Is HIV PEP a Carrot for Finding STDs?

Background: San Francisco City Clinic (SFCC) has offered HIV non-occupational Post Exposure Prophylaxis (PEP) for over a decade.  PEP services are the primary reason for visit of a small, high-risk subset of patients.  To describe STD co-morbidity among patients utilizing PEP, we compared STD morbidity between patients seeking PEP services and those seeking general STD care.

Methods: We examined all visits among HIV-negative patients from January 1, 2010 to December 31, 2012 where the patient self-identified their reason for visit as either PEP only or a STD check-up only. MSM categorization was based on self-reported sexual orientation and reported gender of sex partners. STD morbidity included chlamydia, gonorrhea, and early syphilis.    

Results: During the study interval, there were 14,188 visits to SFCC among HIV-negative patients for which either PEP (n=1061) or STD check-up (n=13,127) were selected as the only reason for visit. Higher morbidity was seen among both PEP only visits compared to STD check up only visits (11.1% versus 7.9%, p=0.0003).  A history of a STD diagnosis in the past 12 months was more also likely at PEP only visits compared to STD check-up only visits (17.3% versus 8.11%, p<0.0001). Of the PEP only visits, 88.3% were MSM compared to 42.2% of STD check-up only visits (p<0.0001).  Additionally, patients with PEP only visits were more likely to be white and Hispanic and less likely to be Black compared to patients with STD check-up only visits (p<0.0001).

Conclusions: STD morbidity rates were high among both those seeking PEP and those seeking general STD care.  Integrating a PEP program at an STD clinic is feasible and STD screening should be bundled with PEP provision; PEP services may be a useful tool to identify additional untreated STDs.