Risk of developing antibiotic resistance in people taking PrEP
The results of an online survey conducted by British researchers show that 9% of PrEP users buy their own antibiotics to prevent sexually transmitted infections (STIs).
Previous studies have shown that the antibiotic Augmentin can be used to prevent STIs similar to how PrEP is used to prevent HIV. Augmentin reduces the incidence of STIs in HIV-positive gay and bisexual men and in HIV-negative PrEP users. Augmentin is an effective treatment for chlamydia and is also used to treat syphilis in people allergic to penicillin antibiotics.
However, the British Association for Sexual Health and HIV does not recommend the use of antibiotics to prevent pre-diagnosis infections because of the risk of developing antibiotic resistance. Gonorrhea has a high level of resistance to doxycycline, so it is unlikely to be effective in preventing this infection. Augmentin and similar antibiotics are used to treat urogenital mycoplasmosis (Mycoplasma genitalium), but there are already serious concerns about antibiotic resistance in the treatment of this STI.
The data were taken from an online survey conducted by community organizations PrEPster and iwantPrEPnow in conjunction with Public Health England to gather information on PrEP use in the UK.
A total of 1,856 PrEP users were identified, of whom 98% were male, 93% identified as gay, and 63% were over the age of 35. It is important to note that 95% of respondents reported having been to a sexual health clinic within the past year.
According to the survey, 9% (167/1856) of those taking PrEP used antibiotics to prevent STIs, compared to 91% (1681/1856) who did not.
72% of those who used antibiotic prophylaxis had condomless sex with five or more partners, compared with 41% of those who did not (p value <0.001). Also, a higher percentage of those who took chemsex medications were in the group that took antibiotics (33%) than in the group that did not (22%, p value <0.001).
The survey did not reveal – which antibiotics were purchased and how they were used. Information about why STI prophylaxis was used and for how long was also not collected. It was also impossible to learn from this data about STI prevention in gay communities not taking PrEP or about STI prevention in other populations taking PrEP.
However, the researchers believe that this is the largest study to date in this area. Studying antibiotic use among gay and bisexual men who have access to PrEP is necessary because there is evidence that PrEP is associated with an increased incidence of rectal STIs. This study shows that gay and bisexual men who use PrEP, who also use antibiotics to prevent STIs, are more likely to have other STI risk factors compared to those who do not use antibiotics for prevention.
Researchers are concerned that some PrEP users who use antibiotics to prevent STIs may not report them to health care providers. And that, in turn, can lead to a lack of correct information and increase the risk of antibiotic resistance. Similarly, no advice can be given about retesting to see if STIs are curable and what antibiotics can be used against hard-to-treat infections if people treat themselves at home without consulting a doctor. The data suggest that antibiotics are being bought, but there is still a lot unknown about preventing STIs with antibiotics, so further research on this issue is needed.