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Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"<jats:p>\n                    HIV pre-exposure prophylaxis (PrEP) is transforming global HIV prevention, but its implementation coincides with observations of rising bacterial sexually transmitted infection (STI) rates among men who have sex with men, raising questions about whether PrEP is preventing one epidemic while facilitating others. To reconcile this apparent contradiction, we developed a minimal dynamical model of the simultaneous transmission of HIV and\n                    <jats:italic toggle=\"yes\">chlamydia<\/jats:italic>\n                    (as an example of a curable STI). The model integrates three key mechanisms: 1) risk-mediated self-protective behavior, 2) reduction in condom use among PrEP users, and 3) PrEP-related asymptomatic STI screening. We show that these mechanisms can generate a \u201ctesting paradox:\u201d True STI prevalence may decline while observed trends rise. This paradox emerges because increased PrEP uptake amplifies screening intensity, which can lower transmission but simultaneously inflate detection. By systematically mapping the parameter space of PrEP uptake, screening frequency, and risk perception, we identify broad and plausible conditions under which the paradox arises. Our findings reconcile conflicting epidemiological evidence and remark that the net effect of PrEP on STI dynamics depends critically on asymptomatic screening strategies. These results highlight the potential dual role of PrEP programs in reducing both HIV and bacterial STI incidence, while emphasizing the need to align screening and treatment policies to maximize benefits and minimize risks, e.g., antimicrobial resistance.\n                  <\/jats:p>","DOI":"10.1073\/pnas.2524944122","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T17:38:17Z","timestamp":1761759497000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":9,"title":["Testing paradox may explain increased observed prevalence of bacterial STIs among MSM on HIV PrEP: A modeling study"],"prefix":"10.1073","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2606-1117","authenticated-orcid":false,"given":"Laura","family":"M\u00fcller","sequence":"first","affiliation":[{"name":"Max Planck Institute for Dynamics and Self-Organization","place":["G\u00f6ttingen, Germany"]},{"name":"Institute for the Dynamics of Complex Systems","place":["G\u00f6ttingen, Germany"]},{"name":"University of G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9612-1912","authenticated-orcid":false,"given":"Piklu","family":"Mallick","sequence":"additional","affiliation":[{"name":"Max Planck Institute for Dynamics and Self-Organization","place":["G\u00f6ttingen, Germany"]},{"name":"Institute for the Dynamics of Complex Systems","place":["G\u00f6ttingen, Germany"]},{"name":"University of G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio B.","family":"Mar\u00edn-Carballo","sequence":"additional","affiliation":[{"name":"Max Planck Institute for Dynamics and Self-Organization","place":["G\u00f6ttingen, Germany"]},{"name":"University of Granada","place":["Granada, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"D\u00f6nges","sequence":"additional","affiliation":[{"name":"Max Planck Institute for Dynamics and Self-Organization","place":["G\u00f6ttingen, Germany"]},{"name":"Institute for the Dynamics of Complex Systems","place":["G\u00f6ttingen, Germany"]},{"name":"University of G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn J. N.","family":"Kettlitz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology","place":["Brunswick, Lower Saxony, Germany"]},{"name":"Helmholtz Centre for Infection Research","place":["Brunswick, Lower Saxony, Germany"]},{"name":"PhD Program \u201cEpidemiology\u201d Brunswick-Hanover","place":["Lower Saxony, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina J.","family":"Klett-Tammen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology","place":["Brunswick, Lower Saxony, Germany"]},{"name":"Helmholtz Centre for Infection Research","place":["Brunswick, Lower Saxony, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4394-7697","authenticated-orcid":false,"given":"Mirjam","family":"Kretzschmar","sequence":"additional","affiliation":[{"name":"University Medical Center Utrecht","place":["Utrecht, The Netherlands"]},{"name":"Utrecht University","place":["Utrecht, The Netherlands"]},{"name":"Center for Complex Systems Studies","place":["Utrecht, The Netherlands"]},{"name":"Utrecht University","place":["Utrecht, The Netherlands"]},{"name":"Interdisciplinary Center for the Mathematical Modeling of Infectious Disease Dynamics","place":["M\u00fcnster, Germany"]},{"name":"University of M\u00fcnster","place":["M\u00fcnster, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8905-5873","authenticated-orcid":false,"given":"Viola","family":"Priesemann","sequence":"additional","affiliation":[{"name":"Max Planck Institute for Dynamics and Self-Organization","place":["G\u00f6ttingen, Germany"]},{"name":"Institute for the Dynamics of Complex Systems","place":["G\u00f6ttingen, Germany"]},{"name":"University of G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8909-774X","authenticated-orcid":false,"given":"Seba","family":"Contreras","sequence":"additional","affiliation":[{"name":"Max Planck Institute for Dynamics and Self-Organization","place":["G\u00f6ttingen, Germany"]},{"name":"Institute for the Dynamics of Complex Systems","place":["G\u00f6ttingen, Germany"]},{"name":"University of G\u00f6ttingen","place":["G\u00f6ttingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"e_1_3_4_1_2","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3004006"},{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00056-2"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002050"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-048478"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001874"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(18)30072-9"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2018.23.27.1800323"},{"key":"e_1_3_4_8_2","first-page":"527","article-title":"Sexually transmitted infections and increased risk of co-infection with human immunodeficiency virus","volume":"104","author":"Nusbaum M. 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