Club drug users on PrEP at increased risk of contracting bacterial sexually transmitted infections

two men exchange drugs at a nightclubClub drug (ketamine, ecstasy, GHB, cocaine, and methamphetamine) use has been documented to be higher among gay and bisexual men (GBM) and has been shown to increase the risk of HIV transmission due to its connection with sexual behavior

Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission and may be particularly beneficial for those who use club drugs. Nevertheless, there is a growing concern about bacterial sexually transmitted infections (BSTIs) associated with decreasing condom use among PrEP users.

To determine the characteristics of PrEP users at the highest risk of contracting BSTIs, a team of researchers including CUNY Graduate School of Public Health Professor Christian Grov and Dr. Steven A. John at the Center  for HIV/AIDS Educational Studies & Training at CUNY Hunter College, surveyed GBM who were active PrEP users at the time of enrolment. The findings were published in the journal Epidemiology.

Twenty-six percent of GBM on PrEP reported a diagnosis of BSTI in the past six months. Men who reported using club drugs had 6.6 times the odds of reporting at BSTI and those reporting more frequent condomless anal sex in the past 30 days had 1.1 times odds of reporting a BSTI.

“The fact that club drug users demonstrated higher odds of bacterial STIs, even after controlling for condomless sex, suggests other variables may be putting club drug users greater at risk for exposure,” said Dr. Grov

The study’s findings led the researchers to conclude that club drug users could be at a unique BSTI risk, perhaps because of higher-risk sexual networks. “We know that club drugs and sex often go hand-in-hand, and our findings may point to a concentration of STIs that are being passed between club drug users,” said Grov, “But more research would be necessary to confirm the network hypothesis.” The researchers recommend ongoing BSTI screening and risk reduction counselling for GBM on HIV PrEP.

John SA, Parsons JT, Rendina HJ, & Grov C. Club drug users had higher odds of reporting a bacterial STI compared with non-club drug users: results from a cross-sectional analysis of gay and bisexual men on HIV pre-exposure prophylaxis. Sex Transm Infect. 2018 Aug 20.