40. Those sexy STDs: opportunities for prevention in an anal dysplasia practice

Abstract

Young gay and bisexual men are continuing to engage in practices that permit new HIV infections. Most of them are unaware that pre-exposure prophylaxis (PrEP) with one pill a day can prevent most of these. HIV providers are poised to prescribe PrEP, but most of their patients are already HIV infected. General PCPs are considerably less knowledgeable regarding PrEP, even if they know/suspect that their patients are at risk for HIV acquisition. Anal dysplasia providers who see HIV-uninfected MSM have a unique opportunity to make an impact by identifying patients who might be candidates and providing basic information and referral.

Chlamydia trachomatis (CT) infection is notoriously difficult to detect by culture. CT is also a frequent cofactor in the transmission/acquisition of HIV. Gynaecologists routinely use nucleic acid amplification tests (NAATs) to diagnose CT and gonorrhoea. Although there is no FDA-approved commercially available NAAT for the diagnosis of rectal CT, individual laboratories are able to develop and validate their own assays, if they follow the protocols established by their regulatory/governing bodies. This may not be as difficult as you would expect, with good collaboration between clinical providers and laboratory administrators. Expect your diagnosis of rectal CT infections and lymphogranuloma venereum (LGV) to increase significantly once you have an NAAT available to aid in diagnosis. Timely treatment of CT infections will decrease the number of new cases and perhaps even HIV incidence.