Revision of the national guideline for first-line comprehensive management and control of sexually transmitted infections: what's new and why?

Lewis, David A.; Maruma, E

doi:10.1080/10158782.2009.11441341

Cited by 28 publications

(32 citation statements)

References 9 publications

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“…Treat STIs syndromically as per national guidelines (Table 2). 36 MSM who test HIV positive should be clinically staged, have a CD4 count taken and be managed in line with HIV treatment guidelines (http://www. sahivsoc.org/practise-guidelines/nationaldept-of-health-guidelines).…”

Section: Managing Abnormal Screening Resultsmentioning

confidence: 99%

Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

Committee

2012

Southern African Journal of HIV Medicine

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Background. The use of oral antiretrovirals to prevent HIV infection among HIV-negative men who have sex with men (MSM) has been shown to be safe and efficacious. A large, randomised, placebo-controlled trial showed a 44% reduction in the incidence of HIV infection among MSM receiving a daily oral fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine (Truvada) in combination with an HIV prevention package. Improved protection was seen with higher levels of adherence. Aim. The purpose of this guideline is to: (i) explain what pre-exposure prophylaxis (PrEP) is; (ii) outline current indications for its use; (iii) outline steps for appropriate client selection; and (iv) provide guidance for monitoring and maintaining clients on PrEP. Method. PrEP is indicated for HIV-negative MSM who are assessed to be at high risk for HIV acquisition and who are willing and motivated to use PrEP as part of a package of HIV prevention services (including condoms, lubrication, sexually transmitted infection (STI) management and risk reduction counselling). Recommendations. HIV testing, estimation of creatinine clearance and STI and hepatitis B screening are recommended as baseline investigations. Daily oral Truvada, along with adherence support, can then be prescribed for eligible MSM. PrEP should not be given to MSM with abnormal renal function, nor to clients who are unmotivated to use PrEP as part of an HIV prevention package; nor should it be commenced during an acute viral illness. Three-monthly follow-up visits to assess tolerance, renal function, adherence and ongoing eligibility is recommended. Six-monthly STI screens and annual creatinine levels to estimate creatinine clearance are recommended. Hepatitis B vaccination should be provided to susceptible clients. Gastro-intestinal symptoms and weight loss are common side-effects, mostly experienced for the first 4 - 8 weeks after initiating PrEP. There is a risk of the development of antiretroviral resistance among those with undiagnosed acute HIV infection during PrEP initiation and among those with sub-optimal adherence who become HIV infected while on PrEP. Risk compensation (increasing sexual behaviours that can result in exposure to HIV) while on PrEP may become a concern, and clinicians should continue to support MSM clients to continue to use condoms, condom-compatible lubrication and practice safer sex. Research is ongoing to assess optimum dosing regimens, potential long-term effects and alternative PrEP medications. Recommendations for the use of PrEP among other at-risk individuals, and the components of these recommendations, will be informed by future evidence. S Afr J HIV Med 2012;13(2):40-55.

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Section: Managing Abnormal Screening Resultsmentioning

confidence: 99%

Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

Committee

2012

Southern African Journal of HIV Medicine

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“…Several sub-Saharan African countries have recently added episodic therapy for herpes to the treatment for GUD. 16,17 Our study should help to inform the implementation of the new treatment guidelines, strengthening the need for men to seek care as early as possible. Our findings suggest that men who delay seeking care might benefit from selection for enhanced sexual health counseling as they are more infectious for HIV and were more likely to have sex with a genital ulcer but no more likely to disclose the ulcer to their partners.…”

Section: Care Seeking For Gud In Menmentioning

confidence: 97%

“…Episodic acyclovir therapy has recently been added to syndromic management guidelines for GUD in several subSaharan African countries including South Africa 16,17 ; therefore, it is important to further examine the health care-seeking and sexual-risk behaviors of men who have genital ulcers. In addition, little is known about the relationship between delays in health care seeking for genital ulcers and HIV-1 and HSV-2 outcomes.…”

mentioning

confidence: 99%

Health Care Seeking Among Men With Genital Ulcer Disease in South Africa: Correlates and Relationship to Human Immunodeficiency Virus-1 and Herpes Simplex Virus Type 2 Detection and Shedding

Leichliter¹,

Lewis²,

Sternberg³

et al. 2011

Sexually Transmitted Diseases

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“…HSV-2 infections are usually self-limited but can cause major complications in immunocompromised individuals [3]. Acyclovir (ACV), a nucleoside analogue of guanosine, was included in South Africa's national guidelines for first-line comprehensive management and control of sexually transmitted infections in August 2008 [4]. ACV, an inactive prodrug, is phosphorylated to its monophosphate form by virusencoded thymidine kinase (TK) and then twice phosphorylated by cellular thymidilate kinases, resulting in the active triphosphate ACV form.…”

Section: Introductionmentioning

confidence: 99%

Genetic Characterization of Herpes Simplex Virus Type 2 UL23 Thymidine Kinase in Johannesburg, South Africa

Müller¹,

Magooa²,

Lewis³

2013

J Antivir Antiretrovir

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Revision of the national guideline for first-line comprehensive management and control of sexually transmitted infections: what's new and why?

Cited by 28 publications

References 9 publications

Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

Health Care Seeking Among Men With Genital Ulcer Disease in South Africa: Correlates and Relationship to Human Immunodeficiency Virus-1 and Herpes Simplex Virus Type 2 Detection and Shedding

Genetic Characterization of Herpes Simplex Virus Type 2 UL23 Thymidine Kinase in Johannesburg, South Africa

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