SirBillybob

A very pricey advertiser I had hedged on for a while without booking has crossed back over to club dancer income supplementation and it was an unexpected fun (well, discounted, depending on how you look at it) ‘bucket list’ experience. I would probably spring for an off-site hook-up after all, as the sampler was a good forecast. —- “Maybe later” being essentially interpreted by a dancer as ‘no’ now means ‘yes’ a while afterwards is rare and could be seen as poor comportment if you didn’t explicitly signal a follow-up exchange. I would view it in the context of the psychological difficulty of being repeatedly rebuffed, however gently, and his later lobbing back with a mini-micro aggression, as if you had owed him a less ambiguous but obviously more emphatic decline in the first place. It may have worked occasionally and he has nothing to lose. That said, I usually just say, before the private dance interest question even pops up, “Thanks for saying hello” and move away a few steps into the crowd (I stand and circulate as it feels less trapped). I think it might be easier as you have extricated yourself rather than the guy needing to separate from your space following being given your regrets. In my case, I lack ambivalence about whether a private dance is in the cards unless he has already successfully provided in the past, which brings us to … A related topic is a (the) dancer with whom you have previously had good experiences naturally approaching you but you wish to case the joint for other prospects. That calls for a modified exchange of pleasantries, tact, and intent. I have found that they take it in stride and wait for a cue later without circling back for a status review.

Devoured all but This Other Eden (yet to access) this summer. Great pleasure. Prophet Song, devastating, lines right up with current events. The Bee Sting is lengthy but I couldn’t put it down; expansive enough to include a gay subplot. Study for Obedience won Canada’s big honour, the Giller Prize. If I Survive You a story collection.

I think I saved about $10 on the I-books pre-order relative to the formal list price. Can’t wait.

I-Books sample looks worth it. I placed on reserve at my library. Hope it doesn’t burn down first. Plot spoiler: biblical ending holds but that is obvious up front. I suggest reading some brief reviews that will help you to immediately grasp the narrator (plural) structure.

I am getting hot under the collar and it’s not fever. It appears that Health Canada and NACI are dicking around holding out for a viable COVID-Influenza combo vaccination. Yet PfizerBioNTech, Moderna, and Novavax new formulations are all set to go. My interpretation of the reason for the USA FDA’s continuing review of Novavax’ submission is that the just approved mRNA monovalent doses target KP.2 strain specifically while Novavax targets the parent strain JN.1 strain and the company asserts cross-reactivity with KP.2 strain. I was at Montréal’s downtown vaxx centre yesterday and the nurses thought November for any product rollout. Impossible, I hope. Canada had better uncouple vaccination for the two diseases this Fall. Again, makes my blood boil. This year is just a repeat of last year’s delay to October-ish. There are sufficient data precedents.

LOL. I’ve proclaimed that about their Viagra more times than I can recall. Find my brief allowable expletives on X. Pfizer and BioNTech will import their whining about profit margins into price gouging. [Restricted expletive]

It isn’t clinically or operationally relevant because the investigational COVID formulation component is last year’s. Meanwhile, companies are vying for financial gain and authorization entities stalling on the upcoming season’s needed version engineered for FLiRT variant. One can always get a separate robust flu vaccine. If the updated COVID vaccine (or prospective combo) were to arrive late to the party then what good would a two-in-one have been anyway, as a window for influenza cases otherwise preventable via timely flu vaccination will have been left ajar? The study merely began to study proof of concept, and immunogenic potential but not efficacy, at that. If all three targets had been each arbitrarily set at 80% desired success, say, the probability of at least one of three failing would be 49%.

Glad you didn’t fall into the syndrome trap.😉 Oops, I mean I’m.

Have you not been reading in the public domain media simple summaries on the science, surveillance, and logic regarding the two clades of relevance? For Canada, the ratio of vaccinated to those susceptible to Clade I is negligible. MVA-BN uptake rate to date confers extremely minimal overall population coverage. Mpox Clade I does not potentiate Clade IIb incidence. The latter does not piggy-back on the former. I wouldn’t conflate Clade I concerns with the unique Mpox strain related to the current estimated completed subpopulation vaccination uptake you referenced, a 1:3 ratio of those vaccinated to those susceptible to a disease that is essentially in abeyance. The emergence of the more lethal Clade does not poke a different sleeping giant. There is minimal evidence that predicts an upsurge specific to those not yet vaccinated against the originally targeted Clade IIb. Again, any latent residual spread over two years has been very self-limiting and the phenomenon of a few cases that were followed by a substantial peak in 2022 has not recurred. There has been an association between level of behavioural risk and either natural or artificial immunity that accounts for relative control. Moreover, further softening of CoV pandemic boundaries since 2022 has had no effect on Mpox incidence. Therefore, Mpox vaccination to date, even if it had been much more widespread for those at risk, should have very little bearing on an impending Mpox incursion as the total susceptible population is a vastly larger denominator. Any level of uptake and infection shielding among GBMSM would just be absorbable within a scenario of the revised targeted population at risk.

Spain and Israel, being closest in proximity to the Africa with which I am familiar (I didn’t know there were additional Africas) have experienced Mpox. I will be in Spain again this year. I think that the country reports cases officially but if I catch Mpox I will report it in some way. If I go somewhere to report it you may have clairvoyantly predicted that movement, that my Swatch is waterproof, and whether Canada had been annexed by Scandinavia or vice versa along with a merger of any shores not geographically specific to an Africa.

There are 3, and a 4th in development by Moderna. We all got MVA-BN which is one of the 3 but has 3 brand names according to global location, not to be confused with the trifecta of distinct products.

Just touched down in Stockholm, as case possibility beyond Africa was expected eventually. Clade I; the b now seems to be unnecessary given the phylogenetic tree structure. Person travelling from the endemic area. Contained thus far, Sweden reports. Public Health Agency of Canada had weeks ago estimated a 10% chance of arrival here by September, without the same expected spread that had been attributable to GBMSM network transmission of Clade IIb. Preparedness now an obvious benefit.

Theoretically, there’s also the population-level effects of Doxy prophylaxis, beyond self and intimate others. If the majority of higher at-risk GBMSM that go condomless simultaneously pursued uptake with high adherence levels over an arbitrary period of time it could attenuate two bacterial STIs, dramatically reducing incidence by controlling prevalence. To some degree that could compensate for poor control of the other two bacterial diseases. The latter would necessitate an arbitrary period of protected sex for the population majority; limited-time mass adjustment not abstinence. We cannot rule out that gaming Gonorrhea will eventually require such an intervention even though now would be ideal. It would cut incidence along with putting the brakes on AMR.

If you like your STIs in even-number clusters of four better than odd-number clusters of three, you might look up MGen (MG) infection and DoxyPEP as well as AMR associated MGen. It was included, for example, in the IPERGAY study and significant PEP protection did not occur. Another glossed over bacterial STI entity. Go to the party for Syphilis and Chlamydia reduction benefits, stay for the Gonococcal and Mycoplasma Genitalium shots. Do you want to live in a world where two highly problematic STIs become irrelevant factors in the prophylaxis research literature and are dismissed in subsequent guidance simply because they were included but no salutary benefit was found? I don’t.

An interesting read attached. So disappointed Aidsmap is done. Dissent on doxyPEP: recent guidelines becoming more cautious | aidsmap WWW.AIDSMAP.COM Two recent statements about taking the antibiotic doxycycline up to 72 hours after sex to prevent bacterial sexually...

Just the part about how that works out with Magnums, as well as the bioavailability of antibacterial treatment with all that cartilage. 😉

There is no Clade II 2nd wave affecting us. Portugal had a minor 2nd wave last summer that petered out. For upcoming Europe travel I track incidence trends. Up to early July; next review early Oct. ‘Circuit’ may elevate Spain incidence but I won’t know as early as I’d like. 965 De Maisonneuve East continues Imvamune offering on walk-in basis. I am single-dosed but likely will get 2nd dose soon. One reason is that impending pilots strike may strand me against booked return date and I’ll get more piggy over there being aggravated with sched disruption. It’s already in the past few days been a challenge to build a back-up flight plan to travel back home. I guess I’ll wing it and see what happens with my AC booking. NACI thoroughly updated guidance in May but 2-year booster recommendations have not been formulated yet for obvious reasons. PHAC constructed a complex algorithm for possible Clade Ib incursion and it’s unlikely anybody landing here and infected would not have it contained, diaspora households and whatnot. Jumping into GBMSM community a very remote possibility. If Canada officials could get their heads out of their asses there would be an attempt to donate some of our abundant MVA-BN supply to African LMICs.

I have enjoyable encounters without STI risk, so what I have done is fill in some of what I perceive to be missing elements in the decision-making process for DoxyPEP use. I don’t have much skin in this game. There is some interesting reading on other jurisdictions’ reviews and perspectives on DoxyPEP validity should you be interested, use search terms such as Europe, EU, Australia. Generally thumbs down from majority proportions of working groups. I test for STIs regularly, even though risk is negligible for me, because there tends to be openness with partners regarding status. I wouldn’t take DoxyPEP even if its current prophylaxis record were to be better for Gonorrhea, the reason being that any of the 3 infections would be detected early in the extremely unlikely event of acquiring one and, similarly, behavioural risk mitigation transfers into partners’ negligible risk from interacting with me. I would follow national guidelines for treatment if I ever acquired Gonorrhea: Ceftriaxone. AMR is creeping up for this drug but remains less than for Doxycycline. Test of cure is a possible contingency for following any treatment failure with a back-up medication. An anecdotal case of Doxy success is not surprising, in the same way that outright ineffectiveness of PEP is refutable, but does not figure prominently in guidance predicated on the broader picture of best GC treatment practice. Happy sex and ‘bonne chance’.

From 2024 CROI meeting, DoxyVAC efficacy for Gonorrhea adjusted down to 33% efficacy from interim 51%. But the incidence curves merge so it has to be even less. In contrast, you can see the incidence curves separating widely for Syphilis and Chlamydia. They omitted recurrent GC infection in the hazard ratio metric. Recurrence not uncommon due to high GC rates over time. They omitted these revisions from subsequent Lancet publication. The entire component was ghosted and, therefore, will be excluded from any meta-analytic synthesis of the small extant body of research. The incidence difference is statistically significant but of questionable clinical significance because 40% of study subjects allocated to PEP were infected with Gonorrhea over the study period and the curve direction portends higher cohort rates over time. 15% of subjects not taking PEP caught Syphilis.

Here’s the updated French IPERGAY/DOXYVAC research I mentioned wrt CROI meeting and an earlier post of mine. They actually omitted the Gonorrhea DoxyPEP results. I cannot access the full text without paying for Lancet subscription, so passing. Just a moment... WWW.THELANCET.COM

I see. Good point. I am only referring to PEP. I think “on” and “taking” can be interchangeable, even if regularly or prn. But I understand that for some “on” connotes taking regularly. The thing is that either DoxyPEP (theoretically on-demand) or DoxyPrEP (theoretically daily) can merge in regularity, obviously in contrast to HIV PrEP and HIV PEP. The caveat is Doxy dosage, never more than 200 mg in any 24-hr period. Technically, like HIV on-demand PrEP (a ‘before’ risk scenario) Doxy STI prophylaxis uptake quantity and frequency is variable in either a ‘before’, ‘after’, or blend of each. —— There is a fair abundance of Gonorrhea discussion, ‘up thread’ or ‘up topic’ as the kids say, under Health here, or a quick Google search will steer you to reputable summaries albeit a bit outdated on research developments. I had tried to fill in some of the gaps past while. The updated (downgraded) DoxyPEP effectiveness presented at the 2024 CROI conference seems to have not yet made it to journal publication. The integration of Ceftriaxone treatment failure reality has also fallen short in health entity summaries and there is more upthread on antimicrobial resistance (AMR). The only research on DoxyPrEP is a decade old and it was not effective for Gonorrhea. You can access that reference any many others from the CDC DoxyPEP guidelines simply by using the word search function for PrEP though you will see most of the yield relates to HIV PrEP.

And here’s the BBC piece that’s the next inner layer Russian doll for the Post piece, both referring to the actual paper I just appended above and whose data are buried deeper in the doll layers. Penile cancer: 6,500 amputations in Brazil in a decade WWW.BBC.COM "It's something you never imagine will happen to you," says João, 63, who under went a partial amputation.

I think The Post distorted some of the findings but here’s the paper and you can view for yourself, including perhaps implications for your geographic location. Global Pattern and Trends in Penile Cancer Incidence: Population-Based Study - PMC WWW.NCBI.NLM.NIH.GOV Penile cancer is a relatively rare genital malignancy whose incidence and mortality are rising in many...

Yes, the recent CDC DoxyPEP guidelines are specific to MSM/TGW that actually acquired a STI within the previous year. There is yet to be devised an official standard of care for those not in that category. But in Canada I believe either scenario is ‘off label’. Not surprised at the BC news because Grennan is running the DISCO trial out of there. Those results will be quite a while coming out. What accounts for non-USA jurisdictions’ reticence to emulate the current guidelines may be related to a different take on the efficacy evidence to date and to a different way of handling the risk behaviours that generate STI incidence. I read the news about BC and thought it was less than fully responsible. The majority of global Infectious Diseases entities are rightfully tentative. DoxyPEP efficacy against Gonorrhea is since revised downward when synthesizing the relevant data, and that update was available months before the final CDC summary. Moreover, along with low effectiveness is a high rate of Gonorrhea infection among recipients of DoxyPEP that would be expected to occur among populations with the same risk as study participants, that is, a previous STI infection essentially serving as a benchmark for sexual activity that supports statistical analysis comparing prophylaxis to placebo. The rates of Gonorrhea while on DoxyPEP are consistently greater than the rates of Syphilis and Chlamydia when not taking it. The guidelines gloss over the likelihood of breakthrough Gonorrhea in spite of attempted prophylaxis. Similarly, the growing rate of Gonorrhea antimicrobial resistance to conventional treatment (i.e., Ceftriaxone) is downplayed. The takeaway from the guidelines among some Infectious Diseases stakeholders is that prospective candidates for DoxyPEP are unfairly considered to be poorly equipped to process information related to differing efficacy data across the targeted infections and that it is futile to educate about problematic incidence rates because transmission will occur anyway. In fact, as seen with MPox for example, folks can and will adjust behaviour when given accurate information, while maintaining self-determination. The few jurisdictions endorsing DoxyPEP are telegraphing cynicism while virtue-signalling support for importance of personal sexual autonomy. You can also detect this in a recent conference rapporteur summary when referencing the recent disappointing updates about Gonorrhea. They are falling short of a transparent rendering of the advantages and liabilities of DoxyPEP. Be an ally fully, not half-measured. I wouldn’t say to anybody that DoxyPEP is a legitimate 3-for-1. Subtracting to 2-for-1 essentially calls for condom protection or other harm reduction with respect to Gonorrhea specifically. If you are not fine with trading off avoidance of Gonococcal infection, that is regrettably refractory to treatment, for the irrefutable benefit of pharmacological protection from Syphilis and Chlamydia (both of which are treatable) then Doxycycline prophylaxis is already obsolete. It is virtually impossible to stratify behavioural approaches to STI prevention according to the above differences among bacterial infections due to commonality in the routes of transmission. Gonorrhea is the more problematic STI but unfortunately evades prophylaxis.

!!?? Is that a random pseudonymous handle, formal legal Elon-ian adoption papers name, a test of our cognitive function recall, or a link to CP3O’s etiquette’n’protocol manual?😉😘