The Characteristics of Men Who Have Sex With Men (MSM) Using Post-Exposure Prophylaxis for Sexual Exposure (PEPSE) in the Pre-Exposure Prophylaxis (PrEP) Era

Daniel Richardson; Kayleigh Nichols; Richard Hughes; Hannah Smith; Colin Fitzpatrick; Fiona Cresswell


HIV Medicine. 2022;23(5):553-557. 

In This Article


Brighton has a large population of MSM and is served by a single integrated sexual health and HIV service which provides PrEP as part of a national roll-out programme. MSM having anal sex are offered either daily of event-driven PrEP where appropriate. The clinic provides PEPSE to MSM who attend the sexual health clinic following condomless anal sex, and follow-up for MSM who attend for and initiate PEPSE at the emergency department following condomless anal sex. MSM who initiate PEPSE in the emergency department are referred to the sexual health clinic and are seen within 5 days of initiation for assessment and continuation of PEPSE. All MSM who use PEPSE are offered a transition to PrEP if appropriate. MSM attending for or using PEPSE will see a sexual health clinician for a sexual history and risk assessment, which are recorded in our electronic patient record (EPR) system using a standard pro forma. MSM are invited to attend 2 weeks later for a clinical assessment and a sexually transmitted infection (STI) screen with an additional assessment 2 weeks later to discuss transition to PrEP. MSM who transition to PrEP from PEPSE are offered follow-up HIV testing at 2 and 6 weeks after starting PrEP and are then tested every 3 months as part of PrEP monitoring.

Using our EPR system, we identified all MSM attending for PEPSE in a 6-month period from 1 January to 30 June 2021 (when PrEP was readily available) and 1 January to 30 June 2017 (when PrEP was not widely available). We collected data on patient demographics, including self-identified ethnicity; details of the sexual event that led to PEPSE being recommended, including recreational drug use during sex; whether they presented to the sexual health clinic or emergency department; and attendance at a follow-up appointment and completion of PEPSE. We also collected data on offer and transition to PrEP on completion of PEPSE. Our service continued to offer full access to sexual health, including PEP and PEPSE from January to June 2021 despite the COVID-19 pandemic, and we were able to deliver PEPSE and PrEP to all MSM contacting our clinical service. Differences in baseline characteristics were examined using Fisher's exact test or Kruskal–Wallis tests using 95% confidence intervals as appropriate.