August 13, 2012
We at NAPWA have disagreed with some of our friends, supporting approval of Truvada for PrEP even though wider use of PrEP will inevitably lead to some cases of "risk decompensation" -- abandonment of safe sex practices. There's plenty of unsafe sex happening already, and we hope the benefits of PrEP in populations as a whole will outweigh the harm to some individuals.
But we also want to see that harm minimized, and it's important for everyone using PrEP to know that HIV is no longer the only incurable sexually transmitted infection in today's world. We still need our condoms.
A case in point: an almost completely antibiotic-resistant strain of gonorrhea, detected in Japan in 2009, has now been observed in a very small number of cases in western Europe. At home, the CDC has responded to rising drug resistance by issuing new gonorrhea treatment guidelines. Instead of being taken orally, the potent antibiotic ceftriaxone should be injected directly into muscle and administered in combination with a second antibiotic (azithromycin or doxycycline). Ceftriaxone is among gonorrhea treatments of last resort, and now it has to be used for first-line treatment. The age of "You can take a pill for that" may be ending.