Sexual and Reproductive Health

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Positive for high-risk HPV

Dear Reader,

Positive test results can be upsetting, whether it’s a diagnosis for basal cell carcinoma (BCC), which is one of the most common kinds of skin cancer (one that’s relatively low-risk) or testing positive for the human papillomavirus (HPV) that is often associated with genital warts and cervical cancer. The short answer to your question is that high-risk HPV strains are the culprits behind the bulk of cervical cancer cases. However, a one-time positive HPV test does not necessarily mean you will develop cervical cancer. For many, the body will fight off high-risk HPV within one to two years. It’s also good to note that in the event that it does begin to develop into cancer, it can take anywhere from one to three decades for a high risk HPV infection to develop into a small tumor. So, even with high-risk HPV, there’s data to support optimism. In addition, knowing a bit more about HPV, HPV tests, and risks factors can help you understand it and take steps to address it.

Time for a quick HPV refresher! HPV is a group of about 40 viruses that are highly infectious and spread very easily from person to person through sexual contact. Of these 40 strains, there are about a dozen that are grouped as “high-risk,” meaning they are associated with changes in the cervical cells and with developing cervical cancer. Two strains in particular, HPV-16 and HPV-18, account for most of the cervical cancer cases due to HPV infection. The “low-risk” HPV types are associated with genital warts, but not with cervical cancer.

You shared that your yearly Pap test has been normal for some time and this is normal for many people. You can have a normal pap smear and still have high-risk HPV. A quick note on pap smears and HPV tests: the Pap test checks the cervix for abnormal cells that could turn into cervical cancer, whereas the HPV test checks the cervix for HPV that could CAUSE abnormal cells and lead to cervical cancer. So, your results (normal Pap, positive HPV) indicate that your cervical cells are normal, but high-risk HPV exists. If you do have an abnormal Pap test in the future, there’s no need to panic. A little less than half of the time, abnormal cervical cells that are seen after a high-risk HPV infection progress to invasive cervical cancer.

Because you mentioned your age, it’s worth noting that age can be a factor in monitoring HPV. For women under age 30, HPV is so common and cleared so often, that screening in that age group is not routine. In women over 30, however, it is more common for health care providers administer HPV tests and to monitor positive HPV results with regular Pap test. Since cell changes can occur slowly over time, a Pap test once a year is the recommended frequency for testing. However, if you tested positive for HPV-16 or HPV-18, your health care provider may also perform a colposcopy: in this procedure, s/he will look at the external vagina and cervix under magnification to check for any abnormal cells.

As a side note, it may interest you to know that research doesn’t show a correlation between cervical cancer due to HPV infection and most cancers, including the type of cancer you’ve had. Those who are at a greater risk of cervical cancer due to HPV infection include people who are severely immune suppressed, or who take immune suppressive drugs (to receive a transplant, those with Hodgkin lymphoma, or people who have had irradiation to the pelvis). In general, more research needs to be done in this area. But for now, your history of BCC doesn’t appear to be related in terms of your cervical cancer risk.

So, what else can you do to keep yourself healthy? Keeping up with your annual testing is one way to take care of your health with regard to your HPV, but it’s not the only thing you can do! Talking to others (e.g., friends, loved ones, or a counselor) can help you process and manage the anxiety you are feeling. Asking questions can help you learn more about a diagnosis, so props to you for reaching out! For some more specific info on cervical cancer, check out Cervical Cancer Info Online in the Go Ask Alice! archives.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Medical Services (CUMC)


Curious about female breast anatomy

Dear Reader,

Breasts can be rather intriguing — so it’s no wonder you’re curious. To get right to your questions, Reader, the components of the female breasts largely dictate the size and shape of the anatomy in question. They are mostly made of fibrous tissue and fat, with the amount of fat accounting for much of the differences in breast size. As far as shape is concerned, this is due in part because they contain the components necessary to make human milk. Though breasts are largely associated with the female of the human species, males have them too — and despite biological sex, there’s a lot of variance with each and every one.

Because the function of the female breast has an impact on appearance, it’s helpful to know a little bit more about lactation or the production of human milk. Milk production takes place within small round glands in the breast (called lobules) and usually occurs during the late stages of pregnancy (starting around the fifth or sixth month) and just after birth in order to breastfeed. Ducts connect the glands to the nipple, where milk exits the body. Breasts of females who are not pregnant and who have not recently been breastfeeding after giving birth do still contain the glands to produce milk, but do not have milk inside of them. It may interest you to know that the ability to produce milk is not the only change in female breasts resulting from pregnancy. Hormonal changes during pregnancy also cause the dark areas around the nipples (areolas) to grow and the overall breast size to increase.

In both males and females, the fatty tissue that composes the breast lies on top of the chest’s pectoralis muscles (or “pecs”) and is protected by a layer of connective tissue called fascia. Even though male breasts may not appear as “breasts” are often thought of, the structure is there. However, males typically have less tissue and also fewer glands and ducts than females. Almost 60 percent of men over the age of 44 have breast tissue that can be detected by touch. Lactation in human males has only been documented in rare cases.

As with other body parts, breasts vary from person to person. In addition to differences in shape and size, breasts can occasionally bear certain characteristics like extra breast tissue (polymastia) or extra nipples (polythelia). Sometimes, an individual may have only one breast or no breasts at all (amastia). Though every breast is unique, check out this Mayo Clinic slide show for a visual aid of the female breast anatomy. Hopefully this will help shed some light on what’s actually inside those mysterious female breasts!

Alice

Possible to get pregnant while breastfeeding?

Dear Reader,

Trying to make sense of an erratic menstrual cycle can certainly be confusing, especially when your hormones are going haywire after recently having a baby. To get straight to the heart of your question, the answer is yes; it is possible to get pregnant within a few months after having a baby — even if you’re still lactating. You may have heard about something called “lactational amenorrhea,” or the breastfeeding method, which is a birth control method frequently practiced by new moms. It works because breastfeeding causes a woman to stop ovulating and in turn, stop menstruating for about six months after giving birth. However, this contraception strategy only prevents pregnancy when under specific circumstances (more on that in a bit). This means that some new moms might still be at risk of pregnancy depending on their particular breastfeeding situation.

How does this whole breastfeeding method of birth control even work? The key is that when a woman is breastfeeding, the action of the baby suckling at her breast is a cue for the mom’s body to stop the release of a hormone known as gonadotropin-releasing hormone (GnRH), which regulates the menstrual cycle. This frequent suckling of a baby increases the levels of prolactin in a woman’s body — the hormone responsible for producing and releasing milk — and those high prolactin levels interfere with the release of GnRH. So, by stopping GnRH in its tracks, breastfeeding is able to prevent the whole cascade of other hormones that lead to ovulation and fertility. But here’s the kicker: just expressing milk with a breast pump or lactating (but not breastfeeding) might not be sufficient to cue the body to stop fertility. Breastfeeding only works as a contraception method if all three of these criteria are met:

  • Exclusive breastfeeding: The suckling action of the baby is believed to be the real key to preventing fertility. Some women are unable to breastfeed exclusively for any number of health or lifestyle reasons, and if the baby is getting formula or other foods, there’s probably a lot less suckling happening. Also, as babies get older and start eating other foods (usually around six months), they rely on breast milk less, so the breastfeeding method of birth control will no longer be effective.
  • Continuous breastfeeding: Again, the key here is the suckling action. If a new mom is not breastfeeding every four hours during the day and every six hours at night because she cannot or because the baby has started sleeping through the night, breastfeeding won’t be a reliable birth control method.
  • No bleeding or spotting: Once a woman starts to bleed or spot, it’s a pretty good sign that she’s fertile again. Keep in mind that a woman can be fertile and ovulate even before she notices spotting and bleeding. Monitoring other physical cues, like body temperature and cervical mucus, might help you stay on top of when you’re ovulating again and your fertility is returning. Check out Fertility awareness: The symptothermal method for information on monitoring fertility.

If you’ve reviewed the list above and think that it might be possible you’re at risk for pregnancy, consider checking in with your health care provider to evaluate whether you’re actually pregnant or not. If you’re not pregnant, there are lots of possible birth control methods out there for you to consider, such as traditional, shorter-term methods like condoms or oral contraceptives, or more long-acting options, like an intrauterine device (IUD). Your health care provider might also be able to help you pinpoint why you’re having irregular spotting.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Impact of hypothyroidism on pregnancy and the baby?

Dear want to be a mother,

Thyroxine is the main hormone produced in the thyroid gland. If there’s too much or too little of this hormone in the body, it can result in hypothyroidism (due to especially low levels of thyroxine) or hyperthyroidism (due to especially high levels of the hormone). For more information on hypothyroidism, check out Hypothyroidism symptoms? Turning to your specific question, want to be a mother, low levels of thyroxine (and, in turn, hypothyroidism) may affect conception and pregnancy and it’s good to be aware of the potential health risks for both mother and baby. The good news is that treating hypothyroidism under the guidance of a health care provider can minimize these risks.

The ability to conceive varies across individuals due to all sorts of factors — one of them being hypothyroidism. In some, but not all people, having low levels of thyroxine may interfere with the ability to ovulate (when an egg is released from an ovary) — which is a necessary step in order to conceive. If the low levels of thyroxine occur due to an autoimmune disease or a pituitary disorder, there may be other risks to fertility as well. For those with hypothyroidism who are able to conceive and become pregnant, there are a number of conditions that they are at a higher risk for, including:

  • Anemia
  • High blood pressure
  • Pre-eclampsia
  • Premature birth
  • Postpartum thyroiditis (a contributing factor to postpartum depression)
  • Placental disruption (in which placenta becomes detached from inner wall of uterus)
  • Miscarriage

Fortunately, treating hypothyroidism — usually by taking the synthetic thyroid hormone levothyroxine — under the supervision of a health care provider may increase the likelihood of conception and a safer pregnancy. Depending upon the specific type of hypothyroidism, treatment during pregnancy may differ. People with overt (or full-blown) hypothyroidism taking levothyroxine are advised to continue taking it during pregnancy. Sometimes a change in dosage is necessary as determined by the health care provider. With the correct dosage, there should be no harm to the fetus, though regular monitoring by the health care provider is essential. Those with untreated subclinical hypothyroidism (which is characterized by a mildly underactive thyroid gland) require monitoring during pregnancy and some health care providers may recommend that they also take levothyroxine while pregnant. This is to make sure their condition does not progress to overt hypothyroidism. Untreated hypothyroidism during pregnancy can increase the risk of serious health consequences to both mother and baby, including:

  • Impaired neurodevelopment of the fetus
  • Mental impairment of baby
  • Acute respiratory distress syndrome of the newborn
  • Postpartum hemorrhage

Receiving appropriate treatment for hypothyroidism as early as possible, under the close supervision of your health care provider, is the best way to prevent health complications of the mother and the child. For more information on becoming and being pregnant, check out the Go Ask Alice! pregnancy archives. Best of luck to you as you begin this exciting new journey!

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Boric acid safe for chronic yeast infections?

Dear Reader,

Considering how common yeast infections are, you’d think the yeast that could be done is to come up with an easy, reliable way of getting rid of them. After receiving confirmation that your symptoms do in fact point to a vaginal yeast infection (and not some other issue with similar symptoms), there are several options for treatment. Using boric acid suppositories is one option that is widely considered to be safe, although it’s also good to be aware of some exceptions and potential side effects.

Boric acid is a chemical that can act as both an antifungal and antiviral agent. Available over-the-counter (rather than by prescription), boric acid can be placed in gelatin caps that are then inserted into the vagina. Usually, these boric acid-filled gelatin caps are inserted vaginally each night before going to bed for a week. Studies have found boric acid to be a safe, affordable, and helpful treatment for many people with chronic or recurrent yeast infections that have not been successfully treated by other means. It may be especially effective for diabetic people with chronic or recurrent yeast infections. While some other antifungal yeast infection treatments only treat the Candida albicans yeast, boric acid treats both Candida albicans and Candida glabrata yeasts.

Though this treatment option may be suitable for many people, there are a few exceptions. Boric acid suppositories are considered safe for treating chronic yeast infections as long as they are not taken orally or used by children or pregnant people. That said, mild to moderate side effects are possible. Even when used correctly, boric acid can cause skin irritation or a burning sensation in the vagina. Before starting treatment, a visit to your health care provider can confirm that what you are experiencing is truly a chronic yeast infection and provide guidance on the best method of treatment for you. For more information about yeast infections and treatment options, check out the related Q&As below.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Essure: non-surgical sterilization

Dear Your #1 Fan,

Thanks for pointing to a gap in the contraception archives. As you allude to in your question, if by surgery, you mean a procedure that requires an incision, then you are correct: Essure is a birth control method that works to prevent pregnancies much like tubal ligation. Both are types sterilization, which means that they both inhibit the ability for sperm to meet an egg (and in turn, fertilization). They do this by physically and permanently blocking the fallopian tubes, but they do this in different ways (more on that in a bit). And much like other birth control methods, Essure does have its share of pros and cons, which are worth exploring prior to deciding on a birth control method.

While tubal ligation is a procedure that physically ligates (ties off, staples, or clamps) the fallopian tubes, Essure is not so much a procedure, but a product. Small coils made of metal and fiber are inserted into the fallopian tubes and over time, scar tissue builds up around the coils and blocks the tubes – thus achieving the same end result. The main difference between tubal ligation and Essure is that tubal ligation requires an incision through the wall of the pelvis. With Essure, no incision is required. A health care provider inserts the coils into the fallopian tubes by passing it through the uterus. To do this, a thin tube with a camera on the end called a hysteroscope is inserted through the vagina and cervix (which is first filled with water to ensure the fallopian tubes are open). The hysteroscope then uses a catheter to insert the coils into the fallopian tubes. Most women who’ve undergone the Essure placement procedure are sent home that same day. Although there may be some pain or discomfort, resuming normal activities are typically given the green light that day or the next.

It’s good to note that Essure is not immediately effective as birth control, as it takes time for the scar tissue to form (up to three months). To prevent pregnancy during this time, using another method of birth control for the first three months, such as the pill, the patch, or condoms is advised. After three months, an ultrasound or X-ray will help confirm whether the coils are in the right place and that the fallopian tubes are blocked. Once that’s been established by a health care provider, other methods of birth control can be stopped. Essure does not protect against sexually transmitted infections (STIs) so the use of condoms or barrier methods are recommended if a person is concerned about her/his risk.

There are additional benefits and risks involved in using Essure, like all methods of birth control. Reviewing them can really inform the decision-making process regarding this specific method.

The other benefits of Essure include:

  • Permanence and effectiveness: women who have had the Essure procedure have a less than one percent chance of becoming pregnant
  • Generally quick and painless insertion: no need for general anesthesia during insertion, the coils can be placed in less than an hour, and placement doesn’t result in scarring or wound healing due to intravaginal insertion
  • Not interruptive to sex: that is to say once scar tissue has developed (not including methods used to reduce STI risk)
  • Menstrual periods are not affected

Risks may include:

  • Considered permanent and not reversible: women who think they may want to become pregnant in the future may want to seek out another method.
  • Some side effects: immediate side effects of the placement procedure can include abdominal or pelvic pain, bleeding or spotting, cramping, dizziness, nausea, or vomiting (though usually short-lived)
  • Infection, persistent pelvic pain, perforation or tearing of the uterus or fallopian tubes
  • Only one of the fallopian tubes being blocked
  • May interfere with a previously inserted intrauterine device (IUD)
  • Eligibility for future surgeries that involve electrosurgical procedures (the metal coils could conduct electricity and damage tissues)

If extreme or persistent pelvic pain is experienced as a result of using Essure, or if a coil comes out of the vagina, it’s crucial to seek medical care immediately. Additionally, this method of birth control isn’t recommended for all women. This includes those who have a sensitivity or allergy to nickel, an existing uterine or fallopian tube blockage, a recent pelvic infection, been pregnant or given birth, or have had her fallopian tubes previously ligated may not be the best candidates for this method.

Learning more about this product is a great first step in deciding whether to use Essure. As far as next steps are concerned for those interested in the method, making an appointment to chat further with a health care provider is recommended!  

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Positive pregnancy test after after surgical abortion?

Dear Reader,

The short answer to your question is that if you had the Depo-Provera contraceptive shot within five days of your abortion, becoming pregnant even if your partner did not use a condom seems unlikely. According to Planned Parenthood, the shot provides immediate protection if it’s administered within five days of an abortion or miscarriage or within three weeks of giving birth. If the shot was not given in the appropriate time frame or not given at all, it’s certainly possible to get pregnant again after an abortion. For more details about possible pregnancy due to unprotected sex after an abortion, read Can you get pregnant within two weeks of having an abortion? In light of this, an unasked question here might be: Is there a possibility that you might have had a false-positive pregnancy test result following an abortion? The answer is yes and that’s why it’s a good idea to get your health care provider involved to confirm.

Since you received the contraceptive shot in the appropriate time frame following the abortion, why would a pregnancy test still come out positive? Pregnancy tests look for a high level of the hormone human chorionic gonadotropin (HCG). All people (regardless of gender) have some amount of HCG in their bodies — but the levels are usually too low to be picked up by a pregnancy test. Pregnant women release much more HCG, with levels changing as the pregnancy progresses. HCG levels in the body gradually decline in the 60 days following an abortion, so many people who take a pregnancy test within that time frame are likely to test positive — even if they are not in fact pregnant anymore or pregnant again because the levels of HCG are still high enough to be detected from the previous pregnancy. Pregnancy tests that use urine simply check for the existence of HCG above a certain threshold, so this can be especially misleading after an abortion. A blood test can identify both if HCG exists above that threshold and exactly what the level of HCG is, which provides a more full picture of what is happening inside the body.

Going to a clinic to take a pregnancy test — rather than relying on an over-the-counter (OTC) pregnancy test — is recommended and has several advantages:

  • A series of blood tests can show if the HCG levels are decreasing (as would be expected after an abortion, miscarriage, or giving birth) or increasing (suggesting a new pregnancy).
  • A pelvic exam can confirm the findings of a blood pregnancy test (both to show the abortion was successful and that a new pregnancy has not started) and also check for any physical complications after an abortion.
  • Talking with a health care provider during your visit to the clinic is a good way to follow up after the abortion experience and ask any additional questions about pregnancy or pregnancy prevention in the future.

Following up with your health care provider after an abortion is always recommended in order to address any physical and emotional needs you might have. If you have any concerns you may be pregnant again or questions about how to stay protected in the future, making an appointment with her/him is an especially good idea. As an additional note, high levels of HCG can point to different medical conditions besides pregnancy. Men can have their HCG levels checked, too! Only a health care provider can determine what the results may mean.

Hopefully, learning more about how levels of HCG remain elevated post-abortion sheds some light onto what may be happening. Going to see a health care provider is the only way to be absolutely certain you know what’s going on — and to be able to put your mind at ease.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


Irritable male syndrome?

Dear Synced and confused,

It’s terrific that a) you are keyed into your boyfriend’s mood changes and b) that you are concerned enough to try and figure out what is causing them. That said, it’s unlikely that he is experiencing what has been referred to as " irritable male syndrome". The term, coined in 2001, was used to describe irritability, nervousness, and depression in males who experience a drop in testosterone. However, this was observed at the end of the mating seasons in male animals (not humans) that breed annually. The "syndrome"  has been touted as a male condition similar to female pre-menstrual syndrome, but there is a lack of evidence to suggest that the condition exists in humans. To the issue of your menstrual period’s influence on your boyfriend, research has shown that menstruation does not affect male testosterone levels in any significant way. Though these biological factors may not give reason for your partner’s emotions, it’s possible that there’s a more psychological explanation at play.

While your menstrual period (biologically speaking) may not be directly influencing your boyfriend’s mood at ‘that time of the month’, your inclination to connect the two isn’t exactly that far off. Interestingly, there is documented evidence of psychological and even physical symptoms ‘syncing up’ among both female and male partners during pregnancy and the post-partum period. It has been well documented that men can be affected by their pregnant partners in a condition called Couvade syndrome. Also called “sympathetic pregnancy,” this condition occurs when men experience physical or psychological phenomena like nausea, depression, or even a toothache seemingly in tandem with their pregnant partners. Along those same lines, maternal post-partum depression is also closely linked and a significant predictor of paternal post-partum depression. These are just a few instances where female fertility has been linked to symptoms that can seemingly be shared between two people.

In your case, it may be a bit more reasonable to suspect that your boyfriend’s moods could be a result of a reaction to another person, rather than hormonal cycles. There is some psychological literature that explains a phenomenon referred to as emotional contagion. This is more or less the process of one person’s mood rubbing off on another. In a given interaction (say between you and your boyfriend), emotional contagion starts to take hold when one person begins to mirror the facial expressions, vocal qualities, posture, and movement of the person with whom they’re interacting — without even noticing. As those actions occur, the person doing the mimicking seemingly adopts the other’s emotions. While this phenomenon is thought to encourage successful social interactions and empathy, it can also make a person more vulnerable to the influence of another’s negativity or bad mood. You mention that your boyfriend seems to experience these monthly emotions even before you mention your period. Do you notice your moods changing around the time you have your period? Is it possible that your moods and emotions during that time are different than what you perceive them to be (i.e., that you feel that they are typical or positive, when in fact, they are not)? Is it possible as your boyfriend experiences a change in your mood, he unconsciously mimics it before you two even talk about it? These might be issues the two of you want to discuss.

Whether his moods are a result of emotional contagion or some other factor, there are some ways to address noticeable emotional change patterns. Together, you could try to maximize positive emotions during these times by taking a fun trip to a museum, taking a walk in the park, or going for a run (to get those endorphins going!), or tag-teaming dinner preparations. Research has demonstrated that those who practice regular reflections of gratitude also have significant and positive health benefits (emotional and physical), so you both might take a few minutes per week to reflect on things you are grateful for or excited about. If you want some help or an outside perspective in working with your boyfriend’s monthly emotional episodes, you might also consider checking in with a counselor or your health care provider, either together or on your own.

All in all, a critical part about emotion management is recognizing that the emotions are there in the first place! So far, sounds like you’re on the right track to being a responsive partner.

Alice

For more information or to make an appointment, check out these recommended resources:

Counseling and Psychological Services (Morningside)

Mental Health Service (CUMC)


PrEP covered by student health insurance at Columbia?

Dear Reader,

The short answer to your question is yes! The student health insurance plan (through Aetna) will cover the cost of  pre-exposure prophylaxis (PrEP) in the form of Truvada. Another piece of good news: Gilead, the manufacturer of Truvada also has a prescription co-pay assistance program for the drug.

PrEP is the use of an antiretroviral drug (Truvada) to prevent HIV infection in HIV negative individuals who are at significant risk of becoming HIV positive. Recent research has demonstrated that the use of this medication has significantly reduced the risk of HIV infection in men who have sex with men, injection drug users, heterosexual cisgender women, and transgender women. Reader, you mention that as a homosexual member of the Columbia community, the answer to this question is especially important to you. About two-thirds of HIV transmission in the United States occurs among men who have sex with men, making PrEP especially relevant to this group. That said, PrEP is effective in reducing the risk of HIV transmission among all populations, regardless of sexual orientation. Post-exposure prophylaxis (PEP) — taken after potential exposure by someone who is not known to be HIV negative — is also available through Columbia Health. For more information on both medications, check out the related Q&A HIV prevention with PEP, PrEP, and ART medications

You can begin the process of obtaining PrEP or PEP by contacting Gay Health Advocacy Project (GHAP) to make an initial appointment (located in Columbia Health's Medical Services). In the meantime, the Safer Sex Map may also be a helpful resource to locate free male and female condoms on campus. Student or not — if you live in New York City and do not have insurance, the NYC Health Department Enroller (available by calling 311) can provide assistance in getting PrEP under Medicaid or low-cost insurance and through payment assistance programs. Some clinics also provide PEP for free. Check out this website for free and confidential clinics in New York. Additional options for uninsured individuals seeking payment assistance are offered through the Gilead website as well.

Columbia Health is committed to ensuring that the process of obtaining PrEP is “simple, non-judgmental, supportive, and relatively rapid” so that students feel as comfortable as possible accessing it. Hopefully, this will put you at ease if you decide to bring up this topic with your primary care provider at Columbia Health.

Alice

HIV prevention with PEP, PrEP, and ART medications

Dear Reader,

It’s great that you recognize that there are ways to be sexually active with your partner while also minimizing your risk of contracting human immunodeficiency virus (HIV). You mentioned four important ways that HIV risk can be minimized, both before and after potentially infectious contact. Since you and your husband are in what is referred to as a HIV-discordant or sero-discordant relationship (where one of the two of you, not both, are HIV positive), understanding the many medications that may help reduce the risk of HIV transmission can go a long way to fostering a healthy, safer, and fulfilling sex life.

Post-exposure prophylaxis (PEP), refers to the drugs that can be taken immediately after someone who is HIV negative is exposed to potentially HIV positive body fluid like blood or semen. Who might need to take PEP? A health care worker who got accidentally stuck with a needle that was used to take blood from someone who might be HIV positive, or someone who got blood or body fluid into their eyes, mouth, or skin that was blistered, chapped or cracked, might be evaluated for PEP use. Other people who might need PEP are those who had a single episode of unprotected sex with someone who could be (or is) HIV positive. Under these types of circumstances, PEP is typically administered within 72 hours of exposure. It’s also recommended that other protective measures (sterilizing needles, using condoms and other barrier methods) are used as well just in case you did contract HIV. PEP is not 100 percent effective, but if it’s used properly, it could reduce your risk of developing HIV. For greater detail about PEP, including where you can get it check out the AIDS.gov website.

Unlike PEP, which is intended for short-term, emergency use directly after risky contact, the three other tools you mentioned: anti-retrovirals for your husband, using condoms, and pre-exposure prophylaxis (PrEP) are all intended for ongoing use to minimize the transmission of HIV between HIV-discordant sexual partners.

First, let’s chat a little about PrEP. PrEP is a prevention method endorsed by the Centers for Disease Control and Prevention (CDC) for people (like you) who are HIV negative but who could be at risk of getting HIV. PrEP combines two drugs, 300 mg of tenofovir disoproxil fumarate (TDF) and 200 mg of emtricitabine, into one pill that is taken once a day. For people who take the drug every day, and engage in other HIV prevention activities (e.g. consistent condom use, HIV couples counseling), research has found that (depending on the population) PrEP is between 62 to 92 percent effective at preventing HIV transmission. In one recent study with subjects who identified as men and transgender women who have sex with men, an effectiveness rate of 0.0 infections per 100 person-years was found among those who took four or more doses of PrEP weekly during the study period. In pregnant women, PrEP might also be a good way to reduce the risk of HIV transmission to the fetus.

Next on the list: the antiretroviral medications that your husband takes. Yep, antiretroviral therapy (ART) consist of a combination of medications that are recommended as ongoing therapy for those who are HIV positive, in order to keep the viral load of HIV in check. ART can be used in combination with PrEP — so for example, your husband could be on ART and you could take PrEP daily. However, the use of ART and PrEP does not completely eliminate the risk of transmission or infection, therefore, an important final step to minimizing risk of transmitting HIV is by using a barrier such as a condom or dental dam when having sex.

Finally, you mention you want to “complete the process like normal.” What is considered “normal” when it comes to sex may be different for different couples. While there is no 100 percent effective way of preventing transmission of HIV while having sex, it's possible to have a satisfying sex life while also taking steps to minimize the risk.

To your health!

Alice

For more information or to discuss these medications, check out these recommended resources:

Gay Health Advocacy Project (Morningside)

Medical Services (Morningside)

Student Health Services (CUMC)


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