{
  "abstract": "Objectives Among users of oral HIV pre-exposure prophylaxis (PrEP), condom use is low and incidence of sexually transmitted infections (STIs) is high, hence guidelines recommend STI screening every 3–6 months. Identifying individuals with higher asymptomatic STI risk for targeted screening may offer an opportunity to reduce the burden of STI screening.Methods In the Netherlands, PrEP has been offered through the National PrEP Pilot Program since 2019, which includes screening every 3 months. We included data of all individuals who received care through the PrEP programme between July 2019 and June 2022 and attended at least one PrEP care visit. STI-related symptoms and notification of possible STI exposure by sexual partners are recorded during each visit. We assessed the predictors of any chlamydia, gonorrhoea or syphilis infection diagnosed during routine asymptomatic STI screening (ie, no reported symptoms or partner notification) using logistic regression and calculated risk scores from coefficients of the multivariable logistic regression model. We estimated the sensitivity and specificity for the optimal prediction score cut-off.Results Among the 11 035 included individuals (97% men who have sex with men), 14 926 bacterial STIs (9114 diagnosed during routine asymptomatic screening) were diagnosed during a median of 24 months (IQR 15–30) of follow-up. We found that PrEP users who engaged in sex work, had condomless anal sex, participated in group sex or chemsex (ie, use of gamma-hydroxybutyrate/gamma-butyrolactone, mephedrone or crystallised methamphetamine during sex), injected drugs or used alcohol or non-chemsex-related drugs during sex had an increased risk of STIs diagnosed during routine asymptomatic screening. PrEP users born in the Netherlands and those who attended college or university had a lower STI risk. A risk score using these covariates resulted in a sensitivity of 0.55 (95% CI 0.54 to 0.56) and specificity of 0.55 (95% CI 0.54 to 0.55). Individuals eligible for STI screening accounted for 54% of STIs diagnosed during follow-up.Conclusions Using routinely available demographic and behavioural data, it was not possible to construct a well-performing risk score to identify individuals at high risk of STIs diagnosed during routine asymptomatic screening. Other factors, methods or ways to analyse data may be needed to increase predictive capacity for STI risk scores.",
  "authors": [
    {
      "affiliations": [
        "Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands",
        "Stichting hiv monitoring, Amsterdam, Netherlands",
        "Amsterdam Institute for Immunology & Infectious Diseases (AII), Amsterdam, Netherlands"
      ],
      "name": "Vita Willemijn Jongen"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands",
        "Amsterdam Institute for Immunology & Infectious Diseases (AII), Amsterdam, Netherlands",
        "Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands",
        "Amsterdam Public Health research Institute (APH), Amsterdam, Netherlands"
      ],
      "name": "Maarten Schim van der Loeff"
    },
    {
      "affiliations": [
        "Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands"
      ],
      "name": "Daphne Amanda van Wees"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Mark van den Elshout"
    },
    {
      "affiliations": [
        "Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, Netherlands",
        "Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, Heerlen, Netherlands"
      ],
      "name": "Christian J P A Hoebe"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Public Health Service of Rotterdam-Rijnmond, Rotterdam, Netherlands",
        "Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands"
      ],
      "name": "Hannelore M Götz"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands",
        "Amsterdam Institute for Immunology & Infectious Diseases (AII), Amsterdam, Netherlands",
        "Amsterdam Public Health research Institute (APH), Amsterdam, Netherlands",
        "Department of Dermatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands"
      ],
      "name": "Henry de Vries"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands",
        "Amsterdam Institute for Immunology & Infectious Diseases (AII), Amsterdam, Netherlands",
        "Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands",
        "Amsterdam Public Health research Institute (APH), Amsterdam, Netherlands"
      ],
      "name": "Maria Prins"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands",
        "Amsterdam Institute for Immunology & Infectious Diseases (AII), Amsterdam, Netherlands",
        "Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands",
        "Amsterdam Public Health research Institute (APH), Amsterdam, Netherlands"
      ],
      "name": "Elske Hoornenborg"
    },
    {
      "affiliations": [
        "Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health Mosa, South Limburg Public Health Service, Heerlen, Netherlands",
        "Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands"
      ],
      "name": "Nicole H T M Dukers-Muijrers"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands",
        "Stichting hiv monitoring, Amsterdam, Netherlands",
        "Amsterdam Institute for Immunology & Infectious Diseases (AII), Amsterdam, Netherlands",
        "Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands"
      ],
      "name": "Anders Boyd"
    }
  ],
  "title": "Regression-based risk scores using sociodemographic and sexual behaviour data do not predict asymptomatic sexually transmitted infections among HIV PrEP users",
  "uid": "1892fcda-5d25-50c7-8749-c9679104e7fc"
}