SirBillybob

1 hour ago, Moox said:

Checked with 2 private providers. Over 45, nope. Not licensed for use. I am beyond angry. I am trying to do the right thing by others and no one is budging. 

That’s what I am coming up with basically as well for UK. 

If you didn’t already reach out to them, It may be a long shot because Lloyds liquidated this year but Lloyds Online Doctor may still exist as a separate entity. It is incorporated as a separate name: Expert Health Limited.

The page on HPV stipulated, albeit ambiguously, that older males (>45) at risk could access Gardasil9 off-label and outside the NHS plan. The lead clinicians seem to be physicians with sexual health focus. Example: Dr Kieran Seyan. 

Gardasil is depicted as ‘out of stock’ but that may be due to the retail pharmacy chain’s closure status. 

Here’s the number. You might see if it is active and get a lead. I am not sure I would use the online consultation option before first determining by phone if it still exists.

17 hours ago, menaughty said:

I took both vaccines (1st & 2nd dose) in 2022. 
 

should I be getting another shot now? 

At this point, consensus is lacking, although early in the outbreak the Canadian guidelines included authorization for a 2-year booster dose following summer of 2022 primary series of two doses, if infection risk still applied. But then that provision was de-emphasized a few months later, seemingly in the context of worries about limited supply and, well, it appeared the incidence curve was flattening and it was impossible to predict the state of affairs for 2 years forward, but here we are.

That said, there is no strong indication of a secondary wave at present that would trigger the need for a booster dose. The likely priority if a repeat outbreak occurs would be vaccination for a majority of the at-risk population with no doses obtained; and a 2nd dose for single-dose recipients to enhance herd coverage at the higher level of immunogenicity, clearly a substantial minority of those having receiving any MVA-BN; followed by considerations of a booster dose particularly for those that received one or two fractioned intradermal doses in their primary series. 

If you are engaging in a high-risk sexual network microcosm where Mpox is less contained, even if case incidence is low within the total population, it wouid be more important to consider the additional dose if you could access it. 

On 3/2/2024 at 6:27 PM, mike carey said:

The clinician who saw me at the ACT government-run sexual health clinic asked whether I had considered the mpox vaccination (and HPV, which they will administer, but I'd have to buy for myself at a chemist's). She said they advise it's worth getting the mpox one, although it wasn't a hard sell. I had a vaccination against the variola virus (smallpox), which would provide some residual protection but I'm considering it.

I had also been Vaccinia-experienced (Smallpox vaccinated), long before your travel-related uptake, and chose to receive only the single dose of MVA-BN some 24 months ago although I had access to the booster, administered subQ, if so desired. Along with the historical residual protection concept was the existence of evidence at the time suggesting that a delayed 2nd dose of MVA-BN yielded a stronger immunogenic response.

Currently a very detailed paper has come out supporting the idea that a 2nd dose taken at this time two years on, obviously depending on whether a new incidence wave emerges, is actually better than having followed the initial recommended two-dose regimen. The single- vs two-dose efficacy difference at the current two-year point is not enormous because antibody decay following the second dose is more rapid. 

The above may be an important consideration for those MVA-BN-naive and considering vaccination uptake with or without the re-emergence of problematic new incidence. Interestingly, for those spared infection to date due to lack of pathogen exposure, two doses in 2022 appears to be less beneficial and to have been somewhat superfluous compared to an as yet delayed second dose, the benefit equivalence of which may justify a third upcoming dose some 23 months following second dose.

I am still holding off on the second MVA-BN dose, balanced delicately against prospective case incidence patterns. 

D below is efficacy trajectory projected over a decade of time; shading is confidence interval.

A, B, C are immunogenicity graphs with y axis demarcation gaps depicted on a log scale 0, 10, 100, 1,000.

Off topic, but I just discovered Tubi for older Nick Galitzine films. Seems to be a free supplement to Apple. He is a co-lead in Handsome Devil playing a student and Andrew Scott plays a secondary role as a teacher. (I just edited out some adjectives due to their plot-spoiler status.😉)

6 hours ago, Moox said:

Is transmission possible if my ejaculate comes into contact with someone else's skin, in a non genital area, from MM for example? 

There would be no way to tease out that type of transmission risk in research because it is so specific and most occurrence of one partner’s semen on another’s skin wouid occur in the context of more extensive touching. However, HPV is essentially a skin infection and any concerns about HPV shedding in seminal fluid seem oriented to reproduction, for example, integrity of sperm.

Personally, I would not be concerned about a guy’s splooge landing on “neutral” zones of my body. I might be more concerned about contact transfer: his hand on my genital area including scrotum if he had already been handling his own genital area. 

That said, GARDASIL vaccination is, at most, moderately protective in males and background HPV rates are considerably higher among MSM. Therefore, vaccinated MSM as a whole stand to acquire breakthrough infection and complications requiring medical attention at rates higher than infection among non-vaccinated non-MSM. That itself simply supports the value of vaccination. 

Mutual masturbation as you described, with risk front of mind, should be no less effective as a behavioural measure compared to more involved sexual activity in which some degree of false security may occur following vaccination. 

42 minutes ago, Cooper said:

Has anyone watched “Baby Reindeer”? It’s based on a true story about a bartender who’s perusing a career as a comedian but finds himself being stalked by a strange woman he feels sorry for.

It’s creepy but most enjoyable. Covers just about every sexual topic. One being the sexual abuse the man faced perusing his career. The episodes are fast moving. 

I tuned in to the first episode immediately upon release, as I often do for determining whether a show goes to watch-or-pass, and ended up binging the series. The final scene is rich. Emmy buzz occurring; nominations in two months. 

10 hours ago, viewing ownly said:

"I will not accept checks". I don't want to embarrass the person who put that, because he was not joking.

As long as he accepts cheeks bouncing on him. 

3 hours ago, newatthis said:

any idea of why the name changed?  new management?

I was an occasional customer when dragged there by some cute dancer who wanted me to buy him underwear.

Just temporary signage as negotiated with the movie production company, among other external set alterations. Subbing for 1987 San Diego Gaslamp Quarter.

3 hours ago, Moox said:

Had a call off the clinic, same old. Outside the age range, we can't vaccinate. The NHS can be a joke. If someone asks for PrEP and explain they get it, despite it being more expensive.

Disappointing. Yes it does appear after all that UK is stricter in its off-label licensing flexibility. In Canada, there is provision for risk that is equivalent to that of GBMSM under age 46, and that equivalency applies to any man’s age. In Quebec, if not nationwide, male seniors can book Gardasil9 online with a pharmacy and pharmacists are authorized to administer without a physician’s prescription; of course paying out of pocket.

In UK it appears that risk equivalency assessment is discretionary for certain subgroups, eg sex workers, but still capped at age 45. At first glance, the guidance language seems more flexible because it stratifies according to NHS covered cost. I thought the implication was age leeway for those willing to pay.

That said, I am not entirely convinced that nobody older has accessed it and all I can recommend is to investigate MSM-user-friendly sexual health programs (I remain unclear as to the status of the clinic you refer to) to discover how much legal professional liability a clinician undertakes for providing vaccination that is deemed harmless for older age cohorts but simply less impactful on HPV population incidence. 

WHO has not taken a stance on HPV vaccination for older folks. This may be partly due to emphasis on capturing young groups worldwide and ensuring adequate supply when there have been, in fact, shortages historically. 

9 hours ago, APPLE1 said:

If the big picture observations are that:

- DoxyPREP only reduces gonorrhea infection rate by 33%;

-studies show evidence that vaccination with meningococcal B by itself reduce gonorrhea by 30 - 50%

I would place my faith in vaccination for gonorrhea, treat syphilis with the superior antibiotic, and treat both gonorrhea and chlamydia with a FULL course of Doxycycline as needed.

And of course, pray to the pharmaceutical and profit gods for vaccines specific for all three!

The conference paper indicates that Bexsero risk reduction dropped from 22% to 16% when analyzing cumulative GC infections, that is, new recurrences as opposed to first infection exclusively. There has been some chatter that a large Bexsero trial has since been cancelled but I have not been able to figure out if that relates to the ongoing large U Alabama study, the smaller Australian study, or a proposal not yet formally registered. I think that a viable vaccine is not on the proximal horizon. 

That said, the revised DoxyPEP analysis excluded a second set of analyses incorporating recurrences; the total incidence appears to add about 25% more cases to first infection incidence. My sense is that GC risk reduction will have dropped from the revised 33% to a less meaningful degree, particularly since the proportional hazards curves eventually intersect following a parallel rather than widening gap. If this omission was intentional, disingenuous even, perhaps it is moot given that I doubt any forthcoming DoxyPEP product monograph will include indication for GC prophylaxis.

I think you mean Ceftriaxone with possibly Azithromycin or Doxycycline added for standard GC treatment.

—-
This brings us to recent data on standard Ceftriaxone effectiveness embedded in Innoviva’s Zoliflodacin noninferiority trial (mentioned in an earlier thread) and now GSK’s Gepotidacin noninferiority trial. The two new oral formulations and current standard treatment are showing around 90% cure rates, and these first-in-class developments are being framed as exciting. Well, no. It’s not a good time to acquire gonorrhea infection. 

Re: thread merging. Thanks for inserting the year-old topic. I had been aware of it. I consciously started the new topic as it is specific to the one bacterial STI [gonorrhea] most concerning for its increasing standard treatment failure rate, as well as adds vaccination concepts (eg, Bexsero) not included in the previous discussion but that had been referenced in at least one other thread on the board. Moreover, the previous topic discussion is antimicrobial resistance focused and requires unpacking the merits and liabilities of DoxyPEP alone across a broader range of viral and bacterial diseases. There are also several separate threads more relevant to gonorrhea alone over the past year, including vaccination as mentioned, newly emerging first-in-class oral treatment medications, and acute disseminated gonococcal disease. Anybody wishing a more integrative reading experience is advised to use the search term ‘gonorrhea’ on the board. 

Let me pose this question. At a certain point virtually everybody sexually active and with a similar risk profile to DoxyVAC eligible study participants and receiving doxycycline PEP will eventually get breakthrough gonorrhea infection that requires standard treatment, treatment that is currently very effective. It’s just a question of when, simply because incident rates are quite high, albeit less frequently compared to no DoxyPEP. According to your own risk tolerance, what is the temporal frequency of breakthrough gonorrhea infection, say, in months, that would for you satisfactorily maintain the ‘worth it’ factor for DoxyPEP uptake? In other words, what is the period of time that you require to stave off gonorrhea infection such that DoxyPEP has enough value to pursue it?

Updated/revised DoxyVAC trial results a year later; reduced benefit from DoxyPEP and negligible benefit from Bexsero vaccine.

https://www.poz.com/article/meningococcal-vaccine-significantly-reduce-gonorrhea-risk

I think that the chance of free HPV vaccination access in UK is slim to none if you are age 46 or older. If not immunosuppressed you would receive the two-dose Gardasil-9 vaccination according to national guidelines. However, each dose costs about 182 pounds and the second dose is administered 6 to 24 months later, so after ponying up the initial charge you have ample time (up to 2 years) to save up for the second dose if money is scarce.

In fact, do ensure that you don’t receive the second dose before at least 6 months has elapsed because getting the second dose too early (example 5 months later) apparently negates the legitimacy of the first dose, then relegating the second dose to prime dose status such that you could end up paying for three doses because a third dose would be considered the boost dose. Immunocompromised adults receive three doses by the 6-month point and I imagine less experienced surgeries may mess up the regimen by providing your second dose too soon compared to those that are immunosuppressed. 

In the UK some eligible subgroups are considered adequately vaccinated with a single dose. If this determination extends eventually, sooner than later, to immunocompetent gay/bi men age 25-45 that have sex with men, then men age 46 and older can probably extend this cost-sparing guidance to their own regimen because vaccination of older age groups is off-label and generally follows the closest logical adjacent recommendations. 

Or 99% are evolved and fit the profile of a customer capable of satisfaction with the 50-Euro-a-pop brothel playbook. Sexually mature and flexible homophiles equally open to insertive and receptive pleasure, not hampered by constrictive specifications, unencumbered by puerile notions of sexual position hierarchy. Trading off choice, perhaps optimal standards and preference, for convenience and the general life benefits of adaptation.

The average new parent will quickly realize that their toddler is a douche, insufficiently developed to be successfully cajoled regarding its laundry list. The best approach is to simply convey that you get what you get and you don’t get upset. 

Binged Ripley on Netflix yesterday and today. 8 episodes. Couldn’t stop, but nice way to wait out a nasty Spring snowstorm in front of the fireplace. Some Fargo-like elements added for humour, one in particular very funny.

If you can get past Flynn at age 41 and Scott at age 47, though. Law and Damon were late 20’s. I don’t know how much Ripley ages thru Highsmith’s sequels. I do believe the plan is further adaptation. 

45 minutes ago, 56harrisond said:

Robots get morning wood too … 

In fact, these two are about to engage in a docking station situation.

Just find somebody with a skilful sensitive tongue to tally an estimate of the number of rings accumulated at point of consistent nocturnal tumescence cessation and that reveals age.

It means little IMHO. If it’s going to be worthwhile in May it will already be good currently. I rarely bother to walk over even though when at home in Montreal I certainly don’t lack the time or financial resources. 

Like-with-like vaccination mixing affects infection breakthrough attack rates. Obviously, if vaccinated person A has 80% reduction in infection risk then the risk to vaccinated person B similarly possessing the benefit of 80% efficacy is less than if A is unvaccinated and had had zero risk reduction at point of A-B contact. Same with HIV PrEP, etc.

It’s a loose guideline. Even if all true (not wilfully distorted) to the best of lister’s knowledge, the sole unequivocal “status” delineation is ‘positive’, unless you deem the not listed option as equivocal in terms of a binary: inquire further, or … accept a range of equivocal along with the one unequivocal and optionally inquire further.

If you require absolute specificity upfront, go with the HIV poz provider. The more ambiguous the listing the greater the justification for cracking open a dyadic conversation. The alternative is to second-guess, depending on the context of activity, and be subject to overthinking and fretting about it. The drop-down menu MO is more to stimulate and encourage dialogue than to completely assuage health concerns at point of attention to ad. 

You may be essentially paying to undertake a complex task. That’s the way the cookie crumbles. The outcome of the exercise further separates the wheat from the chaff.

15 hours ago, viewing ownly said:

What became of it, and did anyone experience them when they were open? I loved how they went against the norm and actually encouraged shirtless workouts, and had a reasonable visitation.

Suboptimally staffed due to wide spread anabolic steroid use.

12 hours ago, augustus said:

Unfortunately I was born before this started happening.

No worries. It is urban myth and the investigators themselves state that their findings need to be substantiated. I wouldn’t run out to invest in large-size condom manufacturing just yet.😉

It is much easier and faster to dismiss these research findings as specious than to undertake the onerous task of a similar investigation. 

One specific mean length difference within the data set across the dozens of studies in the analysis is 11.1 cm (4.4 inches)!! The much higher value is situated within a later decade research project. This difference is equivalent to 5.9 standard deviations from the widely accepted global mean. 98% of adult men fall within 2 standard deviations. No sexologist or researcher with basic analytical skills would accept the legitimacy of such a vast difference. It is bullshit. Moreover, that particular computed difference is over 4 times the estimated temporal increase put forward by the investigators. There is something to be said for face validity and simple logic. Anybody with critical appraisal skills can see that this one methodological measurement flaw alone would skew results. 

There have been other convincing criticisms of the study methods, including the effect of greater prevalence of pubic bone press penis length measurement technique in more recent times. That approach is associated with greater length values, up to almost the temporal length difference reported in this study. It was not mentioned as a relevant factor and not controlled for in multivariate analysis. 

The investigators did not describe testing a null hypothesis of no difference. The most interesting finding would be a change that garnered attention; that bias ran through the article. What is also unknown is the breadth of manuscript peer review submissions and rejections prior to publication of a Stanford/Emory piece of work in the more obscure Korean educational entity journal. There are many high caliber periodicals within the field. 

15 hours ago, 56harrisond said:

- Researchers have offered a wide variety of explanations for lengthening penises, from earlier onset of puberty to the prevalence of porn. 
——

Then why not higher rates of blindness?

( couldn’t find a way out of the redacted quote boundaries.)