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health lab


by bruce olmscheid, md


HIV Prevention and the Increase in Sexually Transmitted Infections NEED TO KNOW WHAT YOU


PrEP You are probably already aware of a pill you cantake that can prevent you from getting HIV − known as PrEP. The availability of this prevention since 2012 has been a game changer, allowing people to have a healthy sex life without the fear of contracting HIV. In many communities, however, the use of PrEP has been associated with an increase in sexually transmitted infections (STIs). If you are taking PrEP, you will have blood work done every three months to be


sure that you are remaining HIV-negative. At the same time, most people also opt to be tested for other STIs. If you are with someone who tells you that they were just tested, do you know what that means specifically? The tests that we order to also be run along with the HIV test includes a


separate blood test for syphilis. The blood test for syphilis can be negative for a short time after getting infected, so it is helpful that we check it repeatedly over time. Very often, the blood test is the only way that the diagnosis is made. Syphilis can present as an open sore in the genital area, or as a rash, but oftentimes neither of these is noticed and the blood test leads to the diagnosis. At One Medical, we also typically obtain a urine sample to test for gonorrhea


and chlamydia, and swabs of other areas of the body such as the throat and the anorectal area to test for gonorrhea and chlamydia there. Both of these infections can be present without you having any symptoms. It is important that these infections be diagnosed and treated to help prevent


complications for you, and just as important, to prevent spread to others. Condoms are effective at preventing the spread of HIV, gonorrhea and chla- mydia, and although they reduce the risk or getting exposed to syphilis, it can still happen because syphilis is spread by skin to skin contact.


GENITAL HERPES Another infection that people often don’t like to talk about is genital herpes.


And testing for herpes is not always included when someone asks for STI testing. Herpes presents as a painful cluster of small vesicles or “bubbles” typically in the genital area and then they resolve on their own over 5 to 7 days. During this active phase of the infection, the herpes virus can be transmitted to others by skin-to-skin contact. Once-a-day medication is available that suppresses the herpes virus, helps prevent recurrences and significantly reduces the risk of transmitting it to a sexual partner. A blood test can be done to determine whether you have antibodies for


herpes, but the results must be interpreted by someone who is fully aware of your sexual history and any prior outbreaks you may have had.


HPV Genital warts or anal warts are caused by human papiloma virus, or HPV. There


is no blood test for HPV. We can test for HPV on pap smears of the cervix, or by some fairly invasive procedures in the anal area, but it is important to know that most routine STI testing does not include testing for HPV, so it is important to ask your partner if they have ever had warts or a pap test that showed HPV. The most important thing I can say about HPV is that it is preventable.


Vaccination against HPV is recommended for people starting as early as age 9, ideally before any sexual activity with others. People who did not receive the vaccination as a child or teenager can get the vaccination up to age 45.


HEPATITIS C Hepatitis C is something you should also be aware of. Hepatitis C is a virus that


can infect and damage the liver. In the past, this infection was almost always asso- ciated with those who injected recreational drugs and did not use clean needles. We now see some sexual transmission of hepatitis C as well. Although this does not happen frequently, it is something to keep in mind. It is recommended that anyone born between the ages of 1945 and 1965 be screened for hepatitis C at least once. Everyone with HIV should be screened at least once as well. Having a sexually transmitted disease, sex with multiple partners and rough


sex appears to increase the risk getting hepatitis C. There is no vaccine to prevent hepatitis C, but there are now good treatments that can prevent damage to the liver, and in many cases, can completely treat and “cure” the person of the infection. STIs can be hard to talk about and can be confusing until you learn more about


them. If you are considering PrEP, are on PrEP, or you just want to be a responsible partner, see a provider to learn more about STIs.


One Medical is an independent primary-care practice, transforming healthcare through a


tech-powered, human-centric, membership-based model that makes it easier and more enjoyable for people to proactively participate in their personal health and wellness. We pair exceptional providers with beautiful, comfortable offices conveniently located where people live, work and shop, and are laser-focused on providing a high-quality patient experience. In addition to providing patients with innovative and user-friendly virtual care tools, One Medical works with nearly 6,000 companies to provide One Medical memberships as an employee health benefit.


36


RAGE monthly | February 2020


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