Clinical assessment before starting PrEP
Assessment and management of sexually transmissible infections at baseline
Individuals at risk for HIV infection are also at high risk for STIs. Clinicians should screen for STIs (specifically gonorrhoea, chlamydia and infectious syphilis) using the standard-of-care tests and procedures, and manage any detected STI as recommended by the Australian STI Management Guidelines (23). Importantly the presence of an STI at baseline should not delay the commencement of PrEP. Of note, in the PrEPX study it was reported that 10.2% of 1,774 evaluable study participants tested positive for STIs at baseline (24).
Patients starting on PrEP should be informed about:
- prevention of STI acquisition and transmission
- frequency of STI testing
- signs and symptoms of STIs.
Patients should be encouraged to present for testing and treatment whenever signs or symptoms of STIs appear.