While reviewing my morning clinic schedule, I noticed that my first patient was a telehealth appointment for "lab results." Upon reading the notes in her chart, I learned that she was recently treated for syphilis. I also noted that she had been diagnosed with other sexually transmitted infections, including gonorrhea, in the past. I wondered if she had been offered preexposure prophylaxis (PrEP) before.
When I spoke with her on the phone, the patient was relieved to hear that the treatment for syphilis was working. While explaining that we would have to recheck her titers in 6 and 12 months, I asked if she had heard about PrEP.
As a medical student, I learned that clinicians should offer PrEP to people at substantial risk of contracting HIV. The "substantial risk for HIV acquisition" was primarily based on individual behaviors and history: sharing drug injection equipment; inconsistent condom use with partners whose HIV status is unknown; diagnosis of syphilis, gonorrhea, or another STI within the past 6 months. A clear challenge with this approach is knowing the sexual history and drug use behaviors of your patients.
The first medication approved by the US Food and Drug Administration for PrEP was Truvada (emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg), which the agency approved for adults in 2012 and later in 2018 for adolescents weighing at least 35 kg (77 lb).
