Choice of antibiotics for prophylaxis of bacterial STIs among individuals currently self-sourcing
Manik Kohli, David Reid, Caisey V. Pulford, Alison Howarth, Jack RG Brown, Hamish Mohammed, Gwenda Hughes, Catherine H Mercer, John Saunders
Abstract
As interest in antibiotic prophylaxis for bacterial STIs grows, there is a need to better understand the current landscape of antibiotic self-sourcing.STI prophylaxis is not currently recommended in routine practice: only two small studies demonstrated efficacy of pre-/ post-exposure doxycycline prophylaxis for syphilis and chlamydia, and there are concerns about antimicrobial resistance (AMR). 1 However, 2-10% of HIV-PrEP users self-source antibiotics for STI prophylaxis. 1 During the COVID-19 pandemic, online surveys of MSM were carried out in the UK within the Reducing Inequalities and Improving Sexual Health (RiiSH-COVID) study. 2 The second survey (23 November -12 December 2020) included questions on STI prophylaxis.The survey had 1,522 respondents, of which 1,520 completed the STI prophylaxis questions.The median age was 38 years (IQR 29-50), 96% were cis male, 82% identified as gay, and 71% were White British.Overall, 20% (308/1,520) had heard of STI prophylaxis, 3.6% (55/1,520) had ever used prophylaxis, and 1.8% (28/1,520) had used prophylaxis in the preceding 12 months.HIVnegative respondents not using HIV-PrEP had lower reported STI prophylaxis use than both respondents with HIV [1.9% (18/933) vs. 6.9% (11/160); p<0.001] and HIV-PrEP users [1.9% (18/933) vs. 6.2% (26/421); p<0.001].Respondents reporting STI prophylaxis use (n=55) were asked which antibiotic(s), being able to select more than one if appropriate