Can Truvada be taken regularly to prevent HIV?

Question

Hi doctor,

I am a 37-year-old heterosexual male. I am HIV-negative with no known STD. I always have safe sex. I always have very safe sex with girls who are not sex workers. But may have casual sex with others. Generally, I would imagine that they, too, would be practicing safe sex with their regular boyfriends, but really, I do not see statistically any real chance of contracting HIV or any other STD. I, too, have had casual sex with a number of such girls.

If I continue these activities with multiple partners of the same profile, then the chance of contracting HIV or STDs should be next to zero. Is this correct? In two situations, like the condom coming out or breaking, but the sex act being stopped immediately, what would be the chance of my contracting HIV or any other STD? What other immediate preventive measure should I take if the condom breaks or comes out other than stopping the act?

Should I take Truvada immediately? If yes, for how many days should I take it to become effective? Does it become effective from day one? Can one take it a few days before sexual intercourse, stop it in between, and again restart it? Do I need to do any blood tests for HIV or other STDs in case the condom breaks or slips out?

If so, what are the blood tests that I need to do, and with how many days gap? Is there any STD one can get from skin-to-skin contact without genital contact? Is there any STD one can get from accidental genital contact, and what preventive measures should be taken if this happens? Can one get an STD from kissing?

Only once in my life, around two to three years back, I had intercourse without a condom. I had myself tested for HIV six months later, and it turned out to be negative. I have not had any symptoms of any STDs, but should I still get myself tested for any STDs, and if so, which test should I do?

Which condom size should I use? My penis is 7 inches in length and 7.5 inches in girth. Do I use XL or XXL? I do not find any condom that supports 7.5-inch girth. What should I do in this case? It seems that if the partner is HIV+, then there would be a statistically low probability that one sex acts with protection.

Would it not be better to take Truvada regularly to be on the safer side? What are the side effects of taking Truvada regularly, even if one is not at high risk? Should I use any lubricant with the condom? Should I get a hepatitis B shot? I am not sure whether I have had the shot earlier.

Kindly guide.

Answer 1

Hi,

Welcome to icliniq.com.

An unsafe sex increases the chance of contracting STDs (sexually transmitted diseases) as well as HIV (human immunodeficiency virus). As you mentioned, the status of your partners is mostly not known, so this puts you at risk of contracting STD or HIV if you get involved in unsafe sexual practices with such partners.

In case of slippage of condoms or breakage of condoms, it puts you at risk, which cannot be neglected while having sexual intercourse. The first and foremost important thing to do is to stop the act and wash your genitals with mild soap under running water. Avoid applying any cream or lubricant that can cause irritation to genital skin. Besides this, avoid promiscuous behavior.

There is no need to take Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate) until and unless you know the HIV status of the partner with whom you have had unprotected sex.

Truvada is not a medication that can be taken on an emergency basis, just like an I-Pill. It is an antiviral drug that is prescribed in case of positive HIV results. Hence, it cannot be prescribed before having unprotected sex like an OCP (oral contraceptive pill). It is not meant for the prevention of HIV but for preventing the progression of worsening of HIV once it has been contracted.
Yes, you should get your as well as your partner's blood tests done, which should include HIV, chlamydia, trichomonas, gonorrhea, syphilis, candida, herpes, genital warts, and hepatitis B and C. For HIV, you need to get yourself tested on day 0, after 12 weeks, and then at six months. One should maintain abstinence or safe sexual practices for a minimum of six months till the tests are done.

Viral infections such as genital warts and herpes can be contracted by even skin-to-skin contact.

For accidental genital contact, first, get the STD profile done, and then, if required, start the treatment for the respective STD that is detected on testing.

Herpes can be contracted by kissing as well.

In your case, you should use XL-size condoms (extra large), which can be procured from a medical store.

Having unprotected sexual intercourse with a partner who is HIV+ then, there is always a risk of contracting HIV; you cannot neglect it or can take the chance of not contracting HIV by having sex only once with such a person.

Truvada is not meant for the prevention of HIV but for the treatment of HIV, as it reduces the viral load once it has been contracted by unsafe sexual practices. Long-term health risks of Truvada include renal failure, hepatic failure, and bone marrow defects.
Yes, applying lubricant with condoms does help, especially the ones that have an acidic base, as it prevents the immediate spread of STD infections in case of slippage or breakage.

If you are not sure about vaccination and you are involved in unhealthy sexual practices, then you should get your hepatitis B done.

For further clarification, consult a sexologist online..