Hi, I’m Dr. Jonathan Ti from Dr. Tan and Partners, and today I’d like to talk about HIV PrEP.
PrEP stands for Pre-Exposure Prophylaxis, and it has emerged in recent years as one of the most effective ways to prevent HIV infection. Individuals taking PrEP can reduce their risk of getting HIV by upwards of 95%. This type of medication must be taken before any risk exposure to be effective. It is different to Post-Exposure Prophylaxis, or PEP, which is taken immediately after a possible exposure and uses additional medications.
PrEP is usually taken as a once daily tablet, a combination of antiviral drugs tenofovir and emtricitabine. Other types of dosing regimens are available as well, depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density, especially with the older version of medication called Truvada. The US FDA recently approved a newer drug called Descovy for use as PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for kidney and bone toxicity. The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters target cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity and side effects.
HIV PrEP is recommended for individuals who belong to a high-risk group for HIV infection, and who do not have any current established HIV infection. HIV high-risk groups may include:
Someone who has an HIV-positive partner
Someone who has multiple sex partners, a partner with multiple partners, or a partner whose HIV status is unknown and does not practice safe sex; there is higher risk in men who have sex with men or transgender women
Someone who has sex with commercial sex workers
Someone who has recently had a sexually transmitted disease
Someone who injects drugs, or has unprotected sex with someone who injects drugs
Both Truvada and Descovy are available in our clinics. They are only available by prescription. Please speak to our Doctors if you think PrEP is right for you.
https://www.dtapclinic.com/wp-content/uploads/2020/10/Generic-Doctor-Image-01.png10811920Miri Yeohttps://www.dtapclinic.com/wp-content/uploads/2021/06/DTAP_FINAL-Logo_Tagline-1ab-1.pngMiri Yeo2021-01-12 17:15:582022-02-21 18:49:16HIV PrEP & HIV PEP For HIV Prevention
HIV Pre-Exposure Prophylaxis (PrEP) is the use of medications to effectively prevent the transmission of HIV. Individuals who are taking PrEP can reduce their risk of contracting HIV infection by up to 99% if taken regularly. This type of medication must be taken before exposure to be effective. It is different from Post-Exposure Prophylaxis (PEP), which is taken immediately after possible exposure and uses additional medications.
PrEP is usually taken as a once-daily combination tablet of tenofovir disoproxil fumarate (TDF) + emtricitabine (brand name: Truvada), although other types of dosing regimens are available as well depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density.
FDA Approved
The FDA recently approved a new drug combination of tenofovir alafenamide (TAF) + emtricitabine (brand name: Descovy) for use as PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.
The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as the kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity.
The DISCOVER trial for Descovy as PrEP showed that the new drug is as effective as Truvada in preventing HIV transmission in men or transgender women who have sex with men, when taken as a once-daily tablet. They have not yet performed specific studies to evaluate protection in vaginal sex, or with other PrEP dosing schedules (such as Event-Based Dosing, T’s and S’s, etc.).
However, given that Descovy is essentially just a new and improved Truvada (which has been extensively studied in these situations), it is likely just a matter of time before further studies are done and show similar efficacy.
Descovy also includes a warning in usage as PrEP for patients with known hepatitis B infection, stating a potential risk of hepatitis B exacerbation after stopping the drug. While it can still be used as PrEP in patients with a history of hepatitis B infection, close monitoring of liver function and hepatitis B viral load for up to 6 months following discontinuation of Descovy is recommended (same as Truvada).
Speak To Our Doctors Today!
Descovy is currently available in all Dr Tan & Partners (DTAP clinics) in Singapore. It is a prescription-only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you. Dr Jonathan Ti, MB, BCh, BAO (Ireland), MRCP (UK), Cert. Men’s Health, is a member of the Singapore HIV PrEP Taskforce and is a co-author of the Singapore HIV PrEP Guidelines and is currently practising at our Robertson Walk Clinic.
HIV PrEP does not protect the user against other STDs. Therefore, even if you are on HIV PrEP, it is important to still to use a condom regularly, as well as get your regular STD screening & HIV Testing.
https://www.dtapclinic.com/wp-content/uploads/2018/09/What-is-HIV-PrEP-Event-Driven-Based-HIV-PrEP-Strategy.jpeg338708Miri Yeohttps://www.dtapclinic.com/wp-content/uploads/2021/06/DTAP_FINAL-Logo_Tagline-1ab-1.pngMiri Yeo2019-09-14 13:12:002022-02-21 19:33:05Descovy As New HIV Medication For HIV PrEP
The neighbouring country has just built a wall to keep outsiders out. These outsiders do not have a passport and are trying to get over the wall through different means. The HIV virus is one of these outsiders, they will try all means to get across the wall
We will discuss in this article, the vehicles the HIV virus can adopt to get over your wall. From taking a plane and DEFINITELY getting over the wall, to taking a ship around the border and MAYBE getting around the wall and lastly climbing over the wall which is NOT possible.
The HIV virus will need a vehicle to get past the wall and in the medical context, the HIV virus from a positive person will need to come into contact with a negative person. The fluids which carry the most viruses are blood and semen whereas saliva and vaginal fluid hold much less of the HIV virus. DEFINITELY getting over the wall – definite transmission, for every 10,000 attempts this will be the number of times successful the HIV virus will get over the wall and cause infection during that activity
Blood transfusion – 9250/10000 (although this is rare, it still happens: https://www.bbc.com/news/world-asia-india-36457517).
Needle sharing in intravenous drug use – 63/10000.
Needlestick injury – 23/10000.
Receptive anal sexual intercourse – 138/10000.
Insertive anal sexual intercourse – 11/10000
Receptive penile-vaginal sexual intercourse – 8/10000
Insertive penile-vaginal sexual intercourse – 4/10000
Receptive and insertive oral sexual intercourse – low (too low for accurate numbers).
According to the Singapore Ministry of Health UPDATE ON THE HIV/AIDS SITUATION IN SINGAPORE 2014.
Estimated risk per exposure to HIV transmission: assume that the ‘source partner’ is always HIV-positive. For a partner of unknown status, the risk is affected by the prevalence of HIV in the relevant community – i.e., the chance that the partner does, in fact, have HIV. Unless otherwise stated, the sexual acts are always without a condom.
MAYBE getting around the wall – theoretical situations where there isn’t enough scientific data on where the HIV virus may get around the wall
Presence of blood getting into contact with an open wound, ulcer – this is a possibility but the risk is lower and unlikely. Open wounds should be treated early to reduce the risk of other infections such as bacterial infections. The risk of bacterial infections into an open wound is often higher than the risk of an HIV infection.
Blood getting into contact on mucosal membrane surfaces such as the eyes or mouth – this is again a possibility, but extremely unlikely
Dried blood on surfaces – some studies have shown that the HIV virus can survive in dried blood for a few days. However for that blood to infect another person, it would have to cross a thick layer of the person’s skin, mucous membranes and get into the bloodstream. The environment has to favourable for this to happen and transmission through dried blood is often very unlikely.
NO WAY of getting over the wall – not possible for transmission
Being in the same room as an HIV positive person and breathing the same air
Sitting on a toilet seat or touching a door handle
Hugging, Kissing (not french kissing), Shaking hands
Drinking from the same water cooler, water fountain
Sharing of food utensils.
Sharing equipment at the gym
Biting or scratching superficially that does not break the skin surface or draw blood.
Skin to skin contact with another person
We hope this short illustration answers and highlights questions people may have over possible ways of HIV transmission. Fluid-fluid contact is necessary for transmission and without this, there is NO risk for HIV transmission.
If you have any new questions, please feel free to ask them on https://www.dtapclinic.com/forum/ Take Care!
Nearly every day here I see a person who is super anxious and has put their life on hold for anywhere from a month to three months in fear that they have contracted HIV from a momentary lapse of judgement. You can lose sleep, your appetite, your hair can fall, you can be visibly emaciated as well with this amount of stress in life on a daily basis for such a long period.
When it comes to staying safe against HIV in a lifestyle where one is exposed to the virus, it is crucial that one adopts multiple precautionary measures against transmission of HIV.
Apart from choosing partners wisely (we always encourage STI testing prior to being sexually active with someone) and using condoms, there is an additional safety precaution when it comes to safeguarding yourself against HIV transmission.
So in this article, let’s talk about the HIV medication you can take to help protect yourself against HIV. Basically, this is a lifestyle choice that you’d have to make based on as much information as possible. Let’s go over some of the details right.
First off, what is HIV and why are we so worried about it?
Would you like to hear the scary part first? Basically, after decades of studying the virus, we still do not have a cure for it. Now, that doesn’t mean everyone with HIV will die of HIV complications but more that if you do pick up HIV sometime in your life, chances are you’ll die with the HIV still in you. How’s that for a daily nightmare?
HIV Infection
HIV stands for Human Immunodeficiency Virus. HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Now, once the virus starts infecting the cells, it goes on a continuous rampage of self-replication and destruction. Basically the more of the virus that is present, the worse of an infection it can create. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. Untreated, HIV reduces the number of CD4 cells (T cells) in the body. This damage to the immune system makes it harder and harder for the body to fight off infections.
So imagine your body is fighting a losing battle with HIV, other bacteria, virus and fungi know that your body is already weakened and they do attack the body at that time. These are called opportunistic infections.
So in combination of HIV and opportunistic infections (see: 10 Common HIV Opportunistic Infections), the body gets worn down over time until it succumbs to these infections.
What is AIDS (Acquired Immuno-Deficiency Syndrome)?
AIDS is the most severe phase of HIV infection; basically, it’s the bigger, older, more aggressive older brother that will stop at nothing until your organs cease to function as intended.
HIV mode of transmission
Only certain body fluids—blood, ejaculate or pre-ejaculate material, rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. Bear in mind that a simple contact or a touch gesture does not guarantee transmission of the virus. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur.
How Would I Know if I Picked Up the Virus?
Acute Retroviral Syndrome (ARS) – Initial HIV symptoms
There are a few stages to an HIV infection. The very first few symptoms can occur within five to 12 days of exposure to the virus. This is the ARS (Acute Retroviral Syndrome) phase. Now this stage is particularly challenging to diagnose because more often that now, you wouldn’t even go through this phase.
In the off chance that you do have ARS, the symptoms can be so vague and misleading that it may be discarded as something completely different if you do not provide a history of a situation where you might have picked up HIV.
If at any time after a potential exposure episode you happen to develop features as listed below, it would be wise to seek medical attention as soon as you can.
Fever – This is usually a high-grade temperature (>38.5) accompanied with chills, tremors, and the occasional night sweats
Rash – Look out for an upper chest angry rash that is reminiscent of a chicken pox rash. Think red, fast growing, vesicular like rashes that can be painful or uncomfortably itchy in general.
Muscle aches – That feeling that your body is heavy and you just don’t want to get out of bed.
A sore throat
Swollen lymph nodes – Look out for any abnormal swelling around your neck, behind your neck and under your armpits especially
Mouth ulcers
So ideally these HIV symptoms will all come in about the same time with a recent history of potential exposure. This can prompt your physician towards a diagnosis of HIV ARS.
It’s also important to recognise which stage the virus is in so we can expect certain infections and treatment with the aim of covering as wide a net as possible when dealing with HIV.
That being said, we’re here to emphasize protecting yourself against HIV instead of being vulnerable to it and its effects on life in general. As I earlier mentioned, nearly every day we see people who lose weeks worth of sleep being so anxiously paranoid that they might have picked up HIV.
The ideal would definitely be the prevention of HIV transmission to begin with.
We’ll start with Pre-Exposure Prophylaxis (PrEP)
This is where the modernisation of medicine plays a huge part in society. The idea of Pre-exposure prophylaxisor PrEP is that it works similar to how a vaccine would in terms of offering protection against a disease.
The premise is simple. You take a tablet once a day and if taken correctly; combined with safe sexual practices, and there are no other complications, there is an up to 99% chance you will not get HIV if ever exposed to the virus. HIV PrEPis basically using anti-retroviral medication (basically HIV medications) to prevent the acquisition of HIV infection by an uninfected person. PrEP is offered here in the form of a combination tablet containing tenofovir and emtricitabine (both medications we use to treat HIV).
Descovy As New HIV Medication For HIV PrEP
Descovy (brand name) is a FDA approved new drug combination of tenofovir alafenamide (TAF) + emtricitabine for use as HIV PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.
Descovy is currently available in all Singapore DTAP clinics only. It is a prescription-only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you.
Can Anyone Take HIV PrEP?
HIV PrEP was initially created for people who are in the high risk group for contracting HIV. This included people whose spouses were HIV positive. Trying to have a healthy relationship is trying enough as it is. HIV PrEP allows for intercouse with a significant less amount of stress and worries about contracting HIV.
Among other people who are in this high risk group include people who:
are sexually active in the last 6 months and NOT in a sexually monogamous relationship with a recently tested HIV-negative partner, and who
has had a sexually transmitted infection in the past 6 months
or is a sexually active adult (male or female with male or female partners), and who…
is bisexual (riskier if you have a very active sex life with multiple partners at the same time)
has sex with partners at increased risk of having HIV (e.g. injection drug users, men who have sex with men) without consistent condom use.
As we have evolved into prescribing PrEP, we realised that the level of protection it offers should not be confined to a certain group of people but to anyone who is wanting that added layer of protection against HIV transmission.
So really, all you have to do is to speak to your doctor, undergo a few simple tests to ascertain that you are healthy and have had no exposure to HIV prior to that before starting PrEP.
When you first start PrEP you may experience side effects like:
nausea
dizziness
headaches
fatigue
stomach cramps
More serious side effects include:
kidney problems, including failure
Liver problems
Reduced bone density
This is why, when on PrEP, it is important to regularly monitor the health of the organs that can be affected by this medication. We’ll have to get regular blood and urine screening is done with regular HIV testing and also bone scans if necessary in some cases. It is always best to continue on these medications with the advice of a physician.
Both our Robertson Walk (Singapore) & KL Eco City (Malaysia, Kuala Lumpur) provide Anonymous HIV Testing if you wish to keep your HIV status anonymous.
Frequently Asked Questions of HIV PrEP
1. Can I get STD even if I am on PrEP?
Yes, of course. HIV is just one type of a STI. There are other STI that aren’t even viruses but are bacteria. In these situations, taking PrEP is irrelevant to the situation. PrEP is designed to protect you against specifically HIV, not all STIs.
2. Do I still need condom even if I am on PrEP
Safe sex practices are always encouraged regardless if you are on PrEP or not. Basically, it is better to be safer really. Using a condom adds another barrier of safety in terms of picking up an HIV infection so really, why compromise on that?
3. Do I need regular HIV testing?
This is indeed encouraged. Its best to go for regular routine check-ups & HIV Testing and discuss your lifestyle and potential risk encounters with your physician to clarify any doubts. We’d also need to confirm that you are not already exposed to the virus before or during your time on PrEP.
4. When can I stop PrEP?
Basically, you can determine that. At any time when you see your lifestyle as not posing a risk of you contracting HIV, you may decide to stop taking the medication. There is no hard and fast rule to this. You can be taking the medications for months or decades if you choose to do so.
Either way, it is imperative that you are safe and in good health whilst taking the medication.
5. Do I have to take it on a daily basis?
Taking PrEP on a daily basis is recommended. This is to ensure compliance to the medication and to allow it to build some sort of protection against the virus. However, if your lifestyle does not call for it, you can choose to do event-based dosing where you take a total of four tablets spaced out over four days before and after a risky encounter.
Obviously, this is less stable a method of acquiring protection against HIV but it is an alternative to people who choose not to take medications on a daily basis ie people who have sexual encounters infrequently.
Here’s a video on Event Based Dosing for HIV PrEP
Now what is HIV Post-Exposure Prophylaxis (PEP)
So now that we have covered PrEP, let’s move on to PEP (Post Exposure Prophylaxis). This is again a very similar ideology to PrEP where we aim to provide as much protection against transmission of HIV to you. Where it differs is that pre-exposure means before an incident that potentially made you vulnerable to HIV whereas post exposure is the period immediately after you have been potentially exposed to the virus.
Early on in this article, I recounted my experiences dealing with very anxious clients who have lost a weeks worth of sleep because they had to wait out the window period to test for HIV (this is at the least ten days).
This is where PEP comes into play. If for whatever reason you feel that you have been exposed to HIV, come in, see your doctor and get PEP prescribed to you within 72 hours of that and if taken correctly, there is an up to 99% chance you will not get infected with HIV.
See the difference? Immediate action within 72 hours after an HIV potential exposure episode can save you weeks worth of anxiety.
So let’s recap what some potentially dangerous incidences are, shall we? If you are in a position where:-
you think you may have been exposed to HIV during sex (for example, if the condom broke), or if you are unsure about your partner’s status
there was an abnormal exchange of body fluids – exposed to blood during intercourse or you noticed open cuts and active bleeding from your partner
shared needles and works to prepare drugs (for example, cotton, cooks, waiter, medical personnel), or
were sexually assaulted
All of the above are just some examples of a risky contact situation which can potentially transmit HIV to you and these are situations where if you have not already been on PrEP, it is advised to get PEP to safeguard against HIV infections.
How do I take PEP?
HIV PEP is a combination of three drugs likely given to you in two tablets. This is similar to PrEP but with the addition of another agent to the regime. Like aforementioned, time is of the essence when it comes to PEP so be quick to get to it and start taking it well within the 72 hours golden period for the best results.
The medications should be taken once or twice daily for a minimum of 28 days consecutively. Keep in mind that this is crucial. Missing out on one dose or even worse, one day’s worth of PEP is definitely not advisable. (HIV PEP is available in all our clinic in Singapore and Malaysia)
How does PEP work?
Essentially, PEP will prevent the replication of HIV in the body. When it cannot replicate, it cannot create a strong enough infection to overwhelm the body’s immune system. Ideally, that will result in the virus eventually dying off because it is unable to further survive in the body with its presence there being insignificant.
How would I know if PEP worked?
As with any medication, we will have to do pre and post therapy testing. Prior to starting PEP, it is ideally advised to get HIV testing done to make sure you have not already been exposed to HIV. Once you have started the medication, try and take them at the same time everyday for at least 28 consecutive days then we’ll have to get you tested within the next two months.
If throughout that time you appear to be well and there is no evidence of HIV picked up in your tests, we can clear you from that particular incident.
Side effects of PEP?
Because the medication regime is somewhat similar to PrEP, you can expect a similar range of side effects but this may be amplified somewhat. Apart from that, it is fairly undramatic.
Can HIV PEP fail?
Yes, unfortunately, there have been reported cases of PEP failure. This means that even with taking medications, the client still got a HIV infection. This is not common and is usually linked to poor compliance or a pre-existing medical condition that may impair the way PEP works.
All in All
To summarise, there are ways to protect yourself from potentially deadly viruses like HIV. You have to be in the know and be responsible for your own health in terms of how you choose to live your life and how to best be safe in it.
As a physician, I am glad to help you out in every step of the way in getting you as safely healthy as possible while allowing you to lead the life you feel will make you happiest and to achieve your full potential.
It is certainly debilitating to catch a virus like HIV when you’re just out doing what you do. It can throw a spanner into your life goals and bring life as you know it into a screeching halt.
Having said that, I hope this article has given you at least a rudimentary idea of how to keep yourself protected and to stay safe. Remember, prevention is always better than cure. Take care.
This Article is Written By Dr. Kaarthig Ganesamoorthy from Our KL EcoCity Branch in Kuala Lumpur.
https://www.dtapclinic.com/wp-content/uploads/2018/11/HIV-PrEP-for-Travel-–-Things-You-Need-to-Know.jpeg6761416Miri Yeohttps://www.dtapclinic.com/wp-content/uploads/2021/06/DTAP_FINAL-Logo_Tagline-1ab-1.pngMiri Yeo2019-01-08 09:22:072022-06-13 16:38:50A Guide To HIV PrEP and HIV PEP - Pills for HIV Prevention
Anal sex, not only consists of penile insertion into the anus (bottom) but also allowing your partner to use his mouth on the anus (analingus) or insertion of fingers and sex toys into the anus.
It is highly recommended to use condoms and lube during anal sex to reduce the risk of contracting a sexually transmitted disease (STD).
What is the STD that you can potentially get from anal sex for Men-Who-Have-Sex-With-Men (MSM)?
1. Chlamydia and Gonorrhea
The reason why we clumped them together in this article is that chlamydia gonorrhoea can present with similar symptoms and may present together in certain patients. These bacteria’s can present in a few ways:
Anal Discharge
Discharge is a term used when liquid is seen coming out of the anus. This is usually very minimal and patients usually notice a small number of stains on their underwear. In very rare situations, the volume may be high and appear yellow in colour. see more of Rectal Gonorrhea
Anal Discomfort
Patients usually present with mild discomfort in the anal region and some of them describe it as a feeling of constant urge to poo. It is never painful, and if patients present with severe pain, it is usually due to haemorrhoids or a tear at the opening of the anus.
Anal Bleeding
This is very rare. If patients present with bleeding, it is usually due to piles or a tear at the opening of the anus.
Lower Urinary Tract Symptoms
The insertive partner (or top) may present with a burning sensation when passing urine, urethral discharge, an increase in urinary frequency, waking up in the middle of the night to pass urine and the feeling of incomplete bladder emptying. However, keep in mind a large proportion of men may not show these symptoms.
It is best to get tested via anal swab or urine test for these bacteria if you have had an exposure as it can be easily treated with antibiotics. Prostate infection and inflammation can be due to non-Sexually Transmitted infections & Sexually Transmitted Infections.
We provide Rapid Chlamydia & Gonorrhea PCR Screening (Next Day Results).
2. Human papillomavirus (HPV)
HPV is, in fact, one of the most common STD’s out there but is less well known. It is usually transmitted through skin to skin contact, through contact with infected mucous membranes or bodily fluids. In other words, condoms will not protect you from this virus. There are many different strains and can cause anal cancer and cauliflower-like growths in the anus and surrounding skin. It is recommended to see a doctor screen for anal warts, or other genital warts because some warts may be inside the anus and may not be visualised externally.
Warts can be treated and you should see a men’s health doctor if you have any suspicious lumps. It is highly recommended for men who engage in anal sex to get the HPV vaccine. Rapid HPV Testing (Next Day Results) is available in our clinics. Check out:How to Get Rid of Warts
There are 2 kinds of herpes virus, HSV type 1 and HSV type 2. These viruses can be easily passed through skin to skin contact, which means condoms have a very limited to a negligible role in reducing the transmission. They usually present in the area of contact with multiple, small and painful ulcers or blisters within a week or sometime months after exposure. If there is any suspicion, the doctor will perform a dry swab to diagnose the lesion. Unfortunately, there is no cure but there is treatment available for flares.
4. Molluscum Contagiosum
Molluscum Contagiosum is caused by a virus call Poxvirus and presented with lesions that may appear anywhere on the body. The lesions are small, raised and usually white or flesh-coloured with a dimple or pit in the centre. The size can range from 2 to 5 mm in diameter and may be itchy or sore. This virus can be passed through skin to skin contact or thru contaminated materials such as clothing, towels, pool equipment or even toys. The good news is that these lesions usually do not cause long-term medical problems and can be easily treated. Water Wart Removal is available in our clinics.
5. Syphilis
Syphilis an STD which is transmitted thru any form of sexual contact. It is caused by a bacteria known as Treponema pallidum. This disease can present in many ways, from a single, big and painless ulcer in the area of sexual contact, to rashes around the body and palms. In certain cases, they can cause an infection in the brain and spinal cord. This symptom can present any time between 9 to 90 days after being infected. The good thing is this disease is usually curable with antibiotics.
6. HIV
The riskiest sexual behaviour for getting and transmitting HIV in men is anal sex. The receptive anal sex is much riskier as the bottom partner’s risk is 13 folds higher than the insertive partner. This virus can pass through blood, semen, pre-seminal fluid (Pre-cum) or rectal fluids.
This risk is higher when recreational drugs are used.
Condoms and HIV pre-exposure prophylaxis (PrEP), if used consistently can reduce the risk of getting HIV significantly. The condom reduces the risk of getting HIV by 63% for the insertive partner and 72% for the receptive partner if they engaged in anal sex with an HIV infected partner.
Yes. it is not 100%!!. PrEP can reduce the risk of getting HIV by more than 90%. If you think you have been potentially exposed to the virus and did not use a condom, you can see a doctor within 72 hours of the exposure to start the HIV post-exposure prophylaxis (PEP) treatment.
Also, a regular HIV Test is recommended if you are sexually active with unknown HIV status partners.
If you think you have had an exposure to HIV or any form of STD thru risky sexual activity, it is recommended you get tested and seek treatment early to reduce any untoward complications and risk of passing it to your partner. Take Care!
https://www.dtapclinic.com/wp-content/uploads/2019/01/STD-CN.jpg14401920Miri Yeohttps://www.dtapclinic.com/wp-content/uploads/2021/06/DTAP_FINAL-Logo_Tagline-1ab-1.pngMiri Yeo2019-01-07 11:43:322022-06-13 15:52:14STD Risk from Receptive Unprotected Anal Sex in Men
HIV Pre-exposure prophylaxis (PrEP) is a combination of 2 HIV medicines, sold under the name of Truvada (Tenofovir and Emtricitabine), when taken daily lowers the chances of a very high-risk HIV negative individual from getting infected with HIV.
Do not mistake this for Post-exposure prophylaxis (PEP) which is taken for 28 days after potential exposure to the HIV virus.
The precept is simple, take one pill a day and you are protected from getting HIV. Also Read: A Guide To HIV PrEP And HIV PEP – Pills For HIV Prevention
7 Frequently Asked Questions on HIV Pre Exposure Prophylaxis (PrEP):
1) How effective is HIV Pre-exposure prophylaxis (PrEP)?
When used daily, it can lower the risk of getting HIV from sexual intercourse by 99%.
The protection against getting HIV from sharing needles is lower at about 70%.
Being on PrEP is NOT AN EXCUSE for going bareback. Using a condom further reduces the risk of getting HIV. Also, PrEP does NOT protect against other STDs. But condoms DO!
Also, remember that medicines work only if they are taken properly. Also Read: STD Symptoms – That You Need to Know
2) How to Take HIV Pre exposure prophylaxis (PrEP)
a. Event-Based HIV Dosing
On-Demand PrEP Regimen:
Planned condom-less sex 24 hours in advance:
Strictly:
take 2 pills 2 – 24 hours before sex
take 1 pill on the day of sex
take 1 pill 24 hours later
If having sex for an extended period of time, perhaps over a few days or a weekend, continue to take a pill every 24 hours until you have 2 sex-free days.
Type:
Only for Anal sex
More studies required to show effectiveness in Vaginal/Frontal sex
Considerations:
This option is not recommended if you have an active hepatitis B infection. The drugs in PrEP also suppress the hepatitis B virus and so starting and stopping HIV PrEP can potentially cause viral flare-ups and liver inflammation.
b. Daily PrEP
Daily PrEP Regimen:
Lead-in time 7 days.
Taken daily at the same time +/- a few hours ok
Type:
Anal, Vaginal/Frontal sex
Considerations:
Can be taken any time of the day with or without food
In the event a pill is missed, adequate protection is still conferred.
c. Ts and Ss (Tues, Thurs, Sat, Sun dosing)
Ts and Ss Regimen:
Daily dosing for 7 days,
then dropping down to 4 pills per week on Tues/Thurs/Sat/Sun
Type:
Only for Anal sex
More studies required to show effectiveness in Vaginal/Frontal sex
Considerations:
If you only have sex once or twice a month, you might not want to take a pill every day.
4 pills per week will maintain a good baseline of the drug in your system and you can choose to increase up to daily 7 pills per week when you know you’re in a more sexually active period.
Some people using PrEP On Demand find that they might be taking 4 pills per week most weeks of the month and so opt for structuring this into the Ts and Ss instead.
d. Holiday PrEP
Holiday PrEP Regimen:
PrEP before a pre-planned block of time when your risk of exposure to HIV will be higher due to:
an increased number of partners of unknown HIV status
situations where condoms are not easily or always used
where alcohol or substances might be used
having sex while travelling to a country with a high HIV prevalence
Based on a 7-day period we recommend 7-7-7:
7 days daily dosing before the period
7 days daily dosing during the period (or for as long as the specific period lasts)
7 days daily dosing after the period.
Type:
Anal, Vaginal/Frontal sex
Considerations:
7 days of PrEP before and after your last sexual encounter for several reasons:
7 days lead-in provides adequate levels for both anal and vaginal or frontal sex.
7 days lead in before the holiday or travel will allow the body to adjust to any possible side effects; most people do not experience any, but should you have side effects, these will usually have subsided within a week.
3. Who should consider HIV Pre exposure prophylaxis (PrEP)?
If your partner is living with HIV
If you are not is a mutually monogamous relationship
If you have been diagnosed with an STD in the past 6 months
4. How long after initiation of HIV PrEP will it then provide protection?
The general rule is that you have to be on PrEP for 7 days before you are protected.
There are ways to speed this up and there are circumstances when this is longer. Please check with our doctor when you consult for your PrEP prescription. Also Read: When To Test For HIV During Or After Completing HIV PEP
5. What are the side effects of HIV PrEP? Is it safe to take it long term?
PrEP is relatively safe. When side effects do occur, most common symptoms are nausea and diarrhoea. Generally, these symptoms usually subside over time. No serious side effects have been recorded and the side effects are never life-threatening.
However, if you do develop side effects that are not improving with time, please contact the doctor that prescribed you the PrEP.
6. How can I purchase PrEP?
You will need to consult a doctor first and he may go through with you your risks based on the type of sexual behaviour. The doctor will also run some blood tests, including HIV, Hepatitis screen, and other blood tests such as full blood count, kidney function test and liver function test. If there are no contraindications, the doctor will then prescribe you PrEP.
Learn more about Anonymous HIV Testing
7. Since PrEP is effective in providing protection, can I not use a condom for oral and anal sex?
Always use a condom. PrEP doesn’t give you 100 per cent protection. Using a condom while on PrEP significantly lowers your risk further. Besides that, HIV PrEP doesn’t protect you against other sexually transmitted diseases (STDs) such as gonorrhoea and chlamydia which can infect the throat, anus and penile urethra.
While on PrEP it is recommended to screen for HIV and other STDs regularly. We provide Rapid HPV Testing & Rapid Gonorrhoea & Chlamydia PCR Testing (Next Day Results). Learn more about Descovy (New HIV Medication For HIV PrEP)
Descovy (brand name) is a FDA approved new drug combination of tenofovir alafenamide (TAF) + emtricitabine for use as HIV PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.
Descovy is currently available in all Dr Tan & Partners (DTAP clinics) in Singapore. It is a prescription only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you.
HIV PrEP is an option for HIV prevention and involves taking medication that can reduce the risk of HIV transmission by up to 95% if taken properly.
Most of the time, Pre-Exposure Prophylaxis, or HIV PrEP for short is taken as a daily tablet and needs to be taken consistently to provide the greatest level of protection.
HIV PrEP is recommended for at-risk groups, including men-who-have-sex-with-men, patients who have a known partner who is living with HIV (PLHIV), or those with multiple partners of unknown HIV status.
What is the difference between HIV PEP (HIV Post Exposure Prophylaxis) & HIV PrEP?
HIV PEP is for any individual who is at risk of HIV infection after an HIV exposed to HIV to take HIV medicines for a month to reduce his or her chances of HIV infection.
HIV Pre Exposure prophylaxis and HIV Post Exposure Prophylaxis do not 100% reduce your chances of HIV infection, nor prevent you from being infected with other Sexually Transmitted Diseases (STDs) besides HIV.
HIV PEP as an HIV prevention strategy was first developed for healthcare workers, who are being exposed to contaminated blood or needles prick. It has since expanded to other HIV high-risk activities such as sexual exposure and intravenous drugs used.
Another development of HIV prevention is by using HIV Pre Exposure Prophylaxis (PrEP) as a strategy to reduce the chances of HIV infection even before any potential HIV exposure.
What is Event Driven Based HIV PrEP Strategy?
Some people may find that taking a daily table is just not suitable for them.
If this is the case, they may consider an option called Event-Based Dosing, or EBD for short.
This entails taking tablets one day before the exposure, the days of exposure, and for one day after the last exposure.
It is a much shorter course of tablets than regular HIV PrEP, and can still provide a high level of protection from HIV, with up to 85% risk reduction.
HIV PrEP is most effective when used in combination with other protective strategies such as condoms and regular STD screening.
Descovy As New HIV Medication For HIV PrEP
Descovy (brand name) is a FDA approved new drug combination of tenofovir alafenamide (TAF) + emtricitabine for use as HIV PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.
Descovy is currently available in all DTAP clinics in Singapore. It is a prescription only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you.
If you are interested in learning more about HIV PrEP or EBD, please come down to our any of our clinics to speak to our doctors, and see if these options are suitable for you. You can learn more about the What is HIV PrEP or HIV Pre-Exposure Prophylaxis.
We can advise you in more detail on the indications, dosage and timing, and potential side effects of the medications, as well as how to follow up with appropriate HIV Testing and STD testing.
Take Care!
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