Sexual risk behavior and demand for prophylaxis for sexually transmitted diseases

Objective: To analyze the characteristics of patients coming to the emergency room

seeking postexposure prophylaxis for sexually transmitted diseases (STDs) after high-risk

sex.

Methods: Over a 6-month period, emergency requests for postexposure STD prophylaxis

were reviewed. We recorded epidemiologic variables, type of sexual risk behavior, reason

for coming to the emergency room, STD prophylaxis prescribed, and cost.

Results: A total of 189 patients with a mean (SD) age of 32.5 (8.3) years were included;

162 (85.7%) were men and 67.2% were Spanish. One hundred thirteen (59.8%) were

men who had sex with men; the partner was seropositive for human immunodeficiency

virus (HIV) in 30.7% of the cases or of unknown serostatus in 61.9%. Condoms were

used by 49.7%, but 45.5% reported breakage. The most frequent practice was anal

penetration (active or passive) (53.4%). Twenty-eight days of preventive HIV

antiretroviral therapy was prescribed for 85.2%; 77.2% also received prophylactic

antibiotics for other STDs, and 22.8% started immunization against hepatropic viruses.

The mean cost per visit and preventive treatment administered or prescribed in the

emergency department was €858 (€275).

Conclusions: Sexual risk behavior is a frequent reason for emergency department visits,

particularly among men who have sex with men. A large proportion of patients come

because a condom has broken, but nearly half do not use a condom even when they do

not know the serostatus of the partner or know the partner is seropositive for HIV.

Emergency care and pharmacologic treatment for these patients are costly.