INFECTIOUS DISEASE

ResponseWith anyone: Assuming it just meant anyone not necessarily with HIV+ person

• Receptive vaginal - 1:1250,000
• Receptive anal - 1: 100,000

With HIV+ person:

• Vaginal receptive 0.08% (~1:1250)
• Anal sex receptive 1.38% (~1:70)

High risk populations (>1% prevalence) = Caribbean, Subsaharan africa, South east asia, PNG
aidsmap.com

ResponseType of intercourse (oral = PEP not required, higher risk if receptive over insertive, higher risk if ejaculation)
Circumcised = lower risk
Concurrent STI - higher risk
Trauma during sex = higher risk
Time of intercourse (>72 hours evidence poor)
Viral load - if positive partner undetectable viral load no PEP needed
Pregnancy - if pregnant need to involve ID

ResponseChlamydia + Gonorrhoea (PCR or NAAT) - Oropharyngeal swab, first pass urine, anorectal swab
HIV serology - Ab + Ag
Syphilis serology
HAV Antibody
HBV HBsAg, Anti-HBc, Anti-HBs
Hepatitis C - Ab + PCR
LFT + EUC
hCG if female
Ask if they looked like their profile pic, and if there’s a second date

ResponseHigh level of protection but is not 100%
Importance of adherence
Adverse effects/drug interactions
Measures for preventing re-exposure to HIV (safe sex, needle sharing etc)
Follow up for HIV testing (Sexual health clinic, GP with knowledge in sexual health)
HIV seroconversion signs and symptoms
Contact tracing (pt/gp)
Vaccination - HPV, hep A+B

ResponseStart ASAP, should complete 28 day course
2 drug regime

• Tenofovir 300mg/Emtricitabine 200 mg (Truvada) daily

3 drug regime (not much evidence for 3rd drug)

• Above PLUS Dolutegravir 50 mg

(lots of options above from pep guidelines .org.au)

ResponseFollow up testing at 4-6 weeks and 3 months = clear
(no longer need 6 month test)

ResponseHep B
If unimmunised patient requires hepatitis B immunisation
If source confirmed hep B positive - HBV immunoglobulins