PReGo: A Trial to Compare Antibacterial vs. Placebo Mouthwash to Reduce the Incidence of Sexually Transmitted Infections (STIs) in Men Who Have Sex With Men (MSM) Taking HIV Pre-Exposure Prophylaxis (PrEP)

Sponsor
Institute of Tropical Medicine, Belgium (Other)
Overall Status
Terminated
CT.gov ID
NCT03881007
Collaborator
(none)
343
1
2
14.4
23.8

Study Details

Study Description

Brief Summary

The study involves a randomized placebo controlled trial that aims to assess if a mouthwash (Listerine cool mint, LCM) is able to reduce the cumulative incidence of gonorrhoea (Ng), chlamydia (Ct) and syphilis in men who have sex with men and receiving preexposure prophylaxis (PrEP) at the Institute of Tropical Medicine (ITM).

Condition or Disease Intervention/Treatment Phase
  • Other: Mouthwash with LCM
  • Other: Mouthwash with placebo
N/A

Detailed Description

The study aims to assess if there is a difference in the incidence rate of gonorrhea, chlamydia and syphilis detected at any site whilst individuals are on daily and pre/post sex Listerine cool mint (LCM) vs. placebo mouthwash.

The study has a double-blind, cross-over design, in which subjects will be screened at the ITM and, if eligible, will be enrolled and randomized to group 1 (LCM) or group 2 (placebo). After 3 months, a crossover will occur and subjects will switch to the other intervention. Each participant will therefore be enrolled for 6 months (2 x 3 months, no wash out period).

Subjects will be recruited from the existing PrEP cohort at the Institute of Tropical Medicine Antwerp. A total of 320 subjects will be recruited (160 in each arm).

Study Design

Study Type:
Interventional
Actual Enrollment :
343 participants
Allocation:
Randomized
Intervention Model:
Crossover Assignment
Masking:
Double (Participant, Investigator)
Primary Purpose:
Prevention
Official Title:
A Double-blind Single Center, Crossover, Randomized Controlled Trial of Antibacterial vs. Placebo Mouthwash to Reduce the Incidence of Gonorrhea/Chlamydia/Syphilis in MSM Taking HIV Pre-exposure Prophylaxis (PrEP)
Actual Study Start Date :
Apr 3, 2019
Actual Primary Completion Date :
Jun 15, 2020
Actual Study Completion Date :
Jun 15, 2020

Arms and Interventions

Arm Intervention/Treatment
Experimental: LCM, then placebo

Mouthwash with LCM for 3 months followed by mouthwash with placebo for 3 months.

Other: Mouthwash with LCM
Subjects will mouthwash daily with LCM and before/after sex

Other: Mouthwash with placebo
Subjects will mouthwash daily with placebo and before/after sex

Experimental: Placebo, then LCM

Mouthwash with placebo for 3 months followed by mouthwash with LCM for 3 months

Other: Mouthwash with LCM
Subjects will mouthwash daily with LCM and before/after sex

Other: Mouthwash with placebo
Subjects will mouthwash daily with placebo and before/after sex

Outcome Measures

Primary Outcome Measures

  1. Patient Counts of Ng Plus Ct Plus Syphilis in Each Study Arm for Each Period [3-month period following each intervention]

    The sum of new diagnoses of Gonnorhea (Ng), Chlamydia (Ct) and syphilis in a 3 month period on LCM/placebo. Each participant can only contribute one diagnosis of Ct and one diagnosis of Ng per visit - regardless of number of sites infected. Thus each participant can contribute up to 3 diagnoses (Ct/Ng/syphilis) at each visit. The diagnosis of Ng and Ct will be made via molecular testing and syphilis via Rapid Plasma Reagin test (RPR) and Treponema Pallidum Antibodies tests (TPA) according to currently used European case definitions.

Secondary Outcome Measures

  1. Difference in Incidence Rate of Pharyngeal Ng Between Each Study Arm for Each Period [3-month period following each intervention]

    Incidence rate of new pharyngeal Ng cases in each allocation arm for each study period of 3 months.

  2. Difference in Incidence Rate of Ct (Combined Pharyngeal, Urethral and Rectal) Between Each Study Arm for Each Period [3-month period following each intervention]

    Incidence rate of new Ct cases in each allocation arm (LCM and placebo) for each study period of 3 months.

  3. Difference in Incidence Rate of Syphilis Between Periods on LCM vs. Placebo [3-month period following each intervention]

    Incidence rate of new syphilis cases in each allocation arm (LCM and placebo) for each study period of 3 months.

  4. Proportion of Days That Mouthwash is Used on a Daily Basis and Proportion of Casual Sex Contacts When Mouthwash is Used Pre or Post Sex [6-month period]

    Daily: Proportion of days in study used mouthwash at least daily Post sex: Proportion of casual sexual contacts in study when mouthwash used post sex. Pre sex: proportion of casual sexual contacts in study when mouthwash used pre sex

  5. Difference in Incidence Rate of Ng Plus Ct Plus Syphilis Between LCM and Placebo After Controlling for Adherence With Daily and Pre/Post Sex Mouthwash [3-month period following each intervention]

    Incidence rate of Ng, Ct and syphilis between both groups (LCM and placebo) post controlling for adherence to mouthwash

  6. Difference in Cumulative Numbers of Antibiotics Used Between Periods on LCM vs. Placebo [3-month period following each intervention]

    Cumulative number of antibiotics used between both groups (LCM and placebo) for each period

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
Male
Accepts Healthy Volunteers:
Yes
Inclusion Criteria:
  • Men aged 18 or more

  • Enrolled in Belgian PrEP program at ITM

  • Has had sex with another man in the previous year

  • Has had a symptomatic or asymptomatic STI (Ct/Ng/syphilis) in the previous 2 years

  • Willing to be enrolled in the cohort for 6 months and attend 3 monthly follow up visits

  • Willing to comply with the mouthwash study schema and willing to ask their casual partners to mouthwash pre- and post-sex

  • Prepared to fill out the online diary once a week

  • Able and willing to provide written informed consent

Exclusion Criteria:
  • Currently using a mouthwash and unwilling to cease use of this mouthwash

  • Enrolment in another interventional trial

  • Tests HIV positive at screening

Contacts and Locations

Locations

Site City State Country Postal Code
1 Institute of Tropical Medicine Antwerp Belgium 2000

Sponsors and Collaborators

  • Institute of Tropical Medicine, Belgium

Investigators

  • Principal Investigator: Chris Kenyon, MD, Institute of Tropical Medicine Antwerp

Study Documents (Full-Text)

More Information

Publications

None provided.
Responsible Party:
Institute of Tropical Medicine, Belgium
ClinicalTrials.gov Identifier:
NCT03881007
Other Study ID Numbers:
  • ITM201801
First Posted:
Mar 19, 2019
Last Update Posted:
May 7, 2021
Last Verified:
Apr 1, 2021
Individual Participant Data (IPD) Sharing Statement:
Yes
Plan to Share IPD:
Yes
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by Institute of Tropical Medicine, Belgium
Additional relevant MeSH terms:

Study Results

Participant Flow

Recruitment Details
Pre-assignment Detail
Arm/Group Title LCM (Intervention), Then Placebo Placebo, Then LCM (Intervention)
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex for 3 months and after 3 months they will switch to the placebo. Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex during 3 months and after 3 months they will switch to the LCM mouthwash.
Period Title: First 3 Months
STARTED 172 171
COMPLETED 121 119
NOT COMPLETED 51 52
Period Title: First 3 Months
STARTED 121 119
COMPLETED 77 74
NOT COMPLETED 44 45

Baseline Characteristics

Arm/Group Title LCM (Intervention), Then Placebo Placebo, Then LCM Total
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex for 3 months and then switch to placebo mouthwash for 3 months. Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex for 3 months and then switch to LCM mouthwash for 3 months. Total of all reporting groups
Overall Participants 172 171 343
Age (years) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [years]
39
40
40
Sex: Female, Male (Count of Participants)
Female
0
0%
0
0%
0
0%
Male
172
100%
171
100%
343
100%
Race and Ethnicity Not Collected (Count of Participants)
Count of Participants [Participants]
0
0%
Sexually Transmitted Infection (STI) history (last 24 months) (Count of Participants)
Any STI
172
100%
171
100%
343
100%
Chlamydia
89
51.7%
82
48%
171
49.9%
Gonorrhea
100
58.1%
117
68.4%
217
63.3%
Syphilis
75
43.6%
66
38.6%
141
41.1%
Other
15
8.7%
21
12.3%
36
10.5%
Antibiotics use (last 6 months) (Count of Participants)
Any antibiotics
140
81.4%
136
79.5%
276
80.5%
Macrolides
71
41.3%
86
50.3%
157
45.8%
Beta-lactam
111
64.5%
121
70.8%
232
67.6%
Fluoroquinolones
4
2.3%
3
1.8%
7
2%
Tetracyclines
47
27.3%
30
17.5%
77
22.4%
Other
0
0%
2
1.2%
2
0.6%
Number of main partners (last 3 months) (Main partners) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [Main partners]
1
1
1
Number of casual partners (last 3 months) (casual partners) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [casual partners]
10
10
10
Condom use with casual partners (Count of Participants)
0-24%
50
29.1%
62
36.3%
112
32.7%
25-49%
42
24.4%
34
19.9%
76
22.2%
50-74%
31
18%
26
15.2%
57
16.6%
75-100%
44
25.6%
42
24.6%
86
25.1%

Outcome Measures

1. Primary Outcome
Title Patient Counts of Ng Plus Ct Plus Syphilis in Each Study Arm for Each Period
Description The sum of new diagnoses of Gonnorhea (Ng), Chlamydia (Ct) and syphilis in a 3 month period on LCM/placebo. Each participant can only contribute one diagnosis of Ct and one diagnosis of Ng per visit - regardless of number of sites infected. Thus each participant can contribute up to 3 diagnoses (Ct/Ng/syphilis) at each visit. The diagnosis of Ng and Ct will be made via molecular testing and syphilis via Rapid Plasma Reagin test (RPR) and Treponema Pallidum Antibodies tests (TPA) according to currently used European case definitions.
Time Frame 3-month period following each intervention

Outcome Measure Data

Analysis Population Description
Intention-to-treat population. LCM (intervention) has a total of 195 participants (121 during the first 3 months and 74 during the last 3 months). The placebo arm had a total of 196 participants (119 during the first 3 months and 77 during the last 3 months).
Arm/Group Title LCM (Intervention) Placebo
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex
Measure Participants 195 196
First 3 months : Any STI
36
20.9%
33
19.3%
First 3 months : Chlamydia
19
11%
18
10.5%
First 3 months : Gonorrhea
19
11%
17
9.9%
First 3 months : Syphilis
2
1.2%
6
3.5%
Last 3 months : Any STI
27
15.7%
21
12.3%
Last 3 months : Chlamydia
11
6.4%
10
5.8%
Last 3 months : Gonorrhea
14
8.1%
8
4.7%
Last 3 months : Syphilis
4
2.3%
4
2.3%
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection LCM (Intervention), Placebo
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.359
Comments
Method Mixed Models Analysis
Comments
Method of Estimation Estimation Parameter Incidence rate ratio
Estimated Value 1.17
Confidence Interval (2-Sided) 95%
0.84 to 1.64
Parameter Dispersion Type:
Value:
Estimation Comments
2. Secondary Outcome
Title Difference in Incidence Rate of Pharyngeal Ng Between Each Study Arm for Each Period
Description Incidence rate of new pharyngeal Ng cases in each allocation arm for each study period of 3 months.
Time Frame 3-month period following each intervention

Outcome Measure Data

Analysis Population Description
Intention-to-treat population. LCM (intervention) has a total of 195 participants (121 during the first 3 months and 74 during the last 3 months). The placebo arm had a total of 196 participants (119 during the first 3 months and 77 during the last 3 months).
Arm/Group Title LCM (Intervention) Placebo
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex
Measure Participants 195 196
First 3 months
8
2
Last 3 months
3
0
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection LCM (Intervention), Placebo
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.024
Comments
Method Mixed Models Analysis
Comments
Method of Estimation Estimation Parameter Incidence rate ratio
Estimated Value 5.78
Confidence Interval (2-Sided) 95%
1.52 to 136.56
Parameter Dispersion Type:
Value:
Estimation Comments
3. Secondary Outcome
Title Difference in Incidence Rate of Ct (Combined Pharyngeal, Urethral and Rectal) Between Each Study Arm for Each Period
Description Incidence rate of new Ct cases in each allocation arm (LCM and placebo) for each study period of 3 months.
Time Frame 3-month period following each intervention

Outcome Measure Data

Analysis Population Description
Intention-to-treat population. LCM (intervention) has a total of 195 participants (121 during the first 3 months and 74 during the last 3 months). The placebo arm had a total of 196 participants (119 during the first 3 months and 77 during the last 3 months).
Arm/Group Title LCM (Intervention) Placebo
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex
Measure Participants 195 196
First 3 months
19
18
Last 3 months
11
10
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection LCM (Intervention), Placebo
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.774
Comments
Method Mixed Models Analysis
Comments
Method of Estimation Estimation Parameter Incidence rate ratio
Estimated Value 1.09
Confidence Interval (2-Sided) 95%
0.61 to 1.95
Parameter Dispersion Type:
Value:
Estimation Comments
4. Secondary Outcome
Title Difference in Incidence Rate of Syphilis Between Periods on LCM vs. Placebo
Description Incidence rate of new syphilis cases in each allocation arm (LCM and placebo) for each study period of 3 months.
Time Frame 3-month period following each intervention

Outcome Measure Data

Analysis Population Description
Intention-to-treat population. LCM (intervention) has a total of 195 participants (121 during the first 3 months and 74 during the last 3 months). The placebo arm had a total of 196 participants (119 during the first 3 months and 77 during the last 3 months).
Arm/Group Title LCM (Intervention) Placebo
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex
Measure Participants 195 196
First 3 months
2
6
Last 3 months
4
4
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection LCM (Intervention), Placebo
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.323
Comments
Method Mixed Models Analysis
Comments
Method of Estimation Estimation Parameter incidence rate ratio
Estimated Value 0.59
Confidence Interval (2-Sided) 95%
0.2 to 1.63
Parameter Dispersion Type:
Value:
Estimation Comments
5. Secondary Outcome
Title Proportion of Days That Mouthwash is Used on a Daily Basis and Proportion of Casual Sex Contacts When Mouthwash is Used Pre or Post Sex
Description Daily: Proportion of days in study used mouthwash at least daily Post sex: Proportion of casual sexual contacts in study when mouthwash used post sex. Pre sex: proportion of casual sexual contacts in study when mouthwash used pre sex
Time Frame 6-month period

Outcome Measure Data

Analysis Population Description
Intention-to-treat population.LCM (intervention) has a total of 195 participants (121 during the first 3 months and 74 during the last 3 months). The placebo arm had a total of 196 participants (119 during the first 3 months and 77 during the last 3 months).
Arm/Group Title LCM (Intervention) Placebo
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex
Measure Participants 195 196
0-24%
11
6.4%
14
8.2%
25-49%
8
4.7%
9
5.3%
50-74%
17
9.9%
14
8.2%
75-100%
80
46.5%
79
46.2%
Missing
5
2.9%
3
1.8%
0-24%
6
3.5%
6
3.5%
25-49%
4
2.3%
5
2.9%
50-74%
9
5.2%
11
6.4%
75-100%
15
8.7%
9
5.3%
Missing
40
23.3%
46
26.9%
0-24%
30
17.4%
36
21.1%
25-49%
15
8.7%
18
10.5%
50-74%
20
11.6%
19
11.1%
75-100%
49
28.5%
41
24%
Missing
7
4.1%
5
2.9%
0-24%
19
11%
13
7.6%
25-49%
13
7.6%
15
8.8%
50-74%
13
7.6%
18
10.5%
75-100%
25
14.5%
24
14%
Missing
4
2.3%
7
4.1%
0-24%
31
18%
38
22.2%
25-49%
16
9.3%
16
9.4%
50-74%
22
12.8%
26
15.2%
75-100%
45
26.2%
34
19.9%
Missing
7
4.1%
5
2.9%
0-24%
22
12.8%
14
8.2%
25-49%
13
7.6%
17
9.9%
50-74%
14
8.1%
18
10.5%
75-100%
21
12.2%
21
12.3%
Missing
4
2.3%
7
4.1%
6. Secondary Outcome
Title Difference in Incidence Rate of Ng Plus Ct Plus Syphilis Between LCM and Placebo After Controlling for Adherence With Daily and Pre/Post Sex Mouthwash
Description Incidence rate of Ng, Ct and syphilis between both groups (LCM and placebo) post controlling for adherence to mouthwash
Time Frame 3-month period following each intervention

Outcome Measure Data

Analysis Population Description
Intention-to-treat population. LCM (intervention) has a total of 195 participants (121 during the first 3 months and 74 during the last 3 months). The placebo arm had a total of 196 participants (119 during the first 3 months and 77 during the last 3 months).
Arm/Group Title LCM (Intervention) Placebo
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex
Measure Participants 195 196
First 3 months: Any STIs
36
20.9%
33
19.3%
First 3 months: Chlamydia
19
11%
18
10.5%
First 3 months: Gonorrhea
19
11%
17
9.9%
First 3 months: Syphilis
2
1.2%
6
3.5%
Last 3 months: Any STI
27
15.7%
21
12.3%
Last 3 months: Chlamydia
11
6.4%
10
5.8%
Last 3 months: Gonorrhea
14
8.1%
8
4.7%
Last 3 months: Syphilis
4
2.3%
4
2.3%
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection LCM (Intervention), Placebo
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.279
Comments
Method Mixed Models Analysis
Comments
Method of Estimation Estimation Parameter Incidence rate ratio
Estimated Value 1.21
Confidence Interval (2-Sided) 95%
0.86 to 1.72
Parameter Dispersion Type:
Value:
Estimation Comments
7. Secondary Outcome
Title Difference in Cumulative Numbers of Antibiotics Used Between Periods on LCM vs. Placebo
Description Cumulative number of antibiotics used between both groups (LCM and placebo) for each period
Time Frame 3-month period following each intervention

Outcome Measure Data

Analysis Population Description
The overall number of participants analyzed is for both study periods. The number analyzed per row is the number of participants analyzed per period. LCM (intervention) has a total of 195 participants (121 during the first 3 months and 74 during the last 3 months). The placebo arm had a total of 196 participants (119 during the first 3 months and 77 during the last 3 months).
Arm/Group Title LCM (Intervention) Placebo
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex
Measure Participants 195 196
Month 3
49
28.5%
55
32.2%
Month 6
39
22.7%
35
20.5%

Adverse Events

Time Frame Adverse events and serious adverse events were collected over the whole study duration (6 months)
Adverse Event Reporting Description Adverse events are reported per intervention. LCM (intervention) has a total of 195 participants (121 during the first 3 months and 74 during the last 3 months). The placebo arm had a total of 196 participants (119 during the first 3 months and 77 during the last 3 months).
Arm/Group Title LCM (Intervention) Placebo
Arm/Group Description Mouthwash with Listerine Cool Mint: Subjects will mouthwash daily with LCM and before/after sex. The total of participants at risk for the LCM intervention is 195 (121 in first 3 months and 77 in last 3 months). Mouthwash with placebo: Subjects will mouthwash daily with placebo and before/after sex. The total of participants at risk for the LCM intervention is 196 (119 in first 3 months and 74 in last 3 months).
All Cause Mortality
LCM (Intervention) Placebo
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/195 (0%) 0/196 (0%)
Serious Adverse Events
LCM (Intervention) Placebo
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 1/195 (0.5%) 3/196 (1.5%)
Infections and infestations
Ludwig Angina 1/195 (0.5%) 1 0/196 (0%) 0
HIV 0/195 (0%) 0 1/196 (0.5%) 1
Psychiatric disorders
Suicidal depression 0/195 (0%) 0 1/196 (0.5%) 1
Reproductive system and breast disorders
Testis carcinoma 0/195 (0%) 0 1/196 (0.5%) 1
Other (Not Including Serious) Adverse Events
LCM (Intervention) Placebo
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 45/195 (23.1%) 30/196 (15.3%)
Gastrointestinal disorders
Dental caries 19/195 (9.7%) 19 12/196 (6.1%) 12
Tooth discoloration 26/195 (13.3%) 26 18/196 (9.2%) 18

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

Results Point of Contact

Name/Title Dr. Chris Kenyon
Organization Institute of Tropical Medicine Antwerp
Phone +32(0)32470786
Email ckenyon@itg.be
Responsible Party:
Institute of Tropical Medicine, Belgium
ClinicalTrials.gov Identifier:
NCT03881007
Other Study ID Numbers:
  • ITM201801
First Posted:
Mar 19, 2019
Last Update Posted:
May 7, 2021
Last Verified:
Apr 1, 2021