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Logo of straninfSexually Transmitted InfectionsVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Sex Transm Infect. 2007 October; 83(6): 498–499.
PMCID: PMC2598704

The extent of self‐initiated STI and HIV prophylaxis (auto‐PEP) and treatment in MSM attending GUM and HIV clinic services

In response to a decline in sexually transmitted infection (STI) diagnoses1 and rising gonococcal antibiotic resistance in men who have sex with men (MSM) attending our genitourinary medicine (GUM) service2, we set out to describe patient's STI treatment histories (including the extent of patient self‐initiated treatment). Ethical approval was obtained to provide anonymous questionnaires to 150 consecutive patients in two clinics: a GUM and human immunodeficiency virus (HIV) outpatient clinic located in central London. Following consent, participants were given a questionnaire, which asked details regarding STI diagnosis and treatment over the preceding 5 years. Reasons for non‐participation were not collected. No significant differences in the response rate were observed between the GUM clinic (70%) and the HIV outpatient clinic (64%; p = 0.269). The median age groups of respondents from the sexual health and HIV outpatient clinics were 26–30 and 36–40 years of age, respectively. Analysis of MSM responses are presented in table 11.

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Table 1 MSM questionnaire responses

Approximately twice the percentage of MSM attending the HIV outpatient clinic reported previous infections with gonorrhoea and syphilis compared with those attending GUM clinic services. The majority of participants reported receiving STI treatment from GUM or HIV clinics. However, in both groups, approximately 5% reported self‐initiating STI prophylaxis or treatment at some time in the past 5 years. All of these men reported at least one STI diagnosis over this recall period. One MSM respondent reported giving anti‐retroviral treatment to a partner as HIV post‐exposure prophylaxis (‘auto‐PEP') without medical supervision. Two non‐MSM respondents reported providing ‘auto‐PEP' to a partner.

The percentage of individuals reporting self‐initiated prophylaxis or treatment in this study is low. However, the issues for this group of patients are important and include the need to screen for co‐existent STIs, inappropriate drug use, antimicrobial resistance and partner notification. The use of HIV treatments as ‘auto‐PEP' in HIV‐negative individuals, if poorly monitored, may be dangerous (e.g. abacavir or nevirapine). It is important that easy access for such patients is maintained and that they are properly educated regarding the relevant issues.


1. Menon‐Johansson A S, Hawkins D A, Mandalia S. et al Failure to maintain patient access to GUM clinics. Sex Transm Infect 2004. 8076–77.77 [PMC free article] [PubMed]
2. Waters L J, Boag F C, Betournay R. Efficacy of azithromycin 1 g single dose in the management of uncomplicated gonorrhoea. Int J STD AIDS 2005. 1684 [PubMed]

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