Pre-exposure prophylaxis and syphilis in men who have sex with men: a network analysis

TL;DR

This study uses network analysis to explore how PrEP usage among MSM influences syphilis transmission, identifying community structures that may sustain the spread of syphilis.

Contribution

It introduces a novel community detection method incorporating sexual partnerships and treatment rates to analyze syphilis transmission dynamics among MSM.

Findings

PrEP users in large, highly connected communities may sustain syphilis transmission.

Community structure influences the role of PrEP users in disease spread.

PrEP usage correlates with community size and sexual network connectivity.

Abstract

Pre-exposure prophylaxis (PrEP) has been established as an effective tool for preventing HIV infection among men who have sex with men (MSM). However, there is the possibility of PrEP usage leading to increased sexual partners and increased transmission of non-HIV sexually transmitted infections such as syphilis. We take here a network perspective to examine this possibility using data on sexual partnerships, demographic data, PrEP usage, and syphilis among MSM in Columbus, Ohio. We use a recently developed community detection algorithm, an adaptation of the community detection algorithm InfoMap to absorbing random walks, to identify clusters of people (`communities') that may drive syphilis transmission. Our community detection approach takes into account both sexual partnerships as well as syphilis treatment rates when detecting communities. We apply this algorithm to sexual networks fitted to empirical data from the Network Epidemiology of Syphilis Transmission (NEST) study in Columbus, Ohio. We assume that PrEP usage is associated with regular visits to a sexual health provider, and thus is correlated with syphilis detection and treatment rates. We examine how PrEP usage can affect community structure in the sexual networks fitted to the NEST data. We identify two types of PrEP users, those belonging to a large, highly connected community and tending to have a large number of sexual partners, versus those with a small number of sexual partners and belonging to smaller communities. A stochastic syphilis model indicates that PrEP users in the large community may play an important role in sustaining syphilis transmission.