October - December 2018

Rebound in Sexually Transmitted Infections Following the Success of Antiretrovirals for HIV/AIDS

Abstract

Nearly 1 million people become infected every day with any of the four major curable sexually transmitted infections (STIs), namely trichomoniasis, chlamydia, gonorrhea, and syphilis. Despite huge global incidence, STIs remain as neglected diseases. The success of antiretrovirals for halting progression to AIDS in HIV-infected individuals and for stopping HIV transmission to uninfected contacts, either as pre- or post-exposure prophylaxis, has to lead to increased risky sexual behaviors through risk compensation. Recent epidemics and outbreaks of STIs among men having sex with men reflect the global loss of fear to HIV/AIDS.The alarming rising rates of STIs worldwide have been fueled by: (1) rapid spread of drug resistance, that is, for Neisseria gonorrhoeae and Mycoplasma genitalium; (2) unprecedented impact of recreational drugs (chemsex) and internet (apps, websites) for facilitating exposure to multiple sex partners; and (3) growing rates of sexual violence and commercial sex, associated with wars, refugees, migrations, traveling, and sexual tourism. Moreover, there is an increasing appreciation of sexual transmission for other agents, including human T-lymphotropic virus type 1, hepatitis A and C viruses, Zika, and Ebola. For addressing this new scenario for STIs, an expert panel workshop was arranged in Madrid, Spain in May 2018. This review summarizes the discussions at the meeting.

Keywords:
HIV. Pre-exposure prophylaxis. Post-exposure prophylaxis. Treatment as prevention. Risk compensation. Chlamydia gonorrhea. Trichomonas. Syphilis. Papillomavirus. Mycoplasma genitalium. Herpes simplex. Men having sex with men.