From targeted therapies for HIV and HIV-prevention to innovative approaches in bacterial STI prevention and treatment, the potential of medication in mitigating STI-related risks is undeniable. Join us on a journey through the topic of of STI protection, where medicinal innovations pave the way for a safer, healthier future.
HIV, a life-threatening, still life-shortening, currently incurable infection, has been a significant global health burden since the 80s. However, recent advancements in medication have revolutionized both: prevention and treatment startegies.
HIV pre-expsosure prophylaxis (PrEP) involves taking a daily pill containing antiretroviral drugs to prevent HIV infections. When taken consitently, PrEP has been shown to reduce the risk of HIV transmission by over 99%.
HIV post-exposure prophylaxis (PEP) is a one month treatment regimen initiated within 72h after a potential exposure to HIV. It involves taking a full HIV-Treatment for one month to prevent the HIV from establishing infection after a high risk contact. Starting as close to the event as possible reduces the risk of HIV infection.
Bacterial STIs like syphilis, chlamydia, and gonorrhea are among the most common STIs worldwide. Therefore, antibiotics are the cornerstone of treatment for such bacterial STIs. While numbers are still rising despite increased testing, treatment and education, medical bacterial STI prophylaxis is now showing promise in breaking chains of infection.
While effective treatment remains crucial, a proactive approach to prevention is key in reducing the burden of bacterial STIs. Education on safer sex practices (→ Check: “How to safe sex”), including condom use and regular testing, plays a central role in preventing transmission.
In addition, and based on recent research, post-exposure antibiotics can be used as a prevention method for sexually transmitted infections (STIs) such as syphilis and chlamydia. This method has shown to be effective in breaking the infection right from the start, with efficacy in clinical studies of up to more than 80% in men who have sex with men (MSM) and trans women. The evidence now derives from several well-conducted clinical studies (Molina JM et al. 2018 (Ipergay), Luetkemeyer AF et al. 2023, Molina JM et al. CROI 2024, Stewart et al., 2023) and convincing real life data (Scott H et al., CROI 2024, #126; Bacon O et al., CROI 2024, #1151).
However, there is still no compelling evidence for women (assigned female at birth), as the only study with cis women did not provide conclusive data due to incorrect intake of prophylaxis (Stewart et al., 2023).
Post-exposure prophylaxis involves taking a single, one-time dose of a specific antibiotic to reduce the risk of contracting an STI up to 72 hours after sexual contact.
While HIV and bacterial STIs often steal the spotlight, other infections like human papillomavirus (HPV) and herpes simplex virus (HSV) also pose significant health risks.
HPV: HPV is the most common sexually transmitted infection worldwide. While most HPV infections clear up on their own or cause contagious but non-dangerous genital warts, certain high-risk strains can cause cervical cancer and other cancers. Vaccination, preferably before the onset of sexual activity but also in adulthood, and regular screening for cervical cancer are important strategies for preventing HPV-related complications.
Genital Herpes: Genital herpes, caused by herpes simplex virus (HSV) 2 and less commonly HSV 1 (cold sores), is a chronic viral infection characterized by recurrent outbreaks of painful genital sores. While there is no cure for herpes, antiviral medications can help manage symptoms and reduce the frequency and severity of outbreaks. It should also be noted that herpes is highly contagious from shortly before until shortly after an outbreak, and even condoms offer limited protection.
In conclusion, medication holds immense potential in STI protection, ranging from the prevention of HIV transmission with PrEP and PEP to the treatment and prevention of bacterial STIs like chlamydia, gonorrhea, and syphilis. Additionally, addressing other infections like HPV and herpes underscores the importance of comprehensive sexual health strategies encompassing vaccination, regular screening, and prompt treatment. By leveraging the power of medication alongside behavioral interventions, we can strive towards a world where STIs are no longer a major public health concern.
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