PS08 Sexual health screening and prevention recommendations for HIV-negative LGBTQI+ individuals initiating traditional immunosuppressants: a scoping review to inform dermatology practice

Abstract

LGBTQI+ individuals experience disproportionate burdens of sexually transmitted infections and blood-borne viruses. While ­biologic-associated infection risk and screening pathways are well documented, traditional immunosuppressants (e.g. corticosteroids, methotrexate, azathioprine and mycophenolate) lack consolidated, dermatology-relevant guidance on sexual health screening and prevention. The objective of this scoping review is to map current recommendations and evidence for sexual health screening and preventative interventions in HIV-negative LGBTQI+ individuals commencing traditional immunosuppressants. Specifically, this review explores hepatitis B vaccination, gonorrhoea vaccination, doxycycline postexposure prophylaxis (doxy-PEP) and HIV pre-exposure prophylaxis. The applicability to dermatology practice was also assessed. A scoping review was conducted using MEDLINE, Embase and hand-searched national and international guideline repositories from 2016 to 2026. Initial database searches combining LGBTQI+ populations, conventional immunosuppressants and prevention strategies identified no directly relevant studies. Therefore, the search was expanded to include sexual health guidelines and reviews focused on LGBTQI+ populations, and infection-prevention literature relevant to immunosuppressed cohorts. Recommendations and evidence were synthesized with attention to applicability to dermatology initiation pathways. No studies specifically addressed sexual health screening or prevention in HIV-negative LGBTQI+ individuals receiving traditional immunosuppressants. However, multiple authoritative guidelines recommend hepatitis B screening and vaccination for high-risk populations including men who have sex with men, alongside HIV pre-exposure prophylaxis with baseline renal and hepatitis B assessment. Emerging UK policy supports targeted meningococcal B vaccination for gonorrhoea prevention in high-risk MSM, and doxy-PEP is recommended for select LGBTQI+ populations. Across all sources, recommendations were framed by sexual risk rather than immune status, with no guidance tailored to patients commencing conventional immunosuppression in dermatology settings. Despite the existence of sexual health prevention guidance for LGBTQI+ populations, there is a clear absence of immunosuppression-specific and dermatology-integrated recommendations. This gap highlights an opportunity for the creation of screening bundles at initiation of traditional immunosuppressants, supporting holistic care.