Preventing Sexually Transmitted Infections (STIs) after Unprotected Sex
It鈥檚 called PEP, but it 颈蝉苍鈥檛 a pep pill or any other type of stimulant. Rather, PEP stands for post-exposure prophylaxis鈥攎edication you can take shortly after you鈥檝e been exposed to a sexually transmitted infection (STI).听
In four clinical trials, doxycycline, a decades-old antibiotic, has been showing promise in protecting men who have sex with men and transgender women from contracting chlamydia, gonorrhea and syphylis after condomless sex.听听
Says Dr. Lawrence Siegel, an Assistant Attending Physician, Assistant Professor of Clinical Medicine and a practicing internist at 麻豆传媒高清版, 鈥the overall conclusion of these studies is that doxycycline 200mg (two 100mg capsules) taken within 72 hours of condomless sex reduces a person鈥檚 risk of acquiring gonorrhea, chlamydia or syphilis by 47 to 66 percent.鈥听
Currently, the New York City Department of Health and Mental Hygiene recommends that doctors discuss doxyPEP with patients at risk of contracting one of the above-mentioned STIs, weigh the pros and cons and engage in joint decision-making.听
What other types of PEP are on offer? Does doxyPEP represent an improvement over these?听听
The current standard of care is to offer pre-emptive antibiotics if a patient has been exposed to a particular STI, says Dr. Siegel.鈥 鈥For example, we would give a patient an injection of ceftriaxone if they were knowingly exposed to gonorrhea, even before that patient鈥檚 test results have been returned.鈥疶his could be considered a version of PEP.鈥听
鈥Doxycycline has the advantage of empowering patients to take a preventive antibiotic before 迟丑别测鈥檙别 informed of the exposure,鈥 he continues. 鈥淗owever, doing so 飞辞耻濒诲苍鈥檛 change the suggested course of treatment once the patient is made aware of the exposure鈥攏ot yet, in any case. Perhaps in the future, doxycycline will change these recommendations and lead to less use of antibiotics overall.鈥听
What are the most common STIs?听
Chlamydia, gonorrhea and syphilis are the most common bacterial STIs.鈥These are readily treatable. These days, of particular concern are rising rates of congenital syphilis.鈥听
A viral STI, human papillomavirus (HPV), is actually considered the most common STI, but 颈迟鈥檚 often asymptomatic and chronic. Vaccination is the best way to prevent HPV and cervical cancer, among other cancers caused by it, but the HPV vaccine is under-utilized in the primary care setting, Dr. Siegel says.听
What is the difference between an STI and an STD?听
The two terms are often used interchangeably, but they are not synonymous. An STI鈥攁 sexually transmitted infection鈥攄oesn鈥檛 necessarily cause an STD鈥攁 sexually transmitted diserase. In fact, two of the most common STIs, syphilis and gonorrhea, don鈥檛 even cause noticeable symptoms, and both can be cured way before they turn into STDs. For this reason, most experts have switched from using STD to the more accurate STI.听
Who is at particular risk for contracting an STI?听
Anyone who is sexually active is technically as risk.鈥疶hat being said, the doxycycline PEP studies regarded anyone who鈥檇 had an STI in the previous year to be at particular risk.鈥听
Typically, though, the risks for STIs include condomless sex, numerous partners (or a partner who has numerous partners) or not knowing the sexual health of your partner.听
How are STIs transmitted?听
Bacterial STIs can be transmitted by oral, anal or vaginal ("front hole") sex.鈥疘n very rare cases, syphilis has been reported to be transmitted by kissing.听
How do you know if you have an STI? What if you鈥檙e asymptomatic?听
STI symptoms may include:听
- painful urination听
- vaginal, penile or rectal discharge听
- itching听
- rash听
- sore throat听
- testicular pain听
Asymptomatic patients who are at high risk for STIs, either by self-identification or provider recommendation, are advised to have screening tests performed quarterly.听
Who should seek testing?听
The Centers for Disease Control and Prevention (CDC) makes the following recommendations for STI testing:听听听
- All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.听
- All sexually active women younger than 25 years old should be tested for gonorrhea and chlamydia every year.听听
- Women 25 years and older who have new or multiple sex partners, or a sex partner who has an STD, should also be tested for gonorrhea and chlamydia every year.听
- Everyone who is pregnant should be tested for syphilis, HIV, hepatitis B and hepatitis C starting early in pregnancy. Those at risk for infection should also be tested for chlamydia and gonorrhea starting early in their pregnancy. Repeat testing may be needed in some cases.听
- All sexually active gay, bisexual and other men who have sex with men should be tested听at least once a year for syphilis, chlamydia and gonorrhea. Those who have multiple or anonymous partners should be tested more frequently鈥攁t least once a year for HIV and for hepatitis C, if already living with HIV.
- High-risk patients who have had an STI in the last year should be screened regularly.听
How soon after a condomless sexual encounter should a person get tested?听
Incubation periods can vary from one day to several weeks, depending on which bacteria or virus is involved, says Dr. Siegel. If patients have no symptoms and have ongoing sexual contacts, 颈迟鈥檚 best to get screened on a quarterly basis. If symptoms appear, testing and treatment should be performed immediately.鈥听
鈥Patients should feel empowered to ask their doctor about DoxyPEP,鈥 he advises. 鈥淎lthough further studies are needed to evaluate the drug鈥檚 efficacy against a variety of bacterial STIs, as well as its safety, the studies conducted thus far indicate that the drug鈥檚 benefits outweigh its risks. For now, doxyPEP may be the best way to stop an STI in its tracks after unprotected sex.鈥听
Reach out to your primary care doctor to discuss your sexual health at /doctors听