Sexually Transmitted Diseases. When do I start PREP for HIV ?

 

For confidential advice, diagnosis, and PrEP prescription, consult Dr. Shireen Surtee online at doctorinyourpocket.co.za. Your sexual health is important!

STDs and When to Consider PrEP for HIV in South Africa: Your Online Guide

Let’s talk about Sexually Transmitted Diseases (STDs), also known as STIs (Sexually Transmitted Infections), and the vital role of PrEP (Pre-Exposure Prophylaxis) in preventing HIV. Understanding these is key to your sexual health, and you can get expert advice and support through an online consultation with Dr. Shireen Surtee at Doctor In Your Pocket.

Major Sexually Transmitted Diseases (STDs/STIs) and Their Treatments

Here’s a breakdown of common STDs, what causes them, and how they’re treated:

1. Chlamydia

• Cause: Bacteria (Chlamydia trachomatis)
• Symptoms: Often silent (asymptomatic); might include unusual discharge, burning when peeing, or pelvic/testicular pain.
• Treatment: Antibiotics, typically doxycycline for 7 days or a single dose of azithromycin.
• Important: Both partners must be treated, and you should avoid sex for 7 days after completing treatment.

2. Gonorrhea

• Cause: Bacteria (Neisseria gonorrhoeae)
• Symptoms: Discharge, burning urination, pelvic/testicular pain. Often occurs with chlamydia (co-infection).
• Treatment: Usually an injection of ceftriaxone, often combined with doxycycline if chlamydia hasn’t been ruled out.

3. Syphilis

• Cause: Bacteria (Treponema pallidum)
• Stages & Symptoms:
  • Primary: A painless sore called a chancre.
  • Secondary: Rash, mucous patches, flu-like symptoms.
  • Latent/Tertiary: Can lead to severe neurological and organ damage if untreated.
• Treatment: Penicillin G (injection). Alternatives like doxycycline or tetracycline if you’re allergic to penicillin.
• Important: Regular testing is vital for MSM (men who have sex with men), sex workers, and anyone with multiple partners.

4. Genital Herpes (HSV-1, HSV-2)

• Cause: Herpes Simplex Virus
• Symptoms: Painful sores or blisters, flu-like symptoms, and recurrent outbreaks.
• Treatment: Antivirals (e.g., acyclovir, valacyclovir, famciclovir). There’s no cure, but suppressive therapy can reduce the frequency of outbreaks and the risk of transmission.

5. Human Papillomavirus (HPV)

• Cause: Virus
• Symptoms: Can cause genital warts, and is linked to cervical dysplasia/cancer, as well as anal and throat cancers.
• Treatment:
  • Warts: Cryotherapy (freezing), salicylic acid, or imiquimod.
  • Cancer/Dysplasia: Requires ongoing monitoring or surgical removal.
• Prevention: The HPV vaccine (e.g., Gardasil 9) is highly effective. Ideally given before sexual debut, but still beneficial for individuals up to age 45.

6. HIV (Human Immunodeficiency Virus)

• Cause: Virus
• Symptoms: Initial flu-like illness, followed by a long asymptomatic phase, and later immune suppression (AIDS) if untreated.
• Treatment: Antiretroviral Therapy (ART) – a lifelong but highly effective treatment that manages the virus.
• Crucial Concept: U=U (Undetectable = Untransmittable). If an HIV-positive person’s viral load is fully suppressed by ART, they cannot sexually transmit HIV.
• Prevention: Condoms, PrEP, and PEP (Post-Exposure Prophylaxis).

7. Trichomoniasis

• Cause: Parasite (Trichomonas vaginalis)
• Symptoms: Often affects women, causing frothy, foul-smelling vaginal discharge and irritation.
• Treatment:
  Metronidazole or tinidazole.
• Important: Both partners should be treated to prevent re-infection.

8. Hepatitis B (HBV) and C (HCV)

• Cause: Viruses
• Transmission: Blood, semen, and sexual contact (especially HBV).
• Treatment:
  • HBV: Antivirals (e.g., entecavir, tenofovir). There’s no cure, but it can be managed.
  • HCV: Direct-acting antivirals, which can actually cure HCV in most cases.
• Prevention: There’s an effective HBV vaccine (no vaccine for HCV).

PrEP (Pre-Exposure Prophylaxis) for HIV: Your Shield Against Infection

What is PrEP?

PrEP is a daily or on-demand medication (commonly Truvada or Descovy) that, when taken correctly, prevents HIV infection in HIV-negative individuals. It’s a powerful tool in HIV prevention.

• It reduces the risk of getting HIV from sex by approximately 99%.
• It reduces the risk from injection drug use by about 74%.

When Should You Start PrEP?

PrEP is highly recommended if you are HIV-negative and any of the following apply to you:

• You have sex with someone who is HIV-positive (especially if they are not on ART or are not virally suppressed).
• You are a man who has sex with men (MSM) and has multiple partners or inconsistent condom use.
• You have recently been diagnosed with an STD (especially rectal gonorrhea or syphilis).
• You use condoms inconsistently with new or casual sexual partners.
• You are in a serodiscordant relationship (meaning your partner is HIV-positive and you are HIV-negative).
• You inject drugs and share needles or other injecting equipment.
• You are a sex worker or have high-risk clients.

PrEP Monitoring: Staying Safe and Effective

If you’re on PrEP, regular monitoring is crucial for safety and effectiveness:

• HIV Test: You’ll need an HIV test before starting PrEP and then every 3 months.
• STI Screening: Regular screening for other STIs every 3–6 months.
• Kidney Function Tests: These are usually done every 6 months.
• Adherence: Taking PrEP daily or on a strict event-based schedule is absolutely essential for it to be effective.

Summary Table: STDs at a Glance

STD	Cause	Treatable?	Cure Available?	Vaccine?
Chlamydia	Bacteria	Yes	Yes	No
Gonorrhea	Bacteria	Yes	Yes (some resistance)	No
Syphilis	Bacteria	Yes	Yes	No
Herpes (HSV)	Virus	Yes (manage only)	No	No
HPV	Virus	Yes (warts only)	No	Yes
HIV	Virus	Yes (manage only)	No	No
Trichomoniasis	Parasite	Yes	Yes	No
Hepatitis B (HBV)	Virus	Yes (manage only)	No, lifelong	Yes
Hepatitis C (HCV)	Virus	Yes	Yes (curable)	No