Trends in Sexually Transmitted Infections by PrEP Use Among Cisgender Men Who Have Sex With Men in New York City,...

Preexposure prophylaxis (PrEP) prevents HIV, although some have hypothesized it may lead to increases in behaviors that put men who have sex with men at risk for other sexually transmitted infections (STIs). However, data on the association between PrEP use and STI incidence are conflicting and prone to biases.

New York City, 2014-2023.

We used serial cross-sectional data from the New York City National HIV Behavioral Surveillance study among men who have sex with men. Log-linked Poisson regression with robust standard errors was used to determine linear trends in bacterial STI diagnoses over time, overall, and among those who did not report having HIV and who had an STI test in the past 12 months, by PrEP use. When linear trends were not present, we examined nonlinear associations between year and STI diagnoses by PrEP use.

We observed increases in all STI diagnoses from 2014 to 2023, overall. Syphilis diagnoses increased among non-PrEP users (aPR: 1.22; 95% CI: 1.05-1.42) and gonorrhea diagnoses decreased among PrEP users (aPR: 0.90; 95% CI: 0.81-0.99), over time. Among non-PrEP users, the likelihood of any STI diagnosis was greater in 2023 than in 2014 (aPR = 2.56; 95% CI: 1.00-1.18), whereas no significant associations or increasing trends were found among PrEP users.

No increasing trends in STI diagnoses were found among PrEP users. These data provide preliminary evidence for informing multipronged STI prevention strategies and counteracting PrEP-related stigma.