Does The Use Of Prep Lead To More Stis
Whether PrEP actually leads to further increases in STIs, or is instead being adopted by people who would already be likely to get them, is unclear on an epidemiological basis.
Some randomised and cohort studies of PrEP have found rises in STIs following the initiation of PrEP. Others have found no increase. And in some, high rates of STIs preceded the adoption of PrEP, suggesting the diagnoses may have been motivators for people to start PrEP.
People taking part in PrEP studies have certainly had very high rates of STIs. The proportion of subjects diagnosed with a bacterial STI during follow-up was 43% during the Ipergay study and 57% during the PROUD study in people taking PrEP. In the DISCOVER study, the annual incidence of bacterial STIs was almost 100% this does not mean everyone in the study caught an STI but that the annual number of STI diagnoses nearly equalled the number of participants in the study.
However, only one of these studies, PROUD, was designed to detect whether PrEP influenced sexual risk behaviour, by comparing participants who knew they were taking PrEP with ones who knew they were not. The proportion diagnosed with STIs during follow-up was 57% in participants allocated to start PrEP immediately and 50% in those allocated to start it a year later. This difference was not statistically significant, and there was no significant difference between arms for individual STIs either.
Special Considerations With Regard To Starting Antiretroviral Therapy
Orolabial and genital HSV should not influence the decision on when to start ART in persons with HIV. Transient increases in HSV-2âassociated genital ulcers have been observed during the first 6 months after initiation of ART in HIV/HSV-2 coinfected persons. In such cases, suppressive anti-HSV therapy can be considered. The frequency and severity of clinical episodes of genital herpes is often reduced in individuals after immune reconstitution on ART. However, immune reconstitution does not reduce the frequency of genital HSV shedding.33
Do I Need To Tell My Partner
In Canada, genital herpes is not a reportable sexually transmitted infection. While it is not legally required, we recommend that you inform any sexual partners youâve had 60 days before symptoms appeared or before the diagnosis date.
It is not mandatory to inform sexual partners you have been diagnosed with genital herpes in Canada.â
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Might Frequent Testing And Treatment Reduce Stis
It is clear that high rates of testing and treatment for HIV are starting to produce substantial falls in HIV incidence in some countries and communities, as the proportion of people with HIV who are infectious shrinks. Might the same apply to STIs?
A couple of mathematical models suggest that, if large numbers of the gay and bisexual men and trans people most at risk of both HIV and STIs are enrolled in PrEP programmes, then the frequent STI testing that should result might lead to substantial drops in STI incidence.
A modelling study presented in 2017 found that if PrEP became widespread among gay men in the US, diagnoses of STIs would rise in the first year, but would fall thereafter.
If the testing interval was once every six months, for instance, the annual incidence of all STIs in all gay men would fall from about 5.4% a year after starting a PrEP programme to 4% after three years, and to less than 2% after ten years.
This was based on an assumption that 40% of all sexually active gay men take PrEP, but also that condom use in gay men on PrEP would fall by 40%. Incidence would decrease further if condom use did not fall.
There was no support for the hypothesis that PrEP and reduced condom use would lead to rises in STIs. In this model, even zero condom use under PrEP could not transform the STI rates seen in the general gay population into the rates seen in PrEP seekers.
How To Prevent Herpes
Its advised to avoid sexual and oral contact with someone who is currently experiencing a herpes outbreak, but its also important to remember that herpes is transmittable even when it is dormant. The risk during latent periods is lower, but its not zero.
While barrier methods can reduce your risk of contracting or transmitting an STI, there is still a risk that you could get herpes during sexual contact if youre with someone who has it.
If you develop herpes, there are certain precautions you can take to reduce transmission to others. These include:
- using barriers, like condoms and dental dams, during sex
- avoiding sexual contact or kissing while youre having a herpes outbreak
- taking medications, such as those listed above these may be associated with lower risk of herpes transmission, though its best to speak with your doctor
If you do develop herpes, inform your sexual partner.
Its important to tell your doctor if youre pregnant and develop herpes, as the virus can spread to the infant during vaginal delivery. Herpes can be dangerous for newborns. Inform your doctor as soon as possible so that they can help you plan and take precautions to help prevent transmission to your baby.
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How Far Away Is A Cure For Herpes
Theres currently no cure for herpes, but that might change in the future.
According to 2020 research published in Nature, scientists from the Fred Hutchinson Cancer Research Center removed 90 percent of the HSV-1 virus from cells in mice using gene editing.
However, it takes time to transition potential treatments from animals to humans. In a 2020 news article, one of the researchers that authored the Nature paper estimated that it would be at least 3 years before human trials.
Scientists are also researching the possibility of creating a vaccine to prevent herpes. A 2022 study outlined a new approach to developing an mRNA vaccine for herpes. The vaccine mentioned in the study worked well in mice and guinea pigs.
The researchers say that theyre aiming to conduct human trials before the end of 2022, and the vaccine could be available within the next 10 years.
General Review Of The Effect Of Antiretroviral Agents In Reducing Infectiousness Of And Susceptibility To Hiv
A number of strategies for HIV-1 infection prevention that are based on ART have been proposed and are being studied . However, to date, ART for the prevention of maternal-infant transmission of HIV-1 is the only prevention strategy involving antiretroviral agents that has been proven to be effective. The effect of ART in reducing susceptibility to HIV-1, by means of postexposure prophylaxis or pre-exposure prophylaxis , and in reducing the probability of transmission of HIV-1 from an infected person to his or her partner is being researched
Research initiatives to reduce acquisition and transmission of HIV-1 through the use of antiretroviral and herpes simplex virus type 2 antiviral interventions
The use of ART for the prevention of transmission of HIV-1 by HIV-1infected persons could have substantial public health importance. Although direct evidence of this prevention strategy has not yet been obtained, indirect evidence supports the plausibility of this strategy. First, the detection of ART-resistance mutations in people with primary HIV-1 infection demonstrates the selective pressure of ART, and recent findings that drug-resistance mutations are transmitted at a lower rate than has been predicted suggest that certain types of drug resistance may decrease the fitness and, thus, the infectiousness of HIV-1 . Second, experience with other infectious diseases suggests the potential importance of preventive and suppressive therapy in reducing transmission
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How Do I Tell Them
When contacting previous sexual partners about genital herpes, be direct and honest. Let them know that you contracted genital herpes and the diagnosis date. Encourage them to seek testing and treatment, and remind them that most people are asymptomatic.
It may be an uncomfortable conversation, but notifying your partners is the best way to protect them and others from transmitting the herpes virus. Although there’s a lot of social stigma associated with STIs, they are a normal part of being sexually active – thereâs nothing to be embarrassed about. It’s also important to remember that genital herpes is extremely common worldwide.
- https://www.ncbi.nlm.nih.gov/books/NBK525787/#:~:text=In%20general%2C%20women%20have%20a,to%2010%25%20of%20the%20couples.
- https://www.healthline.com/health/how-long-does-it-take-for-herpes-to-show-up#incubation-periods
Herpes Simplex Virus Infection
Epidemiology
Anogenital herpes is caused by herpes simplex virus type 1 or type 2 . Infections caused by this virus are common across the world but there are variations in prevalence between countries and population groups.
HSV disease is not a notifiable disease in Australia so there are limited data regarding disease prevalence. A nationwide population seroprevalence survey of HSV infection from 1999-2000 found an overall HSV2 seroprevalence of 12% . HSV2 seroprevalence was two-fold higher in females compared with males , 18% amongst indigenous Australians, and higher in metropolitan compared with remote areas . The overall seroprevalence of HSV1 infection was 76% .
Historically, HSV1 was the most common cause of orolabial herpes and HSV2 the most common cause of anogenital herpes. However, recent data from a large sexual health clinic in Melbourne suggests that HSV1 is now the most common cause of anogenital herpes among women, people younger than 28 years and MSM .
Clinical manifestations
Genital HSV disease typically presents in the anogenital area with blistering, ulceration and lymphangitis . It is a common cause of proctitis in MSM, although only one-third of men will have externally visible ulcers . Herpes proctitis is more common among HIV-positive, compared with HIV-negative, MSM .
Management
Orolabial HSV disease
- Valaciclovir 500mg – 1 g PO BID
- Famciclovir 250 – 500 mg PO BID
- Acyclovir 400 mg PO TID
Initial or recurrent genital lesions
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Genital Herpes And Hiv Treatment Issues
It’s more difficult to treat genital herpes if you also have HIV. Higher doses of antiviral drugs are often needed to treat herpes in people with HIV. Also, many people with HIV have strains of the herpes virus that are resistant to treatment with the standard antiviral drugs.
If you take antiviral drugs for genital herpes and the treatment isn’t working, your doctor can test the virus you have for resistance. If the virus is resistant, there are other possible treatment alternatives, including the drugs Foscarnet and cidofovir.
If you have HIV, ask your doctor if you should be tested for genital herpes. If you already know that you have herpes and HIV, discuss treatment options with your doctor.
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Epidemiology Of Other Stis
Increases in other STIs have been less marked. Chlamydia is more prevalent in women than men and, as an STI that is asymptomatic in 50% of cases in men and 75% in women, diagnoses may be as much influenced by the number of people testing as actual incidence. Male chlamydia cases have risen by 15% in the last ten years but these pale into insignificance compared with a 224% increase in gonorrhoea and a 183% increase in syphilis, both concentrated in gay men.
LGV is caused by a variant of chlamydia which has evolved considerably greater virulence and can cause unpleasant long-term complications. The UK has had over 40% of the LGV cases in Europe, and two-thirds of them are in London. LGV was extremely rare until 2003 when there was an outbreak in the Netherlands, with the first UK cases appearing in 2004. There were 919 UK cases in 2016, somewhat lower than in previous years.
Diagnoses of the most common viral STIs have not increased, unlike the bacterial ones. First diagnoses of genital herpes have increased by 11% in the last ten years but have stayed more or less constant for the last six years at about 32,000 cases a year.
Other STIs that have caused particular concern in the post-AIDS era, especially in gay and bisexual men, includeMycoplasma genitaliumand gut infections such as Shigella.
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How Is Genital Herpes Transmitted
HSV is transmitted through direct skin-to-skin contact with an HSV lesion and it can also be spread through contact with a partners infected oral or genital area. When the virus is shed from infected skin it can be present in genital or oral secretions. Transmission can occur when the infected partner has no visible lesions and, in many cases, is not aware of the infection. HSV can be spread through sexual contact.
Genital HSV-1 or HSV-2 can be passed to a fetus or newborn during pregnancy or childbirth. The risk of transmission is higher if the pregnant person is experiencing a first HSV outbreak.³,,,,
Tenofovir Used To Combat Hiv Also Acts On Herpes
Scientists are working on developing preventive and therapeutic strategies that target both HIV and herpes, as having herpes may make individuals more vulnerable to contracting HIV.
Having genital herpes increases the risk that someone will contract or spread HIV during sexual intercourse, and it also can lead to worse health outcomes for those already infected with HIV. Because herpes is a cofactor for HIV, scientists are eager to develop strategies that will target both HIV and HSV in one fell swoop.
Several clinical trials investigating tenofovir for the prevention of HIV and HSV have been conducted, with varying results. The CAPRISA 004 study found that a vaginal microbicide gel containing tenofovir reduced HIV acquisition by 39% and reduced HSV acquisition by 51%. The VOICE study, which utilized oral tenofovir as well as vaginal microbicide gel, was halted ahead of schedule due to an inability to show that tenofovir reduced disease transmission rates, possibly due to low adherence. Two other studies that had subjects take a form of tenofovir were unable to demonstrate a reduction in transmission rates for HIV and HSV.
These mixed clinical results led a group of Belgian researchers to conduct an in vitro trial to see how tenofovir and PMEO-DAPy affected the herpes virus.
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Transmission Route From Primary Hosts To Humans
B virus is generally transmitted to humans percutaneously or transcutaneously by infected tissue or body fluids of macaques, especially after bites or scratches. Transmissions can also happen through wound or mucous contact with macaque saliva, injuries while handling animal enclosures accidents with cell cultures, needlesticks and with sharps during autopsy. Approximately half of the affected persons are animal keepers with direct contact to the animals. Another half is laboratory staff, e.g. while handling monkey cell cultures or blood components . The last reported fatal disease in 1997 occurred through conjunctival infection . Only one transmission from human to human has been described so far . No cases of transmission to human have been identified in Europe, but it could happen at any time.
Oral And Genital Herpes
There are two main types of herpes virus, HSV 1 and 2. There are also two places that herpes can affect: your mouth/lips and your genital/anal area .
Oral herpes causes tingling or painful fluid-filled blisters on the edge of the lip where it meets the skin of the face . These can occasionally develop on the nostrils, on the gums or on the roof of the mouth.
HSV 1 is most commonly associated with oral herpes, while HSV 2 is most commonly associated with genital herpes. But both viruses can cause either genital or oral herpes, and HSV 1 is now the leading cause of genital herpes in the UK.
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Is There A Cure Or Treatment For Herpes
Theres no cure for the herpes virus yet. A herpes vaccine doesnt currently exist, as the herpes virus has more complicated DNA than most infections, creating challenges for researchers.
However, medication can help with symptoms, like sores, and outbreaks. Medication also lowers the risk of transmission to others. You can take most medications for herpes orally, though you may also apply some as a cream or receive them by injection.
Are More Stis Due To More Sti Testing
One significant confounder of the observed rise in sexually transmitted infections is that there has also been a significant increase in testing for them. This applies to people receiving PrEP as well as the wider population. It is an increase not only in the overall number of tests but in the appropriate testing of all anatomical sites and in screening of people who do not report symptoms.
More testing, especially of asymptomatic STIs, will at least temporarily inflate the number of diagnoses. So it is important to establish the extent to which the rises in STI diagnoses are rises in incidence: are we finding more STIs primarily because we are testing more often for them?
Gonorrhoea and chlamydia are often both asymptomatic and self-limiting the immune system can eventually get rid of the infection . Syphilis is not self-limiting and can have serious acute symptoms as well as chronic ones, but its early stages can often be missed.
In the UK, the number of STI tests performed at sexual health clinics increased by 17.5% between 2013 and 2017, with the largest increases in women and gay men .
In other words, an increase in testing, and especially frequency of testing, often diagnose STIs that would simply have remained undiagnosed before, especially as chlamydia and gonorrhoea infections are often self-limiting.
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Who Is At Risk
All people who are sexually active, including people who experience sexual violence, are at risk for genital herpes. Because HSV stays in the body for life once a person has become infected, rates of genital herpes tend to be higher among older people. The Canadian Health Measures Survey indicated that about 19% of people aged 35 to 59 years had HSV-2 infection compared to 6% of people aged 14 to 34 years. The prevalence of genital HSV-1 infection is unknown but research in Canada suggests that many genital herpes infections are HSV-1.
Genital herpes is more common among cisgenderi women and transgenderii men than cisgender men and transgender women.¹,,