April 7, 2015

Jonathan Mermin, MD, MPH

Director, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30329 Dear Dr. Mermin,

Thank you for your letter dated February 23, 2015 in response to our concerns about inconsistent sexually transmitted disease (STD) testing intervals evidenced in the 2010 STD Treatment Guidelines and the “Pre-exposure Prophylaxis for the Prevention of HIV in the United States – 2014.” We understand that the pace of the evolving sexual health promotion landscape often creates challenges in harmonizing various sets of recommendations and appreciate your efforts to remedy the inconsistencies we identified.

In particular, we would like clarification as to whether the PrEP guidance will be immediately changed to reflect the need for screening gay men and other men who have sex with men (MSM) on PrEP for STDs every three months during the clinical encounter where HIV testing is also being conducted (in order to monitor the HIV status of PrEP users). If such an immediate change to the guidance document itself is not possible, would CDC be able to issue some form of an addendum to the 2014 PrEP Guidance to reflect the change? Any delay in communicating this change in recommendations would be deleterious in fully informing provider practice and may lead to poorer sexual health outcomes for gay men and other MSM, as well as other users of PrEP.

Additionally, we are encouraged by your commitment to pursue more specific recommendations regarding the frequency of STD screening among high-risk MSM. As you are well aware, we are in the midst of concerning increases in syphilis and gonorrhea that compels an even greater urgency to address the gaps in research, conduct speedy analysis of forthcoming findings from bacterial STD infections among enrollees in PrEP demonstration projects, and the prompt dissemination of subsequent clinical guidance that can assist us in this challenging trend. However, we feel that the inconsistencies between the STD Treatment Guidelines and the PrEP guidance ought to be addressed in a more immediate fashion.

We look forward to hearing from you on how the communication of the change to STD testing intervals for those on PrEP can be made swiftly and how NCSD can partner with you in that effort.

Best,

William (Bill) Smith Executive Director

CC:         Dr. Eugene McCray, Director, Division of HIV/AIDS Prevention Dr. Gail Bolan, Director, Division of STD Prevention

Eva Margolies, Assoc. Dir. For Policy and Planning Coordination, NCHHSTP Dr. Laura Cheever, Associate Administrator, HIV/AIDS Bureau, HRSA