{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:36:46Z","timestamp":1777383406002,"version":"3.51.4"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T00:00:00Z","timestamp":1703721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"U.S. Army Medical Research and Development Command, U.S. Department of Defense","award":["Contract No W81XWH-16-C-0225, cooperative agreement W81XWH-18-2-0040"],"award-info":[{"award-number":["Contract No W81XWH-16-C-0225, cooperative agreement W81XWH-18-2-0040"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The evidence for an increased incidence of sexually transmitted infections (STIs) among patients utilizing HIV pre-exposure prophylaxis (PrEP) has been inconsistent. We assessed the risk of incident STI while on PrEP compared to periods off PrEP among military service members starting PrEP.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Incidence rates of chlamydia, gonorrhea, syphilis, hepatitis C virus, and HIV were determined among military service members without HIV prescribed daily oral tenofovir disoproxil fumarate and emtricitabine for HIV PrEP from February 1, 2014 through June 10, 2016. Hazard ratios for incident STIs were calculated using an Anderson-Gill recurrent event proportional hazard regression model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 755 male service members, 477 (63%) were diagnosed with incident STIs (overall incidence 21.4 per 100 person-years). Male service members had a significantly lower risk of any STIs (adjusted hazard ratio (aHR) 0.21, 95% CI 0.11\u20130.40) while using PrEP compared to periods off PrEP after adjustment for socio-demographic characteristics, reasons for initiating PrEP, surveillance period prior to PrEP initiation, and the effect of PrEP on site and type of infection in multivariate analysis. However, when stratifying for anatomical site and type of infection, the risk of extragenital gonorrhea infection (pharyngeal NG: aHR 1.84, 95% CI 0.82\u20134.13, p = 0.30; rectal NG: aHR 1.23, 95% CI 0.60\u20132.51, p = 1.00) and extragenital CT infection (pharyngeal CT: aHR 2.30, 95% CI 0.46\u201311.46, p = 0.81; rectal CT: aHR 1.36, 95% CI 0.81\u20132.31, p = 0.66) was greater on PrEP compared to off PrEP although these values did not reach statistical significance.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The data suggest entry into PrEP care reduced the overall risk of STIs following adjustment for anatomical site of STI and treatment. Service members engaged in PrEP services also receive more STI prevention counseling, which might contribute to decreases in STI risk while on PrEP.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0296054","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T18:24:22Z","timestamp":1703787862000},"page":"e0296054","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Risk of sexually transmitted infections among U.S. military service members in the setting of HIV pre-exposure prophylaxis use"],"prefix":"10.1371","volume":"18","author":[{"given":"Jason M.","family":"Blaylock","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1384-9973","authenticated-orcid":true,"given":"Evan C.","family":"Ewers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth J.","family":"Bianchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6906-0982","authenticated-orcid":true,"given":"David B.","family":"King","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosemary O.","family":"Casimier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hector","family":"Erazo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Grieco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenny","family":"Lay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila A.","family":"Peel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6514-5572","authenticated-orcid":true,"given":"Kayvon","family":"Modjarrad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charmagne G.","family":"Beckett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason F.","family":"Okulicz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul T.","family":"Scott","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7314-4545","authenticated-orcid":true,"given":"Shilpa","family":"Hakre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,12,28]]},"reference":[{"issue":"9","key":"pone.0296054.ref001","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/S1473-3099(14)70847-3","article-title":"Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study","volume":"14","author":"RM Grant","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"pone.0296054.ref002","author":"Centers for Disease Control and Prevention","year":"2021","journal-title":"PrEP for HIV Prevention in the U.S"},{"issue":"9","key":"pone.0296054.ref003","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1001\/jama.2019.1343","article-title":"Ending the HIV Epidemic: A Plan for the United States","volume":"321","author":"AS Fauci","year":"2019","journal-title":"JAMA"},{"key":"pone.0296054.ref004","year":"2019","journal-title":"Centers for Disease Control and Prevention"},{"key":"pone.0296054.ref005","volume-title":"Sexually Transmitted Disease Surveillance 2019.","author":"Centers for Disease Prevention and Control","year":"2021"},{"key":"pone.0296054.ref006","article-title":"Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men.","author":"TA Hart","year":"2022","journal-title":"Sex Transm Infect."},{"issue":"6","key":"pone.0296054.ref007","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1089\/apc.2021.0219","article-title":"Trends in Sexual Behavior and Sexually Transmitted Infections After Initiating Human Immunodeficiency Virus Pre-Exposure Prophylaxis in Men Who Have Sex with Men from Amsterdam, the Netherlands: A Longitudinal Exposure-Matched Study","volume":"36","author":"L Coyer","year":"2022","journal-title":"AIDS Patient Care STDS"},{"issue":"3","key":"pone.0296054.ref008","doi-asserted-by":"crossref","first-page":"15579883211018917","DOI":"10.1177\/15579883211018917","article-title":"Incidence of Sexually Transmitted Infections After Initiating HIV Pre-Exposure Prophylaxis Among MSM in Southern Denmark.","volume":"15","author":"M Azarnoosh","year":"2021","journal-title":"Am J Mens Health."},{"issue":"11","key":"pone.0296054.ref009","doi-asserted-by":"crossref","first-page":"e0259168","DOI":"10.1371\/journal.pone.0259168","article-title":"HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis.","volume":"16","author":"D Chemtob","year":"2021","journal-title":"PLoS One."},{"issue":"9","key":"pone.0296054.ref010","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1093\/cid\/ciz552","article-title":"Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States","volume":"70","author":"JA Serpa","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"11","key":"pone.0296054.ref011","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1097\/QAD.0000000000002281","article-title":"Differences in sexually transmitted infection risk comparing preexposure prophylaxis users and propensity score matched historical controls in a clinic setting","volume":"33","author":"MA Montano","year":"2019","journal-title":"AIDS"},{"issue":"14","key":"pone.0296054.ref012","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1001\/jama.2019.2947","article-title":"Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection","volume":"321","author":"MW Traeger","year":"2019","journal-title":"JAMA"},{"key":"pone.0296054.ref013","author":"Centers for Disease Control and Prevention","year":"2021","journal-title":"US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States\u20142021 Update: A Clinical Practice Guideline."},{"issue":"11","key":"pone.0296054.ref014","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1093\/cid\/ciu184","article-title":"Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men\u2014STD Surveillance Network, United States, 2010\u20132012","volume":"58","author":"ME Patton","year":"2014","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pone.0296054.ref015","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/09564624211047477","article-title":"Triple site sexually transmitted infection testing as a crucial component of surveillance for men who have sex with men: A prospective cohort study","volume":"33","author":"R Zucker","year":"2022","journal-title":"Int J STD AIDS"},{"key":"pone.0296054.ref016","author":"Defense Health Agency","year":"2019","journal-title":"Provision of Human Immunodeficiency Virus (HIV) Pre-Exposure Prophylaxis (PrEP) for Persons at High Risk of Acquiring HIV Infection."},{"issue":"20","key":"pone.0296054.ref017","doi-asserted-by":"crossref","first-page":"569","DOI":"10.15585\/mmwr.mm6720a1","article-title":"HIV Preexposure Prophylaxis in the U.S. Military Services\u20142014\u20132016.","volume":"67","author":"JM Blaylock","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"12","key":"pone.0296054.ref018","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.2105\/AJPH.92.12.1900","article-title":"The Defense Medical Surveillance System and the Department of Defense serum repository: glimpses of the future of public health surveillance.","volume":"92","author":"MV Rubertone","year":"2002","journal-title":"Am J Public Health."},{"key":"pone.0296054.ref019","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1214\/aos\/1176345976","article-title":"Cox\u2019s Regression Model for Counting Processes: A Large Sample Study.","volume":"10","author":"PK Andersen","year":"1982","journal-title":"Ann Stat."},{"issue":"12","key":"pone.0296054.ref020","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1093\/infdis\/jit094","article-title":"Spontaneous resolution of genital Chlamydia trachomatis infection in women and protection from reinfection","volume":"207","author":"WM Geisler","year":"2013","journal-title":"J Infect Dis"},{"issue":"3","key":"pone.0296054.ref021","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/00007435-198707000-00008","article-title":"Effect of prior sexually transmitted disease on the isolation of Chlamydia trachomatis.","volume":"14","author":"BP Katz","year":"1987","journal-title":"Sex Transm Dis"},{"issue":"5","key":"pone.0296054.ref022","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1172\/JCI114040","article-title":"Epidemiologic evidence for the development of serovar-specific immunity after gonococcal infection","volume":"83","author":"FA Plummer","year":"1989","journal-title":"J Clin Invest"},{"issue":"5","key":"pone.0296054.ref023","doi-asserted-by":"crossref","first-page":"e048478","DOI":"10.1136\/bmjopen-2020-048478","article-title":"Oral pre-exposure prophylaxis (PrEP) to prevent HIV: a systematic review and meta-analysis of clinical effectiveness, safety, adherence and risk compensation in all populations.","volume":"12","author":"OM E","year":"2022","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0296054.ref024","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/cid\/ciy182","article-title":"Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis","volume":"67","author":"MW Traeger","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"4","key":"pone.0296054.ref025","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/QAD.0000000000001718","article-title":"Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV","volume":"32","author":"VK Nguyen","year":"2018","journal-title":"AIDS"},{"issue":"6","key":"pone.0296054.ref026","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1136\/sextrans-2017-053377","article-title":"Does HIV pre-exposure prophylaxis use lead to a higher incidence of sexually transmitted infections? A case-crossover study of men who have sex with men in Los Angeles, California.","volume":"94","author":"MR Beymer","year":"2018","journal-title":"Sex Transm Infect"},{"issue":"RR-12","key":"pone.0296054.ref027","first-page":"1","article-title":"Prevention. Sexually transmitted diseases treatment guidelines, 2010.","volume":"59","author":"KA Workowski","year":"2010","journal-title":"MMWR Recomm Rep."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296054","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T18:24:34Z","timestamp":1703787874000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296054"}},"subtitle":[],"editor":[{"given":"Fengyi","family":"Jin","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,12,28]]},"references-count":27,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0296054","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,28]]}}}