During his last screening, the results came back: chlamydia and gonorrhea. Laurent, 42, in a relationship with an HIV-positive man, both of whom are fans of libertinism, was not surprised. He has been taking PrEP daily for two years, a preventive drug treatment against HIV (but not other STIs), and regularly goes without condoms. “Before taking PrEP, I wasn’t kidding about it. I protected myself all the time. » According to him, several men adopt the same behavior, believing that other sexually transmitted infections (STIs) are treatable and are less serious than HIV. They therefore choose, when taking this treatment, not to always go out covered.
In Sex, the new dangers, published in 2021, infectious disease specialist Éric Caumes believes that the reimbursement of PrEP since 2016 amounts to “encouraging risky practices” and contributes to the increase in STIs. Are these infections really on the rise? And if so, can we explain it by the increase in the use of PrEP? Nothing less sure.
Do people taking PrEP use less condoms?
People taking PrEP daily have a greater number of partners and use condoms less often, according to an ANRS Prévenir study. This work, published in 2019, was carried out on 3,057 HIV-negative volunteers at high risk of being infected with HIV.
Among them, 99% of men who have sex with men (MSM) were prescribed PrEP, either daily or on demand. In this cohort, only 20% of sexual acts were performed while wearing a condom. “Condom use has declined among gays, but it continues to be used, particularly when they use treatment intermittently,” assures David Michels, director of Innovations and Programs at Aides. It’s not all or nothing. »
Are STIs really on the rise in recent years?
The number of HIV cases decreased between 2012 and 2022 in France, from nearly 6,400 to 5,700 per year. A decline that we find in the MSM population. “The number of infected people has decreased by 30% over the last ten years among MSM born in France,” adds Jean-Michel Molina. PrEP is therefore a very effective treatment to fight AIDS. »
Unlike AIDS, for which the declaration of a positive serological test is obligatory, positive results for other STDs are reported less often. “The figures concerning STIs are therefore subject to caution. They are very incomplete and very variable,” warns the professor.
Since 2016, the number of diagnoses of gonococcal infection has increased continuously (excluding 2020) in Free Information, Screening and Diagnostic Centers (CeGIDD), according to Public Health France. The number of people infected with syphilis seen in general medicine consultations also increased by 42% between 2020 and 2021. 80% of them are MSM. An increase also noted in people infected with Chlamydia. They more than doubled between 2014 and 2021, going from 40,700 to 96,900, according to figures from Public Health France.
Can we make the link between this increase and the use of PrEP?
According to Jean-Michel Molina, the increase in sexually transmitted diseases can be explained by several phenomena. On the one hand, less fear of AIDS since the marketing of more effective treatments. On the other hand, a lack of communication on STD prevention, which would contribute to a decline in condom use.
Furthermore, “we have changed the way of making the diagnosis” regarding PrEP, indicates Dominique Costagliona, research director at Inserm. Users are now encouraged to carry out a comprehensive screening on a quarterly basis whereas before, tests were only carried out in the presence of symptoms. “If we are seeing an increase in STIs, it is because we are screening for them much more regularly,” analyzes the professor of infectious diseases. We only find what we are looking for. » Knowing that three-quarters are asymptomatic, according to a study he directed.
Finally, Dominique Costagliona insists on the fact that the reimbursement of PrEP dates back to 2016, while the increase in STIs began in the 2000s.