#AskDocQ: Is PrEP Safe? Is There A Strain Of Gonorrhoea That’s Untreatable?

Welcome to Ask DocQ. The Doc has returned for 2018. However, in addition to her regular health updates, Dr Fiona Bisshop is just as interested to find out what’s on your mind. Have you made a health resolution that you’re struggling to keep? Or maybe it’s time to ask about that burning sensation you’ve had since Christmas and have been worrying about regifting?

The Doc knows that it can sometimes be difficult to find time to make good health a priority. Or, maybe your concern is just too embarrassing and you hope it’ll go away. If so, the Doc wants to hear from you! Send your question to doctorqnews@gmail.com, and she’ll pick the best ones to answer each month. But don’t worry! No identifying information will be included in the printed reply, and your personal information stays with the Doc.

And at QNews Magazine, we’ll start collecting all of answers. Look out soon for our new health and wellbeing pages online, your central point for a whole range of LGBTIQ-focussed health resources and services. In the meantime, these questions are only a starting point. If you’re worried, and feel you need help sooner, nothing beats making an appointment and going to see your regular GP in person.

I know a few people on PrEP, but I’ve heard it might not be safe, and someone told me it will make my bones brittle.

PrEP, the once daily pill to prevent HIV infection, is available now at selected QPrEP study sites all over Queensland. It’s being taken by hundreds of thousands of people the world over, and we know that the rate of protection is close to 100%.

It’s actually one of the greatest prevention measures that modern medicine has come up with, probably safer than the contraceptive pill, with very few safety issues.

There are two risks associated with PrEP use that your doctor will discuss before prescribing it. The first is the effect it has on your kidneys. It causes a slight change in the blood level of creatinine, which we use to assess kidney function. For the majority of people, this does not result in a significant drop in kidney function. In very rare cases it can cause a more worrying effect on kidney function; however, this is reversible if you stop the pill. For this reason we always measure your creatinine when you have your routine tests at your PrEP visit.

The second effect is a slight drop in your bone density; we’re talking between 1 and 3%. For most young fit guys who do plenty of weight-bearing exercise this is of no consequence. However, if you have a very slight build, a family history of osteoporosis, or have had a lot of bone fractures, your doctor will probably want to measure your bone density before you go onto PrEP, and every one to two years after you start it.

PrEP, also known as Truvada, a HIV prevention medication

I met a guy who said he’d heard there’s now a strain of gonorrhoea that’s resistant to all antibiotics. Can I avoid this, and what can I do if I catch it?

Yes, there is a strain of gonorrhoea which is resistant to all the usual antibiotics we use to treat it. It’s been documented in several countries, but so far does not seem to have taken hold in Australia.

The bacteria that causes gonorrhoea is very good at developing resistance to each new class of antibiotic used against it, which is why we currently treat it with a combination of an oral antibiotic and an injection. So far this treatment is still holding in the Australian setting. Of course, there are fears that the more resistant strain will spread here, and then spread fast amongst the community.

One of the problems with gonorrhoea is that you don’t always know you’ve got it. It can lurk in your throat or bum without many obvious symptoms, and can be passed on by oral sex as well as by rimming and condom-less anal sex.

For this reason we recommend three-monthly screening―or more often if you feel the need―and it’s always a good idea to use condoms if you’re having sex with someone for the first time, or if they don’t get regular tests.

Oh, and don’t forget good old Listerine mouthwash gargle. Ongoing studies are looking at how well this might kill any lurkers behind your tonsils, so it’s worth freshening up after your date as well as before!

Dr Fiona Bisshop specialises in LGBT health.

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Dr Fiona Bisshop

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