Doxy PEP Offers Alternative To Condoms

[TruthBTold]

It looks as if they are beginning to study the possibility of not wearing condoms during sex and not worrying totally about acquiring STDs.  They are (at least in the Lancet) still worrying about some unintended side effects.  We shall see.  And I am interpreting it to mean this is why the non-condom wearer is either on PrEP or on 2-1-1 PrEP.  Here's hoping.

https://www.washingtonpost.com/health/2023/07/24/doxypep-std-sti-prevention/

 

[Simon Suraci]

From what I’ve read, it sounds promising and worth more studies to corroborate data to make a case for widespread use.

I wonder how the potential for mass long term use of various antibiotics may accelerate the development and spread of antibiotic resistant strains of STIs.

If/when the antibiotics we have now are no longer effective against those problematic strains, and those strains are circulating much more commonly through the population (especially among MSM), what then will we have available to fight infections?

Wouldn’t it be nice if we could eradicate all STIs? …*sigh* 

[+ BenjaminNicholas]

DoxyPrEP and DoxyPEP have been a thing for awhile now. 

I don't know why the Post is treating this like they're breaking news. 

[pubic_assistance]

17 hours ago, TruthBTold said:

They are (at least in the Lancet) still worrying about some unintended side effects.

Most every pharmaceutical product has a list of side effects.

My GP. has long advised me against PreP and is pro-condom for that reason.

 

[Quincy_7]

40 minutes ago, pubic_assistance said:

Most every pharmaceutical product has a list of side effects.

My GP. has long advised me against PreP and is pro-condom for that reason.

 

What are the side effects of PreP?

[pubic_assistance]

12 minutes ago, Quincy_7 said:

What are the side effects of PreP?

Deterioration of kidney function in men over 50 is his major concern.

The stomach issues are more uncomfortable than dangerous.

Some liver damage reported but not common.

DESCOVY appears (thus far) to have fewer incidents than Truvada.

[Guest]

6 hours ago, pubic_assistance said:

Most every pharmaceutical product has a list of side effects.

My GP. has long advised me against PreP and is pro-condom for that reason.

 

6 hours ago, pubic_assistance said:

Deterioration of kidney function in men over 50 is his major concern.

The stomach issues are more uncomfortable than dangerous.

Some liver damage reported but not common.

DESCOVY appears (thus far) to have fewer incidents than Truvada.

As with everything in life, every action and inaction has its risks and benefits. A wise person makes decisions based on a judicious weighing of those risks and benefits. It would be foolish to believe, let alone act, on the assumption that one can eliminate all risks in one's life. Driving down to the grocery store carries a risk that I might injure myself, or possibly even get killed, on the attempt. I can eliminate that risk by having my groceries delivered. However, I like to select my own produce, as well as vary my purchases according to what's on sale, etc., so I go get groceries myself. 

Science has examined the relative efficacy of condoms vs PrEP in HIV prevention among those who bottom. Even when used correctly, condoms provide only 90% protection (more typically 80%), whereas PrEP provides 99.9% efficacy (as discussed in prior strings). Therefore, if someone typically bottoms during intimate encounters, especially with high-risk individuals, it is usually wisest to use both PrEP (for HIV protection) and condoms (to protect against everything else). Now, do I use PrEP? No, because I almost never bottom (once in the last 3 years). However, I would use PrEP if I were a bottom. 

It's probably especially silly to avoid trying a medication because you might develop a side-effect. Side-effects aren't permanent, such as growing a 6th finger. If you get an intolerable side-effect, simply stop the medication--not that complicated. Of course, the exception to this would be Apretude, which is a 2-month injection. If you get a bad side-effect on that, you are, indeed, stuck for a couple of months. This is not the case for the pills, though. As for possible long-term adverse consequences, such as kidney or bone damage on Truvada (not Descovy), those can and should be monitored. If injury is suggested, again, just stop the medication. 

If your GP counseled you to use condoms rather than PrEP based on your individual risk assessment, because you rarely if ever bottom, then that is wise counseling. However, if he advises no one use PrEP, then he has simply not kept up with the primary care scientific literature, which would be quite troubling. Even if he avoids reading journals, physicians are generally required to take 50 hours a year of medical education classes, and one would wonder how he's getting the credits. 

[+ BenjaminNicholas]

12 hours ago, Quincy_7 said:

What are the side effects of PreP?

Side effects are in a very small percentage of users (sub 2%).

Eat with your meds (or half-glass of milk).  That solves the stomach issues.

Kidney and liver issues happen in a tiny fraction of users and if you're going in for the required blood work that goes along with being on PrEP, they can easily see if things are going wrong. 

You're at greater risk taking aspirin, which causes over 3k deaths a year.

[pubic_assistance]

16 hours ago, Unicorn said:

PrEP provides 99.9% efficacy

Just a moment...

WWW.THELANCET.COM

I am somewhat shocked @Unicorn that you are shilling for the pharmaceutical industry with their fantasyland efficacy numbers. Multiple REAL WORLD studies show efficacy ranging from 86% to 93%.

I do agree that safety measures will vary according to one's choice of dominant or submissive roles during anal sex. Since I bottom so rarely condoms suffice. If I were a pig-hole-pup I would likely be on PreP as well as insisting my (multiple)partners strap on a condom.

[Quincy_7]

16 hours ago, Unicorn said:

 

As with everything in life, every action and inaction has its risks and benefits. A wise person makes decisions based on a judicious weighing of those risks and benefits. It would be foolish to believe, let alone act, on the assumption that one can eliminate all risks in one's life. Driving down to the grocery store carries a risk that I might injure myself, or possibly even get killed, on the attempt. I can eliminate that risk by having my groceries delivered. However, I like to select my own produce, as well as vary my purchases according to what's on sale, etc., so I go get groceries myself. 

I don't necessarily disagree with your main argument but this paragraph reminded me of a quote from Stockton Rush - “You know, at some point, safety is just pure waste. I mean, if you just want to be safe, don’t get out of bed, don’t get in your car, don’t do anything."

[pubic_assistance]

Russian Roulette is a game played with "ONLY" one bullet. 

Would you play ? 

[Guest]

7 hours ago, pubic_assistance said:

Just a moment...

WWW.THELANCET.COM

I am somewhat shocked @Unicorn that you are shilling for the pharmaceutical industry with their fantasyland efficacy numbers. Multiple REAL WORLD studies show efficacy ranging from 86% to 93%.

I do agree that safety measures will vary according to one's choice of dominant or submissive roles during anal sex. Since I bottom so rarely condoms suffice. If I were a pig-hole-pup I would likely be on PreP as well as insisting my (multiple)partners strap on a condom.

Well, the 90% figure I gave was for correct and consistent condom use. Real world typical use for condoms is lower:

Effectiveness of condoms in preventing HIV transmission - PubMed

PUBMED.NCBI.NLM.NIH.GOV

---

The consistent use of latex condoms continues to be advocated for primary prevention of HIV infection despite limited quantitative evidence regarding the effectiveness...

"...Although recent meta-analyses of condom effectiveness suggest that condoms are 60 to 70% effective when used for HIV prophylaxis, these studies do not isolate consistent condom use, and therefore provide only a lower bound on the true effectiveness of correct and consistent condom use. A reexamination of HIV seroconversion studies suggests that condoms are 90 to 95% effective when used consistently...".

 

 

Condom effectiveness in reducing heterosexual HIV transmission - PubMed

PUBMED.NCBI.NLM.NIH.GOV

---

This review indicates that consistent use of condoms results in 80% reduction in HIV incidence. Consistent use is defined as using a condom for all acts of penetrative...

I agree that since you don't bottom much, adding PrEP probably wouldn't add enough risk reduction to justify its use. For those who have trouble remembering to take their meds every day, the injectable version is available, and is the most effective protection against HIV out there. 

 

Edited July 31, 2023 by Unicorn

[Guest]

8 hours ago, Quincy_7 said:

I don't necessarily disagree with your main argument but this paragraph reminded me of a quote from Stockton Rush - “You know, at some point, safety is just pure waste. I mean, if you just want to be safe, don’t get out of bed, don’t get in your car, don’t do anything."

Again, this is just silly. If you don't get out of bed, you die, obviously. As I've said before, a risk-free life is an illusion. Yes, you can choke to death on the food you swallow, or even the water you drink. You can slip and fall in the shower, breaking your neck. These are risks we all must take. Some risks are not worth worrying over. However, all decisions involve risk. 

Edited July 31, 2023 by Unicorn

[pubic_assistance]

27 minutes ago, Unicorn said:

Well, the 90% figure I gave was for correct and consistent condom use. Real world typical use for condoms is lower:

I was actually questioning your 99% efficacy statement regarding PreP.

The pharmaceutical industry uses that statistic based on closed studies but general population statistics have efficacy at lower rates because we don't live in a laboratory. 

[Guest]

I was comparing apples to apples: consistent use of oral PrEP and consistent use of condoms.

Resource: Side-by-side comparison: Truvada and Descovy for PrEP - San Francisco AIDS Foundation

WWW.SFAF.ORG

---

See a chart comparing the similarities and differences between the two medications available to prevent HIV as PrEP.

 

TRUVADA	DESCOVY
Effectiveness	Effectiveness
>99% effective	>99% effective
Regimen	Regimen
Daily use & PrEP 2-1-1	Daily use (Although Descovy for PrEP 2-1-1 is being studied, there is inadequate clinical data to support this regimen now)

 

Those who have trouble remembering to take oral PrEP consistently have to option for injectable PrEP now. As shown in my prior post, inconsistent condom use also doesn't provide good protection. But I took the assumption that you'd be smart enough to use both condoms or PrEP as directed. The real-life data for your average shmoe are different, of course. I don't take you for the average shmoe! 👍🏼

[SirBillybob]

21 hours ago, pubic_assistance said:

I was actually questioning your 99% efficacy statement regarding PreP.

The pharmaceutical industry uses that statistic based on closed studies but general population statistics have efficacy at lower rates because we don't live in a laboratory. 

IF I have this right:

The CDC references 99% efficacy when HIV PrEP taken optimally or consistently, based on controlled trials data; and explicitly states LESS effectiveness if taken inconsistently, based on both the very small number of breakthrough infections in controlled trials that are in fact deemed attributable to breaches in consistent uptake, and “real-world” research (eg, case-control) in which inconsistent uptake is expected. Therefore, nobody in the thread arbitrarily cherry-picked the 99% metric without underscoring the necessity of optimal or consistent adherence, or assuming such consistency would occur in your case. As such, neither the CDC nor any contributor here quoting 99% is pandering to the pharmaceutical industry.

Other jurisdictions might say ‘up to 90% efficacy’ without distinguishing between the two research contexts. To my way of thinking that does not suggest greater conflict of interest distancing from industry stakeholders or improved scientific objectivity with respect to recommendations. Packaging optimal PrEP consumption as nearly failsafe does not subvert the messaging related to the liability of inconsistent use. The CDC also references breakthrough infections reported in clinical practice outside of trials and in spite of consistent uptake by the individual, the number too small to reduce the 99% assumption. 

Various national jurisdictions outside of USA may articulate guidance differently from the CDC in terms of how to express the distinctions between optimal and generally inconsistent uptake; optimal (daily) and consistent (ie, 4 doses per week) uptake where generally inconsistent uptake is defined as less than 4 (so 4 meets the optimal/ or consistent standard); and the merits or approval of the 2-1-1 on-demand event-driven regimen, not to be conflated with the 4 per week CDC consistency-defining standard that is distinct from the dispensing of AVERAGE 4 tabs (say, up to 52 doses quarterly supply with doses taken as needed based on demand) within on-demand research. 

What is new and surprising to me today is the assertion of 99% efficacy for what CDC labels as consistent (not optimal) uptake, 4 doses weekly, but the data seem to support it. That the CDC would reference less than daily uptake as extremely effective further supports the idea of distancing from pharmaceutical industry profit agendas. 

I think I have it down well enough that my own playbook is sound. Strictly on-demand but typically when travelling and anticipating activity, but substituting 7-1-1-…N… for 2-1-1 where N is the number of ongoing daily doses determined by the likely small or non-existent span between any one 2-1-1 and it’s subsequent series, and 7 is a daily dose leading up to first event.

Extremely occasionally 2-1-1 where daily dosing a week prior to activity had been impossible, but the applicability of 4 daily prior doses is useful to know as it coheres with the CDC consistency if not optimal standard. That said, if I were to commence 7-day uptake within the 7-1-1-…N… plan, but activity available on earlier impromptu basis, I would likely still take the 2 doses if possible at that juncture. It seems unclear whether the 4 per week effectiveness hinges on having commenced with 7 days of dosing at the outset to reach sufficient plasma levels.

All activity in conjunction with condom use. 

Sorry, Doxy thread …

Edited August 1, 2023 by SirBillybob

[pubic_assistance]

31 minutes ago, SirBillybob said:

Various national jurisdictions outside of USA may articulate guidance differently from the CDC in terms of how to express the distinctions between optimal and generally inconsistent uptake;

Because other countries aren't owned by their pharmaceutical industry like the US.

[Simon Suraci]

Let’s be clear: anyone can get HIV when he tops OR bottoms during unprotected sex. There’s no getting around that. PrEP is equally effective and advisable for both tops and bottoms. It’s virtually impossible to get HIV when you use PrEP consistently, whether that be the pill or injectables. 

Exceptions already noted for the small minority of people with liver or kidney issues (monitored 4x/yr by your doctor), or any other other rare health conditions that may exclude someone from using PrEP. In that case, only have protected sex, even sex with a monogamous partner.

You can’t trust a monogamous partner to maintain fidelity. This is not about relationships or trust, but reality. It’s very common for men in general to have multiple partners over the course of their lives, especially MSM, even the supposed monogamous ones. Women too. Take control of your own health. Protect yourself. 

No method is 100% effective, but condoms are effective for preventing STI transmission. In practice, condom use can be inconsistent or incorrect. Be sure to use latex compatible lubes. Natural oils and other products break down the condom and cause it to rip, or at least reduce efficacy, even if it doesn’t rip.

 

[Guest]

8 hours ago, Simon Suraci said:

Let’s be clear: anyone can get HIV when he tops OR bottoms during unprotected sex...

I feel a song coming on:

 

Well the odds of contracting HIV by an unsheathed, negative top from an untreated positive bottom is about 1 in 1000 if the top is cut. Proper use of condoms lowers that risk to 1 in 10,000. Of course, these days, most people who have HIV are on treatment (not all, obviously). Yes, if I were to have weekly sex as a top with an untreated HIV positive bottom, yes, PrEP use would probably be a good idea. Someone who tops an escort every 2 months or so might evaluate the risks and benefits and rationally decide not to use PrEP. 

Against All Odds: What Are Your Chances of Getting HIV in These Scenarios?

WWW.POZ.COM

---

Playing the HIV numbers game is less—and more—risky than you think.

 

"...As for anal sex, the most risky sex act in terms of HIV transmission, if an HIV-negative top—the insertive partner—and an HIV-positive bottom have unprotected sex, the chances of the top contracting the virus from a single encounter are 1 in 909 (or 0.11 percent) if he’s circumcised and 1 in 161 (or 0.62 percent) if he’s uncircumcised...".

Edited August 2, 2023 by Unicorn

[CuriousByNature]

I'm definitely not a mathematician.  If PrEP is 99% effective, doesn't that mean if a person on PrEP has intercourse 100 times with positive partners who are not undetectable, it almost guaranteed they will contract HIV even if they are staying true to a PrEP regime?  Since PrEP is effective 99/100 times?

What is the incidence of infection if PrEP and condoms are used?  I don't remember how to calculate that properly.

 

[SirBillybob]

2 hours ago, CuriousByNature said:

I'm definitely not a mathematician.  If PrEP is 99% effective, doesn't that mean if a person on PrEP has intercourse 100 times with positive partners who are not undetectable, it almost guaranteed they will contract HIV even if they are staying true to a PrEP regime?  Since PrEP is effective 99/100 times?

What is the incidence of infection if PrEP and condoms are used?  I don't remember how to calculate that properly.

 

Extremely low, 1/9,091 on PrEP and 1/35,714 based on condom use added to PrEP if condom effectiveness is 80%. 

Your estimate is based on inadvertent infection with one episode of unprotected sex. It is 1/72 probability for receptive and much lower for insertive.

In contrast, vaccine efficacy for example is depicted based on the difference between inadvertent infection with and without protection. Or rather, efficacy or relative risk calculations are done using the same formula, but knowledge of HIV transmission probability adds estimates to the number of events that theoretically produces inevitable infection. 

Here is a more detailed breakdown based on relevant variables: 

About the Data | HIV Risk Reduction Tool | CDC

HIVRISK.CDC.GOV

 

 

 

Edited August 4, 2023 by SirBillybob

[mike carey]

11 hours ago, CuriousByNature said:

I'm definitely not a mathematician.  If PrEP is 99% effective, doesn't that mean if a person on PrEP has intercourse 100 times with positive partners who are not undetectable, it almost guaranteed they will contract HIV even if they are staying true to a PrEP regime?  Since PrEP is effective 99/100 times?

I'm replying to the maths (or statistics) not the effectiveness of PrEP. No, a probability of 99% does not mean that in every set of 100 instances the event (in this case infection) will occur. It means that every time there is a 1% chance of it happening, including the 100th. Probability is calculated by a large number of observations and does not indicate that the event will occur regularly every n instances. Think of tossing a coin. There is a statistical probability that it will fall as a head on 50% of instances, but we know that that doesn't happen every second throw.

[Simon Suraci]

To each his own to assess his own risk. If PrEP is available, affordable, and advisable considering your particular body and overall health, AND you’re having sex, or at least open to the possibility of having sex, you have a chance of getting infected. I see no reason not to take it - perhaps other than discretion. Condoms obviously further lower your risk.

Only 20 in one million have documented breakthrough cases, meaning they managed to get infected with HIV while taking PrEP consistently. 0.002% is a lot better odds than the lottery, but pretty darn low, certainly a lot less than 1.0%. The actual number is likely something much less than 1% and something a little bit greater than 0.002% because we don’t have data on unreported cases.

[Guest]

16 minutes ago, Simon Suraci said:

... I see no reason not to take it ...

I agree with the rest of your post, but, really, NO reason??

Possible DESCOVY for PrEP® Side Effects

WWW.DESCOVY.COM

---

Learn about DESCOVY® (emtricitabine200 mg and tenofovir alafenamide 25 mg) tablets. See important warnings. DESCOVY.com

 

What are the other possible side effects of DESCOVY for PrEP?

Serious side effects of DESCOVY may also include:

• Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with DESCOVY. If you develop kidney problems, your healthcare provider may tell you to stop taking DESCOVY.
• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark "tea-colored" urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

Common side effects in people taking DESCOVY for PrEP are diarrhea, nausea, headache, fatigue, and stomach pain. Tell your healthcare provider if you have any side effects that bother you or do not go away.

Common side effects for DESCOVY

The results were analyzed when everyone had been in the study for at least 2 years (~96 weeks). At that point, common side effects† included:
	DESCOVY	TRUVADA
Diarrhea	5%	6%
Nausea	4%	5%
Headache	2%	2%
Fatigue	2%	3%
Stomach Discomfort‡	2%	3%

 

Bear in mind that the above side-effect rates were from those who stuck in the study for at least 2 years. It does not include those who quite earlier due to side-effects.

Edited August 5, 2023 by Unicorn

[CuriousByNature]

46 minutes ago, Unicorn said:

I agree with the rest of your post, but, really, NO reason??

Possible DESCOVY for PrEP® Side Effects

WWW.DESCOVY.COM

---

Learn about DESCOVY® (emtricitabine200 mg and tenofovir alafenamide 25 mg) tablets. See important warnings. DESCOVY.com

 

What are the other possible side effects of DESCOVY for PrEP?

Serious side effects of DESCOVY may also include:

• Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with DESCOVY. If you develop kidney problems, your healthcare provider may tell you to stop taking DESCOVY.
• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark "tea-colored" urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

Common side effects in people taking DESCOVY for PrEP are diarrhea, nausea, headache, fatigue, and stomach pain. Tell your healthcare provider if you have any side effects that bother you or do not go away.

Common side effects for DESCOVY

The results were analyzed when everyone had been in the study for at least 2 years (~96 weeks). At that point, common side effects† included:
	DESCOVY	TRUVADA
Diarrhea	5%	6%
Nausea	4%	5%
Headache	2%	2%
Fatigue	2%	3%
Stomach Discomfort‡	2%	3%

 

Bear in mind that the above side-effect rates were from those who stuck in the study for at least 2 years. It does not include those who quite earlier due to side-effects.

I believe Simon mentioned PrEP only if it is advisable according to your health...