Impact of daily, oral pre-exposure prophylaxis on the risk of bacterial sexually transmitted infections among cisgender women: a systematic review and narrative synthesis

Vasiliki Papageorgiou; Erica Crittendon; Flavien Coukan; Bethan Davies; Helen Ward

doi:10.12688/wellcomeopenres.17457.2

Impact of daily, oral pre-exposure prophylaxis on the risk of bacterial sexually transmitted infections among cisgender women: a systematic review and narrative synthesis

Wellcome Open Res. 2022 Aug 15:7:108. doi: 10.12688/wellcomeopenres.17457.2. eCollection 2022.

Authors

Vasiliki Papageorgiou¹, Erica Crittendon¹, Flavien Coukan^{1

2}, Bethan Davies³, Helen Ward^{1

2

4

5}

Affiliations

¹ Patient Experience Research Centre, School of Public Health, Imperial College London, London, W2 1PG, UK.
² National Institute for Health and Care Research Applied Research Collaboration Northwest London, Chelsea and Westminster Hospital, London, SW10 9NH, UK.
³ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1PG, UK.
⁴ National Institute for Health and Care Research Imperial Biomedical Research Centre, London, W2 1NY, UK.
⁵ MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, W2 1PG, UK.

Abstract

Background: There are concerns that the use of pre-exposure prophylaxis (PrEP) may result in an increased incidence of sexually transmitted infections (STIs). Evidence for this is mixed and has mostly been based on reviews focussed on gay and bisexual men and transgender women, while none have summarised evidence in cisgender women. Methods: We conducted a systematic review to explore whether daily, oral PrEP use is associated with changes in bacterial STI occurrence (diagnoses or self-reported) and/or risk among HIV seronegative cisgender women (ciswomen). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. Results: We included 11 full text articles in a narrative synthesis, with the studies published between 2012 and 2021. The studies were mostly based in Africa (n=7, 63.6%) and reported on 3168 ciswomen using PrEP aged 16-56 years. Studies had marked differences in variables, including measurements and definitions (e.g., STI type) and limited data available looking specifically at ciswomen, principally in studies with both male and female participants. The limited evidence suggests that PrEP use is not associated with increased STI rates in ciswomen generally; however, adolescent girls and young women in Sub Saharan Africa have a higher prevalence of bacterial STIs prior to PrEP initiation, compared to adult ciswomen and female sex workers. Conclusions: We suggest future PrEP research make efforts to include ciswomen as study participants and report stratified results by gender identity to provide adequate data to inform guidelines for PrEP implementation. PROSPERO registration: CRD42019130438.

Keywords: HIV prevention; bacterial sexually transmitted infections; health risk behaviors; pre-exposure prophylaxis; systematic review; women’s health.

Publication types

Systematic Review

Grants and funding

This work was supported by Wellcome [205456/B/16/Z; to HW]; the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London, the NIHR Applied Research Collaborative North West London, the UKRI-MRC and the Bill and Melinda Gates Foundation. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.