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men who have sex with men (MSM)
Epidemiology:
- incidence of unprotected sex on the rise 2008-2011 [2]
Laboratory:
- HIV1 testing annually
- screening for hepatitis C (HCV Ab) if HIV1 + [5]
- Chlamydia DNA & Neisseria gonorrhoeae DNA
Complications:
- HPV-16 & HPV-18 (etiologic agents of anal cancer) have low clearance rates & high incidence rates (despite antiretroviral therapy)
- 43% of U.S. black men who have sex with men will be diagnosed with HIV1 infection in their lifetime [3]
Management:
- doxycycline 200-mg within 24 hours after condomless oral or anal sex (max 6 600 mg weekly) lowers risk for chlamydia & syphilis [4]
- tenofovir/emtricitabine as pre-exposure prophylaxis against HIV1 infection
References
- de Pokomandy A et al
Prevalence, clearance, and incidence of anal human
papillomavirus infection in HIV-infected men: The HIPVIRG
Cohort Study.
J Infect Dis 2009 Apr 1; 199:965.
PMID: 19239366
- Centers for Disease Control and Prevention (CDC).
HIV testing and risk behaviors among gay, bisexual and other
men who have sex with men - United States.
MMWR Morb Mortal Wkly Rep 2013 Nov 29; 62:958.
PMID: 24280915
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4.htm
- Editors
Physician's First Watch, Feb 24, 2016
David G. Fairchild, MD, MPH, Editor-in-Chief
Massachusetts Medical Society
http://www.jwatch.org
- Molina JM, Charreau I, Chidiac C et al
Post-exposure prophylaxis with doxycycline to prevent sexually
transmitted infections in men who have sex with men: an open-
label randomised substudy of the ANRS IPERGAY trial.
Lancet Infectious Diseasees. Dec 8, 2017
PMID: 29229440
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30725-9/fulltext
- Fairley CK, Chow EPF
Doxycycline post-exposure prophylaxis: let the debate begin.
Lancet Infectious Diseasees. Dec 8, 2017
PMID: 29229439
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30726-0/fulltext
- Medical Knowledge Self Assessment Program (MKSAP) 18,
American College of Physicians, Philadelphia 2018