key: cord-1053388-uzfcgj3x authors: Vanbaelen, Thibaut; Van Dijck, Christophe; De Baetselier, Irith; Florence, Eric; Reyniers, Thijs; Vuylsteke, Bea; Jacobs, Bart KM; Kenyon, Chris title: Screening for STIs is one of the main drivers of macrolide consumption in PrEP users date: 2021-06-17 journal: Int J STD AIDS DOI: 10.1177/09564624211025940 sha: 4ae8803b62dbc62f22b363d7dc9976037019d326 doc_id: 1053388 cord_uid: uzfcgj3x nan 'routine PrEP', between October 2019 and December 2020, which was compared to the results from the Be-PrEP-ared period. A total of 1305 patients attended the PrEP clinic during this routine PrEP period, 1297 were male and 8 were female. We performed 2060 CT/NG nucleic acid amplification tests (NAATs), representing 2.16 tests/person/year, whereas during the Be-PrEP-ared study 12 tests were performed per person per year (Table 1) . Macrolide consumption was 3.27 DID during the routine PrEP period. To assess the impact of COVID-19 restrictions we repeated the same calculation for two different periods: 10/2019-03/2020 and 04/2020-12/2020. Macrolide consumption declined slightly from 3.61 DID in the first period to 3.17 DID in the second period. In the routine PrEP period, macrolide consumption was thus almost four-fold lower than during Be-PrEP-ared. The main driver of macrolide prescriptions in PrEP cohorts with 3-site, 3-monthly screening is the treatment of asymptomatic CT/NG infections. 3, 8 Most guidelines still recommend 3-site 3-monthly screening among PrEP users although the evidence supporting this is scarce. In particular, more intense screening for CT/NG has not been shown to reduce the prevalence of these infections compared to less intense screening. 9, 10 We conclude that less intensive screening of CT/NG in PrEP cohorts offers a way to reduce macrolide consumption. Alternative antimicrobial regimens, including those limiting the use of azithromycin, could also be considered. 7 The dramatic increases in macrolide resistance in Neisseria gonorrhoeae, Mycoplasma genitalium and other bacteria in Belgium and elsewhere suggest the urgent need to The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article. Thibaut Vanbaelen  https://orcid.org/0000-0002-5541-6041 Christophe Van Dijck  https://orcid.org/0000-0001-8010-1351 Irith De Baetselier  https://orcid.org/0000-0002-1804-252X Chris Kenyon  https://orcid.org/0000-0002-2557-8998 Demographic and behavioural factors associated with antimicrobial susceptibility to azithromycin and ceftriaxone in Neisseria gonorrhoeae Daily and event-driven pre-exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence Screening for STIs in PrEP cohorts results in high levels of antimicrobial consumption Is there a resistance threshold for macrolide consumption? Positive evidence from an ecological analysis of resistance data from streptococcus pneumoniae, treponema pallidum, and mycoplasma genitalium European guideline on the management of chlamydia trachomatis infections European guideline on the diagnosis and treatment of gonorrhoea in adults European guideline on the management of non-gonococcal urethritis We need to consider collateral damage to resistomes when we decide how frequently to screen for chlamydia/gonorrhoea in preexposure prophylaxis cohorts Cost-effectiveness of two screening strategies for chlamydia trachomatis and Neisseria gonorrhoeae as part of the PrEP programme in the Netherlands: a modelling study Is screening for chlamydia and gonorrhea in men who have sex with men associated with reduction of the prevalence of these infections? A systematic review of observational studies