Avoiding STI's While Travelling

Sex can be a natural consequence of travel, you are having a great time, you meet great people. Sex happens.

I frequently see straight patients who are worried about HIV and other STI’s but are not sure the best way to avoid them. Many are not aware they could access things like PrEP, a drug that prevents HIV infection, because they had not heard of it or thought it was only for gay men.

In good news We’ve got your back, no matter who you have sex with!
One of the criteria for considering PrEP is:

When a person plans to travel to countries with high HIV prevalence during which time they anticipate having condomless sex with casual partners who are HIV positive or of unknown HIV serostatus ¹ (ASHM PrEP Guidelines)

PrEP works very well for preventing HIV infection in both straight and gay people.

If you’re a gay male PrEP on demand is a good option for HIV prevention when on holidays.

If you are a straight male and only having insertive anal or vaginal sex, PrEP on demand is also an option for you:
It’s highly effective, reducing risk of HIV infection by 97%².

On-demand (2:1:1) dosing is very effective for anal sex or for straight men having vaginal sex. ³

To Take PrEP on demand it’s very simple:

Take 2 tablets of PrEP 2 -24 hours before you plan to have sex.
Take one tablet of PrEP every day till you wish to stop
When you wish to stop just take 1 tablet of PrEP daily for 2 days until 2 days has passed since your last sexual activity.

For people travelling I recommend:

Take 2 tablets when you get on the plane
Then take 1 tablet of PrEP every day till 2 days after your return
This way you are protected against HIV for the whole trip of your holiday

Worried about other STI’s?

Doxy PrEP might be an option for you. Doxycycline taken after sex has demonstrated a strong ability to reduce the chance of infection with Chlamydia, Gonorrhoea and Syphilis.

Doxy PrEP

Efficacy:
1. In persons taking HIV PrEP, doxy-PEP reduced syphilis by 87%, chlamydia by 88% and gonorrhea by 55%.
2. In PLWH, doxy-PEP reduced syphilis by 77%, chlamydia by 74% and gonorrhea by 57%.
3. Efficacy against other bacterial STIs is not known, and doxy-PEP does not prevent HIV, monkeypox (MPX) or other viral infections, for example HPV: The wart viurs, and HSV: The herpes virus

Dosing and prescribing:
1. 200 mg of doxycycline should be taken ideally within 24 hours but no later than 72 hours after condomless oral, anal or vaginal sex
2. Doxycycline can be taken as often as every day, depending on frequency of sexual activity, but individuals should not take more than 200 mg within a 24 hour period.
3. Either doxycycline hyclate delayed release 200 mg (1 tab) OR doxycycline hyclate or monohydrate immediate release 100 mg (2 tabs taken simultaneously) are acceptable.
4. Immediate release may be less expensive than delayed release and should be equivalently bioavailable. ⁴⁵

You just need to be aware that Doxycycline can be a little rough on the stomach so have it with food. It can also cause a skin reaction to the sun so avoid getting sunburned.

How Do I get These Medications?

Getting These Drugs:

you need a script from a doctor
If you are in Australia you can get these medications from any pharmacy.
If you are overseas you can purchase from the following proven and reliable suppliers:
- Dynamix: https://www.purchase-prep.com/
- Green Cross Pharmacy: https://www.generics.greencrosspharmacy.online/
- Bangkok:
  - Red Cross: https://th.trcarc.org/prep-pep-service/
  - Pulse Clinic: https://www.pulse-clinic.com/

Should I get tested on my return?

Yes! It’s a great idea to get tested when you get home.

I recommend the following:

A blood test for HIV, Syphilis and Hepatitis C
A urine test for Chlamydia and Gonorrhoea
If you have kissed anyone, a throat swab for Gonorrhoea and Chlamydia
If you have any any anal play, fingers, toys, rimming… then a bum swab for Chlamydia and Gonorrhoea.

Your doctor can easily help you with this.

If you are not comfortable covering these issues with your GP, I am happy to talk with you at my Collins Street clinic in Melbourne’s CBD. My office is discrete, “just a regular GP practice”.

You can discuss your needs either face to face or via a tele-health appointment.

You just need to book in. Full details are here: Dr George Forgan-Smith or call: +61 3 8575 6900