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What is PrEP?

What is PrEP?

For those of you who aren’t familiar with it, PrEP is pre-exposure prophylaxis (PrEP) to prevent people from contracting HIV. The medication was called Truvada (tenofovir/emtricitabine) until it recently came off patent making it far more accessible, which is used as .

Why are we talking about it?

Let us preface our answer by saying that the advancements in HIV/AIDS prevention and treatment, including PrEP, have been overwhelmingly positive and we fully support the use of PrEP as an extra form of protection for those most at risk of contracting HIV including those within the Gay Community. Having said that, it has come to our attention that there is a not so positive conversation taking place in the Gay Community about PrEP and it revolves around a little concept called Risk Compensation, meaning people using PrEP may be prone to taking more risks with their sexual activities, such as not using condoms, due to the fact that they feel safe from HIV, which let’s face it, is the most serious STI.

PrEH-Health-prescriptions-without-the-personal-questions

How did we become aware of this conversation?

Well, members of the gay community started having it on our Facebook posts, which focused on the increasing rates of STIs such as Gonorrhoea and Syphilis in males, as highlighted in the Kirby Institute’s 2018 Annual Surveillance Report. Comments such as ‘blame PrEP’ began to appear so we decided to find out more.

So what is the concern about PrEP and is it warranted?

We need to start by saying that there is currently no evidence to suggest that PrEP is directly associated with increasing levels of any STI in any demographic in Australia. The PrEP trials that are being run are all relatively new and there is no data available yet that reports on the STI diagnoses during the period the trials have been running. However, overseas some trials have been running longer and we found that the concerns in the Australian gay community may, in fact, be warranted if you take cases such as Northern California in America into account as reported on here by Benjamin Ryan for Poz*.

The article reported that “the quarterly rates of rectal gonorrhoea and urethral chlamydia increased steadily and about doubled after one year” amongst people accessing PrEP from the Northern California health system.

The article also goes on to say that, “In a September 2015 analysis of Kaiser Permanente’s San Francisco clinic’s population of 600 men who have sex with men (MSM) on PrEP, researchers found that many of them were using condoms less since starting PrEP and that during their first year or partial year on PrEP half of them had contracted at least one STI.”

So even without local evidence to suggest PrEP use may be decreasing the use of condoms and potentially increasing the occurrence of other STIs, it seemed like there might be a conversation that needed to be had now, as the use of PrEP is increasing in Australia.

Currently New South Wales, Victoria, Queensland and the ACT all have PrEP Trials in progress and South Australia’s started this month as well. In January, The Victorian AIDS Council also announced an extra 100K in funding for the Victorian trial allowing an extra 600 gay and bi-sexual men to join it.

PrEP promises to play a key role in the federal government’s commitment to end HIV by 2020 and we’re all for that, but we think there needs to be more said about the fact that PrEP only prevents HIV, used alone it is not an adequate method to protect any person from STIs and whilst Gonorrhoea and Chlamydia might seem like small fries they should not just be overlooked.

We were lucky enough to gain the support of Daniel Ceh, a Sydney-based Marketing Strategist & concerned member of the Gay Community, in writing this article.

He says, “The negative impact (of PrEP) lies in the way it has been adopted socially in LGBTI culture, and the lack of care that has been taken in making sure the drug is not having a negative impact on the sexual behaviour of the individuals in the trial.

This has effectively led to the establishment of a sexual recklessness that I have recognised in both close friends and the wider gay community. The common mindset is ‘Sure, I can still contract other STIs, but they’re curable with a simple pill or shot. I’m protected from the dangerous one.’

PrEP should not be adopted as a security blanket. It is not a free pass to unprotected sex, and without communicating this we have a substantial problem.

One such problem is the increase in antibiotic resistant strains of STIs such as Syphilis and Gonorrhoea.

At PrEP Health, we believe antibiotic resistance is one of the greatest medical challenges facing the modern world, as recognised by the World Health Organisation. Without being alarmist, it’s important people understand that antibiotic-resistant bacteria — including gonorrhoea and syphilis — are likely to become much more common. Of particular concern is gonorrhoea: ceftriaxone-resistant gonorrhoea has been identified overseas, and this is deeply concerning because treatment options may be extremely limited. This is a serious issue, and we need to talk about it.

Why is this happening? There are several drivers, including inappropriate or incorrect prescribing of antibiotics, people not completing antibiotic courses, and the excessive use of antibiotics in agriculture to increase yields.

What does this mean for people who may be at risk of catching these STIs? Having previously had an infection that has been treated doesn’t automatically increase an individual’s risk of developing a resistant STI. However, the more often bacteria are exposed to antibiotics — and especially if they’re not treated effectively — the more likely resistant strains can emerge and then spread through the community.

The fact is: having a cavalier attitude to any infection that poses a risk to your health (and the health of others) is irresponsible. Modern medicine can make us feel protected in different ways, but bacteria adapt — and we need to be aware of that, particularly when it comes to gonorrhoea and syphilis.

The bottom line is they are infections and we should all be trying to avoid them, especially as the presence of other STIs has been shown to increase a person’s risk of contracting HIV.

If you’re still wondering what all the fuss is about, let’s go back to Daniel. Among his concerns, Daniel points to the way PrEP was introduced to the gay community. He says, “I was introduced to the drug after seeing it on profiles on different popular gay dating/hookup apps. Predominantly it was used to market an individual’s sexual perks. Statements like ‘Into raw, on PrEP’ were popping up left right and centre.”

“I began to question the way this preventative drug had been adopted recreationally. Surely the intention wasn’t for it to be used as an endorsement for raw sex, but the way PrEP was introduced into safe sexual health practice is reducing other forms of protection from necessary to optional.”

“What urged me into action was a recent discussion with an acquaintance of mine. His exact words were, ‘How great is PrEP?! I’ve taken so many poz loads without a problem’. I was shocked, and scared.”

“PrEP does not eliminate the risk of contracting HIV. It decreases the risk greatly, but it is not a failsafe.”

At PrEP Health, we agree with Daniel that PrEP is not 100% effective. Some people argue that condoms aren’t 100% effective either — and that’s true — but choosing to increase risk by not using an additional form of protection (particularly when many people on PrEP are already used to using condoms) is unnecessary.

It’s still early days for Australia with PrEP and its positive contribution to the battle against HIV is far too important to overlook, but we felt this discussion needed to be had now and Daniel agreed with us, “as more results on PrEP’s success become apparent, naturally sexual health organisations will revel in it and encourage those at risk of contracting HIV to start taking it. I believe the more the success of the drug alone is talked about the more at ease people will be to use it and have unsafe sex. The way this drug is shaping sexual behaviour in the rainbow community does not have to be an issue though, providing that sexual health organisations begin campaigning about the importance of condoms and the need for protection from other STIs in addition to PrEP.”

So here’s our final word at PrEP Health:

Women have The Pill to prevent one potentially unwanted outcome of unprotected sex, but it does not prevent STIs. In 2015, more than half of chlamydia diagnoses between the ages of 15–29 were in females. That may have nothing to do with The Pill or other forms of contraception, but it can suggest a lack of concern about STIs in an at‑risk age group — whereas if The Pill wasn’t available, condoms might feel more essential.

In some ways, PrEP is similar. It drastically decreases the most serious outcome of unprotected sex for men who have sex with men — HIV — but it does not protect against other STIs. People using PrEP need to be responsible for their sexual health as a whole: use PrEP for what it’s meant to be used for (HIV prevention) and use condoms to help prevent other STIs.

We also urge PrEP users to get tested regularly — and more often if they’re engaging in riskier sexual behaviour. Current guidelines for people at high risk of contracting STIs are generally once every three months, but if you’re having condomless sex with multiple partners, the responsible thing to do is to test more frequently.

STIs like chlamydia and gonorrhoea are often quickly detected, and early detection and treatment helps stop the spread of these increasingly common infections. While many STIs are treatable, they should not be underestimated. There are departments in every State Government dedicated to STI prevention, and while HIV remains a major concern, chlamydia and gonorrhoea are also increasingly treated as priority public health issues — and we think they should matter to all of us.

So there you have it take PrEP, use condoms, take the Pill ladies, use condoms. Let’s all be as safe as we can be.

One a closing note, we’d like to say a big thank you to Daniel for his openness and support in helping us address this sensitive subject. We have done so because we believe that as part of the sexual health community it is our duty to make sure people are taking every precaution.

As always, Be Safe Not Sorry and Get Tested Regularly.

*Data of the North California Study Participants was outlined by POZ as, “By and large, the study population was affluent, white, well educated, did not have a history of substance abuse and was presumed to consist almost entirely of men who have sex with men (MSM). A total of 97.9 percent were men. Their ages ranged from 18 to 68; the average age was 37. A total of 69.6 percent of them were white, 12.2 were Latino, 10.3 percent were Asian/Pacific Islander and 4.3 percent were Black. A total of 11.5 percent lacked a high school diploma. The median household income was $74,094.”

Clinical Accuracy & Attribution

All medical content on this site is authored by registered Australian medical practitioners. Content is reviewed and aligned with the Australian STI Management Guidelines for Use in Primary Care as managed by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM).
Last clinically reviewed: February 2026 by Dr Cris Quitral, Chief Medical Officer.

References
The barriers to STI testing
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