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Sexually Transmitted Disease Specialists

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Pre-exposure prophylaxis?

Posted on January 31, 2014 at 12:34 PM
Recently a patient asked about pre-exposure prophylaxis. He described himself as a "hobbyist," and explained that he often gives and receives unprotected oral sex with high risk partners. He asked if there were any medications that he could take to minimize the risk of infection, should he be exposed.

Well, there are no currently approved FDA protocols for pre-exposure prophylaxis. However, we do have post-exposure protocols which, with slight modification, should protect almost anyone against the most commonly transmitted STD's found in the high risk community.

The most common STD transmitted through oral sex is herpes (both type1 and type 2). While there are currently no FDA approved pre-exposure treatments, 1 gram of Valtrex, taken the day of exposure (preferably before the exposure) seems to offer very good protection.

Other common STD's transmitted orally include Chlamydia and Gonorrhea. With 4 tablets of Azithromycin, both of these conditions can be cured. However, to prevent, the old axiom "an once of prevention is worth a pound of cure" holds true, and as few as 2 tablets should do the trick (if taken within hours of exposure).

Syphilis is most easily addressed with either a shot (Rocephin) or single pill (Suprax 400 mg). Most other possible bacterial or protozoal infections are well covered with 2-4 tablets of Flagyl (500 mg) as a single dose (the number depending upon whether it is pre- or post- exposure).

Finally, all patients should be vaccinated against hepatitis B.



Categories: STD Treatment considerations

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18 Comments

Reply sEglhIAdDCONX
12:08 PM on September 11, 2021 
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Reply ngZGYjPhmSsJq
5:41 PM on October 28, 2021 
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11:30 AM on November 23, 2021 
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6:30 AM on December 23, 2021 
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Reply OKPWMmXJCIjsngZT
12:58 PM on February 1, 2022 
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9:25 AM on February 9, 2022 
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5:45 PM on February 17, 2022 
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Reply ZcynYzhwjusogxW
7:09 PM on February 25, 2022 
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Reply tcsindustrys
10:30 AM on February 28, 2022 
cidofovir, brand name vistide, is an injectable antiviral medication primarily used as a treatment for cytomegalovirus (cmv) retinitis (an infection of the retina of the eye) in people with aids.

cidofovir was approved for medical use in 1996.

medical use
dna virus
its only indication that has received regulatory approval worldwide is cytomegalovirus retinitis. cidofovir has also shown efficacy in the treatment of aciclovir-resistant hsv infections. cidofovir has also been investigated as a treatment for progressive multifocal leukoencephalopathy with successful case reports of its use. despite this, the drug failed to demonstrate any efficacy in controlled studies. cidofovir might have anti-smallpox efficacy and might be used on a limited basis in the event of a bioterror incident involving smallpox cases. brincidofovir, a cidofovir derivative with much higher activity against smallpox that can be taken orally has been developed. it has inhibitory effects on varicella-zoster virus replication in vitro although no clinical trials have been done to date, likely due to the abundance of safer alternatives such as aciclovir. cidofovir shows anti-bk virus activity in a subgroup of transplant recipients. cidofovir is being investigated as a complementary intralesional therapy against papillomatosis caused by hpv.

it first received fda approval on 26 june 1996, tga approval on 30 april 1998 and ema approval on 23 april 1997.

it has been used topically to treat warts.
Reply tcsindustryc
2:25 PM on April 10, 2022 
oritavancin, sold under the brand name orbactiv, is a novel semisynthetic glycopeptide antibiotic medication for the treatment of serious gram-positive bacterial infections. its chemical structure as a lipoglycopeptide is similar to vancomycin.

the u.s. food and drug administration (fda) and the european medicines agency (ema) have approved oritavancin for treatment of acute bacterial skin and skin structure infections.

in vitro activity
oritavancin shares certain properties with other members of the glycopeptide class of antibiotics, which includes vancomycin, the current standard of care for serious gram-positive infections in the united states and europe. it possesses potent and rapid bactericidal activity in vitro against a broad spectrum of both resistant and susceptible gram-positive bacteria, including staphylococcus aureus, mrsa, enterococci, and streptococci. oritavancin was more active than either metronidazole or vancomycin against strains of clostridium difficile tested.

oritavancin has potential use as a therapy for exposure to bacillus anthracis, the gram-positive bacterium that causes anthrax, having demonstrated efficacy in a mouse model both before and after exposure to the bacterium.

mechanism
the 4'-chlorobiphenylmethyl group disrupts the cell membrane of gram-positive bacteria. it also acts by inhibition of transglycosylation and inhibition of transpeptidation.
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4:21 AM on April 11, 2022 
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5:18 AM on May 1, 2022 
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Reply tcsindustrye
5:41 AM on May 21, 2022 
daptomycin, sold under the brand name cubicin among others, is a lipopeptide antibiotic used in the treatment of systemic and life-threatening infections caused by gram-positive organisms. it is a naturally occurring compound found in the soil saprotroph streptomyces roseosporus. its distinct mechanism of action makes it useful in treating infections caused by multiple drug-resistant bacteria.

daptomycin was removed from the world health organization's list of essential medicines in 2019. the world health organization classifies daptomycin as critically important for human medicine.


medical uses
daptomycin is indicated for use in adults in the united states for skin and skin structure infections caused by gram-positive infections, s. aureus bacteraemia, and right-sided s. aureus endocarditis. it binds avidly to pulmonary surfactant, so cannot be used in the treatment of pneumonia. there seems to be a difference in working daptomycin on hematogenous pneumonia.

adverse effects
common adverse drug reactions associated with daptomycin therapy include:

cardiovascular: low blood pressure, high blood pressure, swelling
central nervous system: insomnia
dermatological: rash
gastrointestinal: diarrhea, abdominal pain
hematological: eosinophilia
respiratory: dyspnea
other: injection site reactions, fever, hypersensitivity
less common, but serious adverse events reported in the literature include

hepatotoxicity: elevated transaminases
nephrotoxicity: acute kidney injury from rhabdomyolysis
also, myopathy and rhabdomyolysis have been reported in patients simultaneously taking statins, but whether this is due entirely to the statin or whether daptomycin potentiates this effect is unknown. due to the limited data available, the manufacturer recommends that statins be temporarily discontinued while the patient is receiving daptomycin therapy. creatine kinase levels are usually checked regularly while individuals undergo daptomycin therapy.

in july 2010, the fda issued a warning that daptomycin could cause life-threatening eosinophilic pneumonia. the fda said it had identified seven confirmed cases of eosinophilic pneumonia between 2004 and 2010 and an additional 36 possible cases. the seven confirmed victims were all older than 60 and symptoms appeared within two weeks of initiation of therapy.
Reply tcsindustryy
9:09 AM on May 24, 2022 
procarbazine is a chemotherapy medication used for the treatment of hodgkin's lymphoma and brain cancers. for hodgkin's it is often used together with chlormethine, vincristine, and prednisone while for brain cancers such as glioblastoma multiforme it is used with lomustine and vincristine. it is typically taken by mouth.

common side effect include low blood cell counts and vomiting. other side effects include tiredness and depression. it is not recommended in people with severe liver or kidney problems. use in pregnancy is known to harm the baby. procarbazine is in the alkylating agents family of medication. how it works is not clearly known.

procarbazine was approved for medical use in the united states in 1969. it is on the world health organization's list of essential medicines, the safest and most effective medicines needed in a health system. in the united kingdom a month of treatment cost the nhs 450 to 750 pounds.

medical uses
when used to treat hodgkin's lymphoma, it is often delivered as part of the beacopp regimen that includes bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine (tradename oncovin), prednisone, and procarbazine. the first combination chemotherapy developed for hodgkin's lymphoma (hl), mopp also included procarbazine (abvd has supplanted mopp as standard first line treatment for hl, with beacopp as an alternative for advanced/unfavorable hl). alternatively, when used to treat certain brain tumors (malignant gliomas), it is often dosed as pcv when combined with lomustine (often called ccnu) and vincristine.

dose should be adjusted for kidney disease or liver disease.

side effects
very common (greater than 10% of people experience them) adverse effects include loss of appetite, nausea and vomiting. other side effects of unknown frequency include reduction in leukocytes, reduction in platelets, reduction in neutrophils, which can lead to increased infections including lung infections; severe allergy-like reactions that can lead to angioedema and skin reactions; lethargy; liver complications including jaundice and abnormal liver function tests; reproductive effects including reduction in sperm count and ovarian failure.

when combined with ethanol, procarbazine may cause a disulfiram-like reaction in some people.

it weakly inhibits mao in the gastrointestinal system, so it can cause hypertensive crises if associated with the ingestion of tyramine-rich foods such as aged cheeses; this appears to be rare.

procarbazine rarely causes chemotherapy-induced peripheral neuropathy, a progressive, enduring, often irreversible tingling numbness, intense pain, and hypersensitivity to cold, beginning in the hands and feet and sometimes involving the arms and legs.
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