Technology to prevent HIV could be abetting spread of STIs

Sunday June 09 2019

The latest medical technology could be indirectly fuelling the spread of sexually transmitted infections (STIs). Pre-exposure prophylaxis, the use of drugs that prevent HIV infection (known as PrEP in short), coupled with social media, especially dating apps, have inadvertently combined to encourage promiscuity, health experts say.


Although there is not enough data on the scope of the prevalence due to lack of proper surveillance, experts suspect that the introduction and roll-out of (PrEP) could be contributing to the rise in STIs.

The introduction of PrEP has seen a reduction in the use of other protective methods such as condom use and testing.

This, Prof Matilu Mwau of the Kenya Medical Research Institute (Kemri) says, has seen Kenyans continuously engaging in risky behaviour, which could trigger an “explosion” of STIs.

“With these apps, one is able to turn over partners more quickly, and the quicker you change partners, the more likely you are to get infections,” he told the Nation.


This explains recent data from the World Health Organisation (WHO) showing that there are more than one million new cases of curable STIs daily among people aged 15-49 years.

This is more than 376 million new cases a year of four infections: chlamydia, gonorrhoea, trichomoniasis, and syphilis. This means that on average, one in every 25 people globally has at least one of these STIs, also known as sexually-transmitted diseases (STDs).

WHO says there has been no progress in stopping the spread of these diseases. It notes that too little attention  is paid to STIs, and data is inadequate, with the risk that some will spiral out of control as they become resistant to antibiotics.

Prof Mwau, who has carried  out research on chlamydia and syphilis among sex workers, says many are testing positive for these preventable diseases.

“I was shocked, and honestly, I think the question is, aren’t people using condoms anymore?” he said.

The infectious disease expert says that, with the uptake of PrEP, and  the use of ARVs, exposure to HIV is reduced.


“But people are forgetting that PrEP is not a magic bullet for all diseases. And neither are ARVs used to prevent STIs,” he notes.

This might just be the case, as Kilifi-based research scientist Simon Masha notes.

“Increased cases of STIs that have been reported among people on PrEP, and a reduction in condom use could be pushing up these numbers,” Dr Masha noted.

In 2015, the government introduced PrEP to people at high risk of contracting HIV, before the drugs were made accessible to the rest of the population. Last year, public health researcher Jordan Kyongo, says about 46,000 Kenyans started using PrEP.

“However, as at October, only half were on the drugs. What we know is that there is an increasing trend among people on PrEP to ignore other methods of protection, like using condoms, which prevent STIs,” Dr Kyongo noted.

It is important for PrEP users to use condoms whenever possible because PrEP does not prevent STIs or unintended pregnancies.

The situation is worsened by the fact that STIs, especially gonorrhoea and syphilis, are becoming resistant to antibiotics; they are becoming almost untreatable.

Dr Marianne Mureithi, a microbiologist, notes that there is an increase in gonorrhoea (commonly known as the clap) and chlamydia.

“What’s worrying is that people with new sexual partners are not using condoms, yet these STIs are quite vicious. We’re already detecting drug resistant strains of gonorrhoea circulating in Kenya,” she says.


STIs are spread through unprotected vaginal, anal and oral sex. Some can be passed from mother to child during pregnancy or childbirth, notably chlamydia, gonorrhoea and syphilis. Syphilis can also be transmitted through contact with infected blood.

Untreated, these infections can have serious consequences, such as infertility in both men and women, stillbirths, ectopic pregnancy and higher risk of  getting HIV.

While these infections are treatable with antibiotics, shortages of benzathine penicillin have made it more difficult to treat syphilis, and antimicrobial resistance to gonorrhoea is a growing health threat, the WHO said.

Newborn deaths

The infections can result in stillbirths, newborn deaths and infertility. Syphilis alone causes more than 200,000 newborn deaths and stillbirths each year.

“These infections indicate that people are taking risks with their health, their sexuality, and their reproductive health” said Dr Melanie Taylor, lead author of the report and medical epidemiologist at the WHO Department of Reproductive Health and Research.

WHO regularly evaluates the global impact of the four common STIs with the latest figures dating back to 2015.