FISTING AND SYPHILIS AND HIV

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Apart from the conference, for a research paper I am writing, I found an article which showed that fisting is associated with transmission of more syphilis and HIV. Maybe there are more tears of the rectum and anus with this practice and then if they have sex after the tears, the HIV and syphilis can more easily enter the broken mucosa (lining). I have no data on how long it takes to heal the lining after a fisting event.

PREVENTION OF STIs
Prevention of gonorrhea with antibiotics for those who have frequent, unprotected sex has been shown to cause resistance (the medications stop working since the bacteria has mutated). This resistance can now be passed to others. In fact, there is a small amount of resistance in the world to gonorrhea with the current treatments. It might take a year or two or more for this resistance to reach the US. Chlamydia and syphilis are different kinds of bacteria than the regular kind (like E Coli, gonorrhea, Salmonella, Shigella, Pseudomonas). Chlamydia must be inside a host’s (that’s you!) cell to live. It can’t live outside the cell. Syphilis looks and swims/moves like a corkscrew with a long tail. These two have not become resistant to the routine antibiotics like gonorrhea has over many years. In fact, Penicillin, when first discovered killed most bacteria; now it is pretty much only used for Strep (e.g. Strep throat) and Syphilis.

CO-FACTORS OF HIV TRANSMISSION IN AN AREA
Geography:
What is the prevalence of HIV in your area (what percent have HIV in your pool of possible sex or needle partners)?
Behavior:
Number of Partners and number of sex acts: the more times you throw the dice, the more times you are a winner = get infected. I mean loser!.
Are they using stimulants (meth, cocaine) which jack up the virus too?
Are they using substances which help them make harmful decisions (have sex, unprotected, rough, catch STIs)?
Type of sex (anal is more risky than vaginal which is much more risky (so probably ignore the HIV risk but not of other STI risks of) oral sex.
Biological/Virological factors:
How healthy are you by your lifestyle and your genes (unable to measure or change this one). How much virus did you receive and how strong is your immune system to fight a few of them off?
How destructive is the virus you received?
Do the partners have a break in their membranes (a sexually transmitted disease-STI)?
Is the HIV positive partner on medication and is the viral load minimal?

METH AND HEROIN=GOOFBALLS
This combination causes more HIV infections, drug abuse and more meth addiction, which we know causes a downward life spiral.

NEW ANTIVIRALS
The long acting injections of rilpiverine and cabotegravir are moving along and successful at each step. A study showed many would prefer the injectables over pills. But remember when you start injectables and when you stop, there is a month or so where you must take pills. Timing of the injectables and pills and good medical supervision is essential.
A medication-leakng ring to put inside and around a woman’s cervix to prevent HIV and pregnancy are also desired by patients, a study found. These surveys inspire the manufacturers to move on these products.
Injected antibodies to HIV are also showing promise.
The cure and a good vaccine are years away still.
Hepatitis B cure is still a long way off. Asia has many of these, but taking medicine for life is working well, just like for HIV. Remember, a few of the HIV drugs control HIV and Hepatitis B.

90 90 90 IS WORKING IN AFRICA
If 90% of those with HIV are found, and 90% of those are put on treatment, and 90% of those have controlled virus (i.e. very hard to transmit it) then we can stop HIV in a region. San Francisco, Los Angeles, London, and many large African cities are decreasing transmission dramatically with putting funds into this approach. Vans go out and test people in hot spots and if positive, the patient is offered treatment and an appointment immediately. Good follow up happens after that first appointment. New cases of HIV drop dramatically with this approach.

INTEGRASE INHIBITORS ARE VERY POWERFUL
Stribild®, Genvoya®, Triumeq®, Tivicay®, Isentress® are in this class and a study showed they drop HIV so fast that there is a risk in those with low CD4s that a low-grade opportunistic infection can bloom and hurt the patient. So good and bad news. If providers are vigilant, then they will be ready to treat the Immune Reconstitution Inflammatory Syndrome, and not start the antivirals until the opportunistic infection is somewhat controlled. So these medications are not only powerful, have less drug interactions, and are quite tolerable. Genvoya® / Stribild® does have more drug interactions than the others.

Be Safe! Wear protection. Get tested. Keep those questions coming.

Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV Specialist, Assistant TB Physician, Riverside County Public Health Department
Member, Coachella Valley Clinical Research Initiative

REFERENCES: Medscape®

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