MSM&TGpopulations. Management in. Sex. Sex. Outline. STIs/HIV. Sex. Sexual fluidity and HIV. Risk behavior. Recreational drugs

Transcription

1 Outline MSM = (at least) 9 patients /day Management in MSM&TGpopulations OPASSPUTCHAROEN M.D. CHULALONGKORNUNIVERSITY BANGKOK, TH /HIV Recreational drugs ual fluidity and HIV Risk behavior AIDS Patient Care STDS. 2009; 23(7):

2 ual network ual relationships within a set of individuals Recreational drugs Chemsex is a term commonly used by Gay men and Men who have sex with Men (MSM) to describe the use of certain drugs in a sexual context. It is a very specific form of drug use and is defined by the use of three drugs ('chems ): Methamphetamine (Crystal/Crystal Meth/Tina/Meth). Mephedrone (Meph/Drone). Gammahydroxybutyrate/Gammabutyrola ctone (GHB/GBL, G, Gina) Chemsex involves using one or more (specific) drugs to enhance sex The three main drugs used for chemsex : GHB Mephedrone Crystal meth Participating in chemsex is never 100% safe N= 874 Drug using, sexually active episodes of between 12 and 48 hours were the norm Chem poses considerable risks including the possibility of clusters of acute HIV infections amongst participants having condomless sex with multiple partners

3 How does the application work? DRUGS Drug interaction between recreational drugs and ARV Common in MSM Syphilis: Secondary syphilis, latent syphilis Hepatitis A, C GC and Non-GC urethritis Propor on* of MSM A ending STD Clinics with Primary and Secondary Syphilis, Urogenital Gonorrhea, or Urogenital Chlamydia by HIV Status, STD Surveillance Network (SSuN),

4 Recognition of common and uncommon features of Syphilis is on the rise Jarisch Herxheimer reaction Syphilis is on the rise Practical management in syphilis/hiv Serologic diagnosis: VDRL, RPR, TPPA, CMIA for syphilis Serologic response: decline in titer > 4 times of pretreatment titer Serologic response after treatment Success Two-dilution (4-fold) declines in nontreponemal titer Treatment failure or reinfection Persistent of clinical signs of syphilis Four-fold or more increase in nontreponemal titer Serofast or sero-resistence Failure of nontreponemal titer to decline more than four-fold or no decline A young man presented with right upper quadrant pain and proctitis Final diagnosis Amebic liver abscess Proctitis from amebic and chlamydial infection Proctocolitis Symptoms of proctitis, diarrhea or abdominal cramps Etiology: Campylobacter sp. Shigella sp. Entamoeba histolytica LGV serovars of C. trachomatis. Hepatitis A vaccination Vaccination is superior to immune globulin with respect to achievable antibody concentrations and durability of immune response In immunocompromised individuals, the serologic response to HAV vaccination may be diminished In HIV-infected individuals, seroconversion rates range from % HIV patients with lower CD4 cell counts (<300 cells/mm3) have lower seroconversion rates than those with CD4 cell counts 300 cells/mm3 (87 versus 100 %) J Viral Hepat Mar;14(3): Clin Infect Dis. 2004;39(8):1207

5 Active screening is crucial in high-risk population 90% of PrEP users had unprotected anal intercourse and had a mean 3 sex partners/ 3 months Asymptomatic are common Reliance on symptom alone to prompt testing would have missed 77% of at 3 months and 6 months Routine screening is recommended ually transmitted infection diagnoses, by time point and routine or symptom-based screening. Top Antivir Med. 2016;24(e-1):368. How frequent? More frequent STD screening (i.e., for syphilis, gonorrhea, and chlamydia) at 3 6 month intervals is indicated for MSM, including those with HIV infection if risk behaviors persist or if they or their sexual partners have multiple partners CDC 2015 How to screen STI Routine screening regardless of symptom Urine and rectal NAATs for C. trachomatis and gonococcal infection Pharyngeal NAAT for gonococcal and chlamydial infection Pharyngeal and rectal specimens can be patient-collected Syphilis serology and HBV, HCV, HAV (optional) serology Anal cancer Target population: MSM and persons with HPV-associated dysplasia* Digital rectal exam ± anal cytology every 1-3 years * Includes Anal Intraepithelial Neoplasia (AIN), Penile Intraepithelial Neoplasia (PIN), Cervical Intraepithelial Neoplasia (CIN), Vaginal Intraepithelial Neoplasia (VAIN) and Vulval Intraepithelial Neoplasia (VIN).

6 TG TG Medical and surgical affirmation (cardiovascular disease) erectile dysfunction TG

7 MSM/TG Conclusion HIV infection and are prevalent among MSM Recurrent STI is common in MSM/TG with high risk behavior ual risk reduction in this population is crucial Screening asymptomatic STI is very important Drug interaction between ART and chemsex agents or hormonal agents should be checked