    People are also being tested more frequently since PrEP protocol usually requires quarterly testing. So more people are being diagnosed with treatable STIs.

  16. Vince

    I get asked constantly to go bareback now has a top since my profile says I’m on PrEP. These fools honestly think it’s a cure-all for everything I don’t see why that’s the case because the information out there is clear that it only protects against HIV. I have never had an STD in my life until last year, I had both for gonorrhea and chlamydia. And I’m sure it’s from the four times I did not use a condom with both male and female partners. I certainly learned my lesson the hard way and I will not waiver from condom use in the future.WISE UP MEN!!!!!

  17. Libertarian Queer

    Gee, imagine that. I’m quite surprised herpes wasn’t mentioned as well because it doesn’t care if you’re on PrEP or not, either. Yes, ladies and germs, while one of our microbial enemies, HIV, has been on the losing end of it’s battle against us some of them have become better at developing resistance to antibiotics, too. (Methicillin resistant gonorrhea? Anyone?) Some of of us have been committing biological treason by giving aid and comfort to our microbial enemies and transporting them to the front lines of the battle through unprotected sex. Face it, guys. In due time the microbes will eventually have their way with all of us because nobody reading this will get out of this life alive. All we as individuals can do is fight a holding action for as long as we possibly can. Part of a successful holding action strategy is to avoid unprotected sex regardless of the perceived “magic” of PrEP. You’ve seen the profiles that go kind of like “Hey I’m on PrEP so come pump me full of jizz condom free!” Does that kind of ad profile seem familiar? How about ones like “I’m on PrEP and I’m a bareback top! Let me fuck you!” C’mon, guys, get an elementary understanding of biology. Please! Never let the little head or the hole do your critical thinking for you.

  18. David

    No comments on undetectable HIV because it is not what the article is about. Why ask? Is it because people make stupid comments about HIV undetectable no matter the article? I hope so because they’ve faced enough crap as it is. As Matt said-anyone with common sense knew this was coming. I’m curious to know about the elephant in the room: HSV2. How many new cases of that? I hope none. Chances are there are at least some. Chances are even greater there are more than at least some. 90% may never know it which will only increase those numbers. PREP is a great thing which I fear is being used for the wrong reasons. I’m not judging. Each of us is free to make our own decisions. We shouldn’t judge one another. I say the wrong reasons because I’m fearful of something new which may appear in the future. Hopefully it is just a fear and will never come to pass, however; it worries me.

  19. David

    We are a community. We can disagree but please stop judging and attacking. It’s getting us nowhere. HIV is still very real. Other STI’s are very real. They are all realities with which each of us has to deal and come to our own decisions. We have the right to make our own decisions. We don’t want to be judged by the public at large. Why are we turning on each other and attacking when we don’t agree? Most straight people I know are less judgmental toward gay people than many gay people I know. Each of us is a human being. Not one of us is perfect. Each should be able to present his or her own opinions without fear of exclusion or reprisal or condemnation; even if it’s a controversial subject. We are allowed to disagree. We are going to disagree. It’s how we do it that matters. Please Please Please…can all of us be kinder and gentler with each other? Like it or not, we are a community which has faced tremendous persecution, and still does in many places of the world. I think we’d do well to appreciate our liberty in being able to even express our opinions in a public forum. I have very strong opinions on this subject. My first concern is the well being of each of us. That is just me. I know there are others. If we attack each other we only make things worse where so many sacrificed so they would be better.

  20. Hunter4B

    In the 1960s, the discovery of “The PILL” led to similar factors … no longer worried about ‘pregnancy’ many threw caution to the wind, and STD/Is thrived in that Sexual Revolutionary environment.
    Every time, A4A has run a similar story and someone replied “SAFE SEX FINALLY” … I responded that there was no SAFE sex where PrEP was involved, EVEN FOR HIV INFECTION. While PrEP has gone great lengths in curbing future infection rates, it is still a realistic possibility, and it has definitely exacerbated exponentially the infection rates of the myriad of other known STD/Is. After talking to several people here with “surprising Syphilis” infections, I also included that data in a post, but it never made it to publication … that is okay, I understand it makes the vetting of the articles difficult, however, Syphilis Infection Rates have been increasing at wildly concerning rates since PrEP’s onset. I have several times gone to the website, and included links with those statistics (which I appreciate Moderator Dave has allowed through, because I am aware we are not supposed to place links in our posts). It is ridiculous for those BLAMING the CDC for this problem. YOU are solely responsible for YOUR ACTIONS, and CAN decrease the opportunistic chances of the Russian Roulette style many choose to take with health and avoidance …
    Sadly, it is laughable to read the continual diatribes from the SAME guys here … some who mock the infected, others that decry that status, and many who ironically chastise those doing the exact same behaviors – NOBODY DESERVES a painful rash, an infection, or a disease … so please stop promoting those negative and harmful stereotypes that have been used by OTHERS outside THIS community to describe what many see as the punishment of GAY VALUES [or the lack there of]. I have learned so much from those willing to share their honest stories, and I appreciate your sharing even when it is difficult to hear or support. I always appreciate reading the posts of everyone here who promote modern and realistic depictions of what it means to be savvy, smart, and GENTLEMEN of quality! Though in that last statement, I purposefully disavow those using stereotypes and promoting homophobia here through the use of pejoratives … the ONLY STUPID FA**OTs I SEE HERE, are the ones using that terminology against themselves!
    I was too young in the 1980s to understand HIV, however, I made it my personal responsibility to become INFORMED prior to participating in behaviors which could lead to any or all STD/Is, and as many have pointed out here, ONLY abstinence is a 100% effective method, ALL ELSE involves risk and we can decide to mitigate or take seriously those risk factors, however, none of that implies the denigration or vilification of my brothers

  21. 7FigureMane

    A lot of these guys can’t even afford Prep. Hell most of them don’t even work. Insurance may cover it, if they have medical insurance. I think the CDC knew exactly what would happen. Everybody pnp’n and fucking raw. Their excuse: “I’m on Prep.” Lol

  22. Scientific Gay

    Y’all better start using “COLLOIDAL SILVER” internally and topically on the daily, to reduce that statistic. Stop waiting on people and entities to tell you how to TREAT stuff, CURE YOURSELF. Research it. WISE UP MEN. WISE UP.

  23. Jeffrey

    While prep does not protect against other std’s it is a good safety net from HIV. It is important we do not take away the good when we are pointing out the bad of this drug. It would be interesting to see a study done on how many men are HIV neg today because they are on it.

    I can count on my hands how many times in my life I have worn a condom. The same statement can be said about how many times I have caught an STD. My profile clearly states that I bareback only. It is risky behavior as well as honesty. I wish I could tell you how many men have condoms listed or even say safe sex only in their profiles but have taken my cock raw and left with my man juice up their ass.

    It is this reason I went and got on Prep. My cock is not that special. My doctor requires me to get tested every 3 months before he will give me another prescription. While it will not prevent me from any other STD I am protected against all these safe sex only guys that will take a raw cock. It is them I fear more then an STD

  24. John

    This does not surprise me at all. It is very bizarre to me how it’s becoming normal to have unprotected sex under the excuse of being under Prep. Not too long ago, having unprotected sex was almost a taboo, now, some guys won’t even consider having sexual encounters if you even mention wearing a condom. It’s a shame, and a huge step backwards

  25. PostGayGrandDad

    So glad I’m PostGay (I used to be gay, I don’t participate anymore) and no longer have to deal with any of that. I used to have a daily poke (sex at least every day), but now my biggest concerns are whether I want bacon or sausage with breakfast (my daily po’k).

    It’s amusing that the tight-bodied young things look at older gay men with disdain. I was sucking cock before Stonewall. Yes, we are old. That means we fucking survived. In my case never infected despite losing a husband to the plague. I may be an old troll, but I’ll likely outlive you.

    Wrap it up.

  26. Tulsa21

    Been on PrEP over 3 years. And yes, i bb. Luckily never had an STD. BUT IF I HAD, it would have been caught due to all testing we have to have for PrEP. I think there is merit to the argument rates have increased cuz so much more testing. Also, for the haters: most of u have done bb but w/0 PrEP. And u sure as hell have sucked dik w/o a condom. Boom. Just as much exposure sucking that meat. So get on PrEP. Get tested regularly. Stop hatin’ on PrEP folks.

  27. Lamar

    This isn’t at all surprising to me, as some people have no common-sense. For some time now, I wondered ‘if’ too many guys (in their heads anyway) thinking or taking for granted, “if’ I use PrEP, then I don’t have to worry about catching anything else; forgetting-not realizing, its only for HIV, is why it was formulated. It seems to much for them to realize this, and using the “glove” is for all STD’s period that maybe present; that person maybe carrying in their bodies. It’s about the critical thinking process, and you really don’t need college, for that or maybe some do, its a survival tactic for the maintenance of good health and life. JUST READ FOLKS, read for crying out loud.

  28. Mark

    I started PrEP thinking I had full knowledge risks involved. Yes, I got bacterial STI’s and took care of them quickly by testing every 3 months and getting treated if necessary. Then I got Hep C. Holy crap balls! I had lots of sex, but nothing beyond vanilla sex. I thought it was virtually impossible to get Hep C from vanilla sex. NOT TRUE. New studies now show Hep C spills into the the semen of guys who are carrying a high viral load of HCV. And THAT alone is enough to infect you as a bottom without protection. After 1 year of waiting to see if I was going to clear HCV on my own, it didn’t. And lot’s of liver damage along the way. Finally treated with Harvoni. One month following treatment, still undetectable. Fingers crossed.

  29. Dillion

    I thought I’d share my story. I’m a 35 year old man who migrated to the US from a homophobic country where I didn’t have gay encounters. I started having sex with men in 2011 always with a condom. I perhaps had the most sex in my life between 2011 to 2013 and was screened for STDs at least twice a year – never caught a thing. Since PrEP, I have been still using condoms but faced with extreme push-back from people who insist that I fuck them bare, many refuse to have sex with me because I use condoms. I am alarmed to say that over the past year and a half, even while still using condoms ALL the time I have had three episodes of gonorrhea. It’s particularly frightening that I have not been having as much sex over the past two years as I’ve outgrown the hookup culture. I know causation is hard to prove, but I am convinced that the increase bareback sexual encounters because of PrEP use is playing a role. Yes, it’s quite clear that I got gonorrhea from having my dick sucked… but how comes that never happened to me back in 2011 and 2012 – the answer is simple, so many guys weren’t fucking around raw and being irresponsible.

    • Lamar

      !!! What?! Wow, you did everything right! Receiving oral, even. There’s nothing left is there, in the way of what we gay men call “normal-sex,” anyway, looks like I was way ahead of my time, grinding-frottage. Kissing is the most wonderful thing, seems that’s out of the question, too.

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