目的:评估暴露前预防(PrEP)对细菌性性传播感染(STI)发生(总体;衣原体;淋病;梅毒)的影响,在MSM。
方法:系统评价和荟萃分析。
方法:在PubMed中进行了系统搜索,Embase,和Scopus没有语言限制,直到2023年2月1日。我们寻找报告发病率比率(IRR)估计数据的研究,关于细菌性STI发生的患病率比或累积发病率比(后者在PrEP开始之前和之后的相同时间段内).对任何STI进行单独分析,梅毒,衣原体和淋病(总体;直肠;尿道;后两种情况的咽部);比率大于1表示PrEP开始后STI发生率增加。
结果:纳入23项符合条件的研究,11776名参与者(年龄范围:18-71岁),中位随访时间为12个月。总的来说,PrEP开始与任何性传播感染的发生率显着增加相关(合并效应大小:1.15,95%置信区间(CI):1.04-1.26),任何淋病(合并效应大小:1.17,95%CI:1.02-1.34),任何衣原体(合并效应大小:1.31,95%CI:1.09-1.58)和直肠衣原体(合并效应大小:1.31,95%CI:1.05-1.64),而在尿道衣原体中发现临界增加(合并效应大小:1.25,95%CI:0.99-1.60,P=0.064).咽部衣原体的改变和部位特异性淋病的发生没有达到统计学意义。梅毒在PrEP开始后几乎没有变化(合并效应大小:0.99,95%CI:0.72-1.37)。
结论:这些结果凸显了对更全面,可访问的STI测试,以解决PrEP用户中的细菌STI感染。
To evaluate the effect of preexposure prophylaxis (PrEP) initiation on bacterial sexually transmitted infection (STI) occurrence (overall; chlamydia; gonorrhea; syphilis), in MSM.
Systematic review and meta-analysis.
Systematic searches were performed in PubMed, Embase, and Scopus without language restrictions until 1 February 2023. We sought studies reporting data for the estimation of incidence rate ratios (IRR), prevalence ratios or cumulative incidence ratios (the latter in equal time periods before and after PrEP initiation) regarding bacterial STI occurrence. Separate analyses were performed overall for any STI, syphilis, chlamydia and gonorrhea (overall; rectal; urethral; pharyngeal for the two latter conditions); ratios greater than unity denoted increase in STI occurrence after PrEP initiation.
Twenty-three eligible studies with 11 776 participants (age range: 18-71 years) with a median follow-up of 12 months were included. Overall, PrEP initiation was associated with a significant increase in the occurrence of any STI (pooled effect size: 1.15, 95% confidence interval (CI): 1.04-1.26), any gonorrhea (pooled effect size: 1.17, 95% CI: 1.02-1.34), any chlamydia (pooled effect size: 1.31, 95% CI: 1.09-1.58) and rectal chlamydia (pooled effect size: 1.31, 95% CI: 1.05-1.64), whereas a borderline increase was found in urethral chlamydia (pooled effect size: 1.25, 95% CI: 0.99-1.60, P = 0.064). Changes in pharyngeal chlamydia and site-specific gonorrhea occurrence did not reach statistical significance. Syphilis showed virtually no change after PrEP initiation (pooled effect size: 0.99, 95% CI: 0.72-1.37).
These results highlight the need for more comprehensive, accessible STI testing to tackle bacterial STI infections in PrEP users.