STI/D and PrEP
We believe that everyone should be aware of his or her STI/D(sexually transmitted infection/disease) status. How often STI testing is necessary varies from person to person and is based on individual safer sex practices, frequency of sexual encounters, and number of partners a person (or a person’s partner) has.
Complete STI testing includes testing for:
Syphilis (blood test done in our office at the time of service)
Gonorrhea and Chlamydia
Hepatitis B if you do not know your immunization status
An important part of any safer sex regimen is knowing your status.
Pre-Exposure Prophylaxis to HIV (PrEP)
In recent years, PrEP (pre-exposure prophylaxis to HIV) has become available and for some has become an integral part of safer sex practices. This office supports the use of PrEP as part of an overall safer sex regimen. We are committed to assisting in the reduction of new HIV infections. Our years of experience in managing HIV and STI counseling provide you with most current advice and care as you make your personal decision regarding PrEP.
On October 3, 2019 the FDA approved the use of Descovy (emtricitabine 200 mg and tenofovir alafenamide 25 mg) for PrEP as an alternative to Truvada. Both are HIV treatment medications. Both must be taken once a day to be effective in prevention of HIV infection. Neither drug prevents any other STI or other infection. There are no medications or vaccines that can be taken to prevent infection by Gonorrhea/ Chlamydia, Hepatitis C, or Syphilis.
If you are interested in beginning PrEP you may schedule an appointment with Dr. Ang. At your appointment the physician will order tests to assess your general health as well as your STI status. These include, but are not limited to:
Complete Blood Cell Count to determine your status regarding current bacterial or viral infection and whether or not you are anemic. Results will be available at the time of service.
Comprehensive Metabolic Panel with particular attention to your kidney (serum creatinine level in particular) and liver functions as Truvada can negatively impact both. Descovy has not been shown to impact creatinine levels. Results will be available at the time of service.
RPR to assess current or past infection with Syphilis. Results will be available at the time of service. If positive, treatment for active infection will be prescribed.
HIV panel will be sent to an outside lab to determine if you are currently infected with HIV. If positive you will be contacted to return to the office for further testing of HIV viral load, CD4 (T cell levels) and drug resistance.
Gonorrhea/Chlamydia tests will be sent to an outside lab, if positive you will be contacted to begin treatment.
Bone Density Heel Screening will be done in our office to identify, at the earliest stage, any sign of bone loss. Truvada, over time, can impact bone density which can lead to osteopenia or osteoporosis. This screening is commensurate with more expensive bone screenings. Descovy has not shown bone loss properties
Hepatitis C can be ordered in consultation with the physician. If ordered and found positive, you will be contacted to return to the office for Hepatitis C Viral load testing and discussion of treatment. Hepatitis C can now be cured.
Hepatitis B can be ordered in consultation with the physician - generally if you do not know your immunization status or past exposure status Hepatitis B antibody will be ordered. If you have not been immunized, immunized many years ago, or exposed to Hepatitis B (a negative antibody result), the physician will advise you as to receiving Hepatitis B immunization.
Assuming there is no reason not to start PrEP, a prescription for 3 months (90 days) will be issued by the physician. If there are any problems the physician will discuss these concerns with you.
According to CDC guidelines, only a 3 month prescription can be issued. You MUST return to the office for an office visit with repeat testing of the above tests (and any others that may be indicated) in order to receive a new prescription for PrEP. Please plan follow-up appointments according to the refill date for the prescription - a week ahead of the refill date should be sufficient so that you do not run out of medication.
Currently, most insurance plans cover PrEP and the associated medical visits according to the terms of the policy in which you are enrolled.
For those who choose not to use insurance or do not have insurance, we can offer a subscription of $125.00 per month for 12 months which covers 3 visits over 12 months. Or, $500 per visit (paid in full at the time of service). These packages cover all services offered in our office. Outside lab fees are paid separately to the outside lab and we do not have control over their fees - however cash prices are generally offered upon request by speaking with the billing department for the laboratory.
Safer sex practices reduce the chances of infection by STIs. PrEP can be part of that regimen.