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 (sic)858 ((sic)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.