How PrEP and PEP have changed LGBTQ medicine

LGBT Health rainbow cross with doctors

Out Medicine

Sexually Transmitted Infections (STI’s), formerly known as STD’s are running rampant in the LGBTQ community as well as the community at large. What was once rarely seen has changed dramatically with the advent of Pre-Exposure Prophylaxis (PREP) and PEP (Post Exposure Prophylaxis), created to block and prevent the spread of HIV.

Dr. Tom Ziering
Dr. Tom Ziering

As a physician who lived through the pandemic of HIV/AIDS with few treatments in the 1980s, I witnessed the loss of many patients. At that time, people became wise and began to practice safe sex as an effective means of prevention. This resulted in the amount of new cases dropping dramatically for all STIs. Often people do not practice safe sex since they are on PREP, which can lead to more STI’s. Sadly, illnesses such as syphilis, gonorrhea, chlamydia, human papilloma virus, herpes, hepatitis C and HIV are creating a resurgence. Most STI’s are treatable; however, some leave people with long term medical issues.

Chlamydia can show in the genitals and the mouth, usually causing burning with urination and a sore throat. Treatment with Doxycycline (a form of tetracycline) proves curative in most cases. Syphilis has also come back into all communities; it can be simply treated with injections of penicillin. Initially seen as a painless chancre (crusty sore), it is often found on the genitals or the anus. Left alone and not treated, the second stage involves a rash over the hands. (Both of these can be cured with penicillin given in the buttocks for just first and second stage; in the third stage of syphilis, the brain is irreparably damaged).

Gonorrhea, much like chlamydia, can cause a sore throat and a painful green discharge from the penis and rectum. This is getting harder to treat as resistant cases are now popping up. Recurrent gonorrhea and retesting is essential; initially it can be treated with two oral antibiotics.

Herpes causes painful burning vesicles or little bubbles in the area of infection. Although we can’t eradicate it, we can suppress this with simple oral antivirals.

HPV or genital warts consists of many different strains, some extremely dangerous and some not. With persistent avoidance of detection, it can lead to cervical, rectal or throat cancer. Often this STI is passed not just from sexual contact, as it can also transfer by rubbing bodies together. This virus can be prevented by a series of injections of the vaccine Gardasil, now approved to age 41. This vaccine can help prevent cancer; getting it is a no brainer in my mind.

HIV is thankfully considered a chronic illness and not a death sentence if treated properly. Of course, this is transmitted mainly through sex. A person with undetectable viral loads will not pass the virus, and those on PREP are safe as well. With the advent of new medications, we can keep the virus undetectable so positive patients can live a normal and healthy life.

Now that HIV seems under control, people are engaging in unsafe sex again… especially the younger community. The result is that we are seeing the STI rate rising again. Please see an LGBT educated physician; they don’t have to be LGBT, but they must be versed in LGBT medicine and be LGBT friendly. Proper assessment of risk is a priority to determine what tests need to be done and which need not be done.

Yes, we are at a much healthier place where gender and the choice in partner matters less. I applaud this and find it refreshing, but as a physician I must remind our community we are each responsible to protect ourselves and our partners. PREP and PEP patients still need to be tested for all STI’s and HIV on a quarterly basis. Condoms remain our best prevention. There is no need for embarrassment or judgement; our job is to educate and treat people with support, education and lack of judgement.