Just*in Time: September 2017

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Dear Justin,
I’m very scared; I don’t know who to talk to. I don’t like using condoms but I am on PrEP. So, I’ve protected myself from HIV. I know that I’m open to being infected with other sexually transmitted diseases. I have made an effort to visit my primary care physician more often than just twice a year. However, I’ve developed a rash and it is getting worse. I visit my doctor next week but I wanted to reach out to you to see what you think. I think I may have gotten syphilis because, in the Florida area where I live, syphilis infections have increased. Do you think this is because of PrEP [use without condoms]? I’m thinking of going back to condoms because I’ve never had a sexually transmitted disease before.
—Fearful Florida Dude

I hope all is well. Let me first thank you for writing in.

Let’s start with your suspicion of a possible syphilis infection. Since you are on PrEP, doctors will require you to come in at least once every three months to make sure that, if you have been infected by a sexually transmitted infection (STI), it is caught early. The earlier a STI is detected the better, because it may prevent the development of other STIs, progression of the STI detected, and, in some cases, death. When PrEP is prescribed, physicians know that you are more susceptible to being infected with other STIs. I’m not going to tell you that you have syphilis because that is your doctor’s job, but I will tell you to see him or her as soon as you can.

Now I will go into some of the symptoms of syphilis and, yes, a rash is only one of the many skin symptoms. With a syphilis infection, you may experience ulcers, sores, and wart-like growths in your groin, and vaginal discharge. On your skin, you might experience ulcers, bumps, or rashes. Your body may experience weight loss, inflammation of the rectum, rashes on your palms and/or feet, fatigue, enlargement of lymph nodes, and a sore throat. Unlike some STIs, syphilis goes through stages of infection. The first stage is characterized by sores on the genitals, rectum, or mouth, which might go unnoticed because they are painless. When the sores heal a lot of people think they are in the clear, hence why there may be more syphilis infections than others. When the sores heal, the syphilis infection, if left untreated, will go into the second stage, which is the inevitable skin rash. This is the stage that most people notice that they may need to be checked by a physician. The third stage is the most severe, and can damage many internal organs such as the eyes, nerves, brain, and the heart. So, since you are going to see your doctor next week, mention your symptoms and have your physician run a test for you.

Okay, I have to correct you and everyone who is reading this on something. We in the public health field are trying to get away from using the term “STD” as now we are trying to use the term “STI,” because there is a difference. An STI is a broader and more encompassing description because some infections are curable and may not show any warning signs. If the infection changes a normal function of the human body, then it’s considered a disease. It is more accurate to use the term STI and it is a reminder to the general population to get tested for possible infections because many infections have no symptoms.

Just an FYI for everyone: In 2015 Florida came out with its State Health Profile. According to the Centers for Disease Control and Prevention (2015) primary and secondary (P&S) syphilis (the stages in which syphilis is most infectious) remains one of Florida’s main health issues, primarily among men who have sex with men (MSM). In Florida, the rate of primary and secondary syphilis was 6.6 per 100,000 in 2011 and 10.5 per 100,000 in 2015. Florida now ranks sixth in rates of P&S syphilis among fifty states. I have not been able to find the 2016 stats because I do not think they are out yet.

If you want to go back to using condoms that will be up to you. I cannot tell you how to protect yourself against STIs. But I will say I am a PrEP advocate and a condom advocate. Do what you feel is most comfortable for you. But do not be afraid. Weigh the possibilities and dangers. Empower yourself to take control of your own sexual health.


Justin B. Terry-Smith, MPH, has been fighting the good fight since 1999. He’s garnered recognition and awards for his work, but he’s more concerned about looking for new ways to transform society for the better than resting on his laurels. He started up in gay rights and HIV activism in 2005, published an HIV-themed children’s book, I Have A Secret (Creative House Press) in 2011, and created his own award-winning video blog called, “Justin’s HIV Journal”: justinshivjournal.blogspot.com. Presently, he is working toward his doctorate in public health. Visit his main Web site at www.justinbsmith.com. He welcomes your questions at [email protected].

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