Quote: (02-14-2014 05:45 AM)DaveR Wrote:
Quote: (02-14-2014 02:20 AM)gringochileno Wrote:
tl;dr: yes you can treat known or strongly suspected STDs before knowing the results of testing. But you should get tested anyway and you should not take antibiotics "just in case" every X number of notches or rawdogs.
Which is essentially what I wrote in my original post. You could have saved yourself from this crusade against prophylaxis by simply reading that post more carefully. Much of what you wrote has been debunked previously by doctors on this forum (for example, Thomas the Rhymer gave actual data rather than rhetoric in another thread).
Your original post did not sound to me like that's what you were saying. Saying something like "if you go on a rawdog romp for a few weeks, it isn't a bad idea to take the medication for the big three STDs at the end" seems to indicate that you'd advocate taking antibiotics without a positive test result just because you rawdogged several girls, even if you don't have any symptoms yourself and haven't banged anyone with a known infection. If that's not what you meant then great, we agree.
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You are dreaming if you think a single round of antibiotics is a concern for creating resistance.
Of course not, and I never said it was. The risk is cumulative--the more often you take inappropriate antibiotics, the higher the risk of breeding a resistant bug.
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There are many cases where they are prescribed based only on suspicion. For example, If someone shows signs of gonorrhoea (even without testing), doxycycline will also be prescribed for Chlamydia.
Yes, if you treat someone for gonorrhea it's usually indicated to treat for chlamydia as well because the diseases are very co-morbid (and vice-versa). That's only if treatment is indicated in the first place--meaning one or more of: a) clinical signs and symptoms of infection, b) sex with someone with a known infection, or c) a positive STD test.
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The articles you quoted in relation to testing for Trichomoniasis and Chlamydia confirm what I wrote earlier.
The fact that point-of-care testing (meaning a test where the result comes back rapidly enough to know the result during the same clinic visit) isn't available shouldn't impact any decision to treat or not treat. It's not a big deal to wait a couple days for a culture to grow if you're asymptomatic and haven't been banging people with known STDs.
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Prophylaxis is indicated whenever there is a perceived risk. Where I am, the 3-drug regime is indicated for condom-broke-in-hooker incidents and other risky events. Pharmacists are authorised to recommend prophylaxis for high-risk events. Truvada is provided to some hookers as pre-exposure prophylaxis against HIV.
Is this in SEA? As far as I know the CDC or IDSA guidelines don't recommend anything that contradicts what I wrote above but admittedly I'm not very familiar with differences in practice guidelines outside the US. HIV PrEP for hookers isn't something I know a whole lot about either but that's a completely different patient population than what we're talking about here.