srider

PrEP taken daily approaches 100% reduction in HIV transmission. If you miss a dose, it's probably fine. For trans men, frontal sex requires daily dosing as the genital tissue doesn't absorb as well as the rectum.

Just remember that PrEP is better than nothing or condoms at HIV prevention.

Also, I can assure you that there are very few PrEP failures.

Also, we do know long term side effects, there can be kidney, liver or bone mineral density problems. But these should be monitored by your prescriber.

I agree it could possibly be LGV. You should ask for a test of cure and doxycycline 100 mg orally twice a day x21 days. They should also do a rectal exam to rule out other causes. 

On 3/27/2019 at 8:12 PM, concerned1 said:

Can you explain what you mean exactly by not in line with current practice?

Usually a titre of 10 or greater is immune to HBV. And the kidney function issue, there may be greater benefit to PrEP than the risk of harm to your kidney. You'd have to discuss with a MD/NP to see about your specific situation though. 

On 3/27/2019 at 10:43 AM, Chargedup said:

I’m always at 1.1 sometimes non reactive 

 

That's not uncommon.

On 3/27/2019 at 11:23 AM, Pigmut said:

Is HPV immunization successful if done above age 50 ?

For most people the benefits outweigh the risks. It hasn't really been studied in that population. Discuss with your MD, but I think it is a good idea. 

On 3/15/2019 at 1:30 PM, concerned1 said:

I went to the sexual health clinic today and i got 3 more months supply of PrEP. 

But some bad news. The nurse asked me if I have ever been vaccinated against Hep B, and I said yes. I had the full course of 3 injections in 2013. I told him this, and he said "Well it hasn't worked very well. You've got very low immunity." And he said my number was 17. I didn't understand and I asked him what that meant. Basically, he said anything between 0 and 10 means you've got no immunity...and over 100 means you have strong immunity. So at 17, I have very low immunity. So I'm having to go through another 3 jabs for the Hep B. 

And this isn't all. He said my liver function tests (which had been taken during my initial PrEP consultation) had shown creatinine levels which were very high...112. I said I was concerned and he said "yes, you are right to be. It could indicate you have something seriously wrong with your kidneys, I'm afraid"....and he did some rapid testing of my urine but fortunately it showed nothing serious going on. He did say that it will have to be closely monitored, that he hoped creatinine levels will go down but it's not garaunteed that they will...he said if they remain this high over a long period of time or even if they go up, then he will refer me to a doctor who he said will most likely seriously consider whether I should come off PrEP  

We'll have to see what happens. So I learned I'm not protected against Hep B like I thought I was AND that there's a strong possibility that I might have to come off PrEP soon. What sad news to recieve after being on PrEP for only 3 months and just as I've started to enjoy barebacking without any fear or anxieties (due to being on PrEP).  

You may want a second opinion on both of those suggestions. This is not medical advice, and there may be specific circumstances that lead the nurse to their conclusions, but it doesn't seem in line with current best practice for HBV vaccination and kidney function. 

Glad to hear you got it sorted. 

On 3/19/2019 at 6:06 PM, wildbottom said:

I have Syph myself - here's what I can tell you.  If you have it, you're never cured - you'll hear about "viral load" which is not just an HIV term, when the viral load drops to a certain point it's considered in remission.  Those figures mean when blood with Syph in it is analyzed, it is still detectable after they've thinned the blood 64 times, 32 times, 16 times, 8 times, etc.  My syph was diagnosed in July of last year (along with Hep B), was latent and tested 1/64 by the time they found it, so it wasn't contagious but it had a long time in me - I was treated (3 shots of penicillin over a 2 week period) and I've been monitored every 3 months since it is now at 1/16 - I just so happened to see my doctor today and she was happy with the drop - said it will soon be undetectable and no longer a problem. She is ready to put me on a preventative dose of 100mg Doxy daily to lessen the chances of Syph, Chlam and Gono.  Hep B, by the way, is similar - you're never cured, but in 75% of all cases here in the US the liver takes care of it for you and puts it into remission.  She's checking my viral load  this week and if it's low enough she'll have me get a Hep B immunization.  FYI - she gave me an HPV immunization today and is ready to put me on PrEP when I say go.. I'm getting as bulletproof as possible little by little.

Syphilis is cured through penicillin (or another antibiotic). The bloodwork is not direct detection or culture. The screen and confirmatory is looking for antibodies. The RPR which is the titre (e.g. 1:16) is also an indirect testing method, which is measuring something released due to damage from syphilis. It's more accurate to say that the test will always be reactive if you have had syphilis in the past. 

On 2/19/2019 at 8:48 PM, Chargedup said:

It means he never got the shots. Should be detected only at 1.1 if he got the penicillin.  He’s highly charged. Get your shots.  

It can take a while for your titre to drop. Some people, especially HIV+, will serofast at higher titre levels.

On 2/19/2019 at 7:45 PM, Cutedelicategay said:

This long weekend I had mind blowing sex with a friend I ran into at a gay bar. He mentioned to me that he was infected with syphilis in March 2018 with titre of 1:32 and treated since. His last test in November 2018 was 1:8 which was 4 fold decline in titres and the doctor declared him cured. His recent test as of last week after November 2018 test showed titre to be 1:16 which is 2 fold increase. The norm is that a person is syphilis positive if there is 4 fold titre increase. I already had my test fir syphilis negative as of beginning of February this year. 

I am really concerned about opportunistic infections and I have booked my doctor's appointment for first week of Mach. My question is how did a 4 fold decline increase 2 fold? Does this mean he is still infected to pass syphilis to me? Of course I am not expecting medical responses unless there is a medical health professional on this forum but out of your experience and research please help me calm down. My research says a 4 fold increase from last titre is infection or reinfection.

Nurse here in Canada with lots of syphilis experience for context. 

There are likely two possibilities, the margin of erroe for the test is a 1 dilution or a 2-fold difference. Therefore a 1:8 and 1:16 could be just down to the lab tech's interpretation. 

Alternatively, he could have been re-infected with syphilis and it was incubating and that represented a true increase and if he doesn't receive treatment a repeat test in 2-4 weeks would be a much higher titre. 

For yourself, if you had a non-reactive syphilis test, repeat in 2-4 weeks from that time. If you were infected the serology would become reactive by that point. Also, if you have a chancre at the site of exposure, swollen lymph nodes, a rash, or neurological symptoms that may be indicative of a syphilis infection. 

18 hours ago, Rendae said:

I’m HIV negative but have been engaging with a partner who is Poz.

Is there a cut off or number where transmission is more definite? Just found out sexual partner is not actually undetectable, but has, what he calls, a low viral load of 6350 and a cd4 of 310. What are my chances of transmission after multiple hookups?

With that viral load there is the possibility of sexual transmission. If it was in the last 72 hours, you could start PEP. You may want to go to your healthcare provider or a sexual health clinic to discuss options for testing.

At this point the most important thing is to find out your status. If you are HIV+ there are lots of supports and if you go on medication you can live a long and healthy life. If you are HIV- you should strongly consider going on PrEP.

On 2/10/2019 at 9:41 PM, bihairy said:

So do you think PrEP could be used as PEP?

No, the medication is different. 

7 days is more than enough time. Nurse here who works in sexual health. 

Go see a doctor and have them do a rectal exam. Also, consider getting tested for rectal chlamydia and gonorrhea. Ask specifically for LGV testing in case they don't do it automatically for rectal chlamdyia. 

In most cases the lab is the one that reports it, not the healthcare provider. Some health departments don't call people routinely, they just collect the data and monitor to make sure others are doing their job correctly. 

Lol I find it funny you are concerned about the health deparment calling you. As that's actually what I do as a job. We collect data to reduce spread of communicable disease. We also make sure you were treated correctly, as some healthcare providers don't follow guidelines. We also provide counselling in case your healthcare provider is sex negative. As annoying as it may be, we do much more good than the harm from your lack of privacy. 

He has an injection there, plus pills but in one tablet. There is a tablet form of a similar medication to ceftriaxone, but in many parts of the world there is gonorrhea resistance to the pill form. 

Taking azithromycin for that long of a time will probably give you a lot odlf stomach issues.

There is no vaccine for Hep C. There is treatment and you can be reinfected. 

If you are in the midst of taking doxycycline then you reduce the risk of chlamydia and syphilis (there was study thar found doxy prep reduced infections but did not eliminate them). Gonorrhea is usually resistant to doxy.

Azithromycin stays in your system 2-3 days, so it might help right afterwards. 

Benzathine Penicillin G is long acting over a week. It prob gives protection from syphilis in the first few days. 

Ceftriaxone is short acting so probably not much past the first day. 

Reinfection is quite common and the best bet is to test regularly and go for treatment if symptomatic. 

Also syphilis shouldn't cause scars. Primary stage is a chancre (painless raised bump at site of inoculation), secondary is classically a self-resolving rash that typically is on the trunk, hands and feet, early and late latent are asymptomatic. If it goes untreated, neuro, cardiac or gummatous (skin lesions) can develop. Of course, syphilis can present differently in each person. 

Go to MedsExpert in the village and they can advise you.

Alright a few things about syphilis - many doctors don't have a lot of experience with it. To clear up some confusion about syphilis.

Syphilis that has been adequately treated does not flare up again without re-exposure. First line treatment for primary (chance), secondary (rash, lymph swelling, etc.) and early latent (confirmed non-reactive within last 1 year) is one dose of 2.4 million units benzathine penicillin (bicilin) and for late latent (greater than 1 year since last non-reactive) is three doses over 3 weeks of 2.4 million units bicilin. Syphilis is easy to transit on physical contact with intact skin or mucous membranes. It is generally considered non-infectious when symptoms resolve or within 7 days if no symptoms. The RPR drop for adequate treatment depends on the stage of syphilis but if you have an RPR greater than 1:8 after a while then you should be evaluated by a healthcare provider who is knowledgeable about tertiary syphilis. The 1:16 in isolation means nothing. 

Did they test you for LGV? If not, ask about that.

And when you say you were cured are you certain? Did they perform a test of cure? 

This may seem silly but clean your sex toys, douche, etc as they can harbor chl.

If you have regular partners check to see if they get tested and treated 

I love Andy Star. I want to rough his hole up hard. 

You probably won't get too many breeders out that way. You'd be better off at a sleazy hotel downtown.