Comment by iknowstuff | Hacker News Reader

Comment by iknowstuff | Hacker News Reader

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Condoms are less effective at HIV prevention, but also they’re unpleasant and don’t prevent most STIs because of oral sex. Nobody’s giving or getting head with a condom. People who stay on top of preventative measures tend to not bother with condoms since PrEP became prevalent.

Preventative:

1. Gardasil 9 (vaccine against 9 strains of HPV, prevents genital warts and cancers caused by HPV)

2. Monkeypox vaccine

3. Meningitis ACYW vax

4. Meningitis B vax (35% effective against gonorrhea)

5. doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea)

6. PrEP (prevents HIV infections)

7. and the usual suite of vaccines against the rest like hepatitis A/B, mumps etc

Treatment of the bacterial ones (which transmit through oral too):

1. syphilis - butt shot of penicillin 2. chlamydia - 1 pill of an antibiotic 3. gonorrhea - a week of doxycycline pills or one butt shot of ceftriaxone

Remaining: HSV. Half of the population has it, so no big deal. Condoms dont prevent it either.

As for hepatitis: even though it requires blood contact and as such is not necessarily considered an STI, hepatitis c is curable these days thanks to DAAs taken over the course of 8-12 weeks. a/b have vaccines.

> 5. doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea)

Preventatively using antibiotics is a horrible idea, for one it increases the risk of creating resisitant strains, and we are already running out of antibiotics (especially broadband ones). Moreover, antibiotics in general are known to mess with you gut biome whose importance we are just beginning to understand (we know it plays a role in many physical and mental illnesses for example). Then there are the side effects which for doxycyline include diarrhea, increased risk of bowel cancer, higher sensitivity to the sun (and associated risk of skin cancer).

Been taking it every day for 15 years with no problems and actually I seem to look 10 years younger than everyone in my age group.

The problems are for humanity not for you, with spurious use of antibiotics. Resistant strains can kill everyone.

Please tell me this is a joke / satire

No, there are many many people who are this entitled.

This is really surprising to me since there is a lot of evidence that oral antibiotics can mess up your gut flora, creating all sorts of bad side effects. Do you have any digestive issues?

The people responding to this seem to assume you’re doing so for funsies, which might be true. But that’s not what you said. So for their benefit, it’s worth pointing out that daily doxycycline is a pretty normal therapy for a range of chronic stuff—malaria prophylaxis, rosacea and skin that’s prone to infections, I’m sure there’s more.

If loopdoend’s doing this, it feels like a good bet that there’s a doctor in the mix judging that it’s medically appropriate for them.

This all feels really general—precipitated on the idea that there’s one Right Way for everyone to use these drugs, about which the doctors and public health professionals recommending doxyPEP are somehow uninformed.

Suppose you’re immunocompromised. Wouldn’t it be worth the diarrhea to avoid infections your body couldn’t fight off?

Suppose you’re in a situation where you’re having lots of opportunities for infection. Whether you can or can’t control that situation, the end result is the same: you know your body is going to be challenged by infectious disease frequently in a way that most people’s bodies aren’t. Isn’t it plausible that the infectious agent may have less opportunity to evolve if you didn’t contract it as frequently?

Different forms of therapy might be both individually and collectively optimal for people in different situations. What’s right for a person who isn’t at risk isn’t the same as what’s right for a person who is at risk.

Doxy is already prescribed in the US as a treatment regimen for acne, so if that’s going to be allowed STI prevention seems way more useful.

The overuse of antibiotics is mostly in farm animals, which represent 73% of global antibiotics use, and 90% of American antibiotics use.

antibiotics are toxic in general, likely affecting way more than bowels. many are ototoxic for example.

Thanks your professional healthcare research expertise will really come handy to all the researchers studying effects of doxypep and routine anti-acnne doxycycline prescriptions.

> Nobody’s giving or getting head with a condom.

In the early days of AIDS (wasn't called HIV back then) the recommendation was to use a condom or dental dam (depending on the hardware of the recipient). That's how I learned what a dental dam was. Later it was suggested that plastic food wrap would work (the jokes just write themselves).

Sadly the ubiquity of paper toilet sheet covers in US bathrooms dates back to the 80s due to straight paranoia over AIDs + widespread and overt anti-gay prejudice, so every time I see one of those dispensers I grit my teeth.

Reminds me of the early days of COVID (not the anti-gay part, but the weird practices when nobody really had yet a good theory of what's going on).

HIV (human immunodeficiency virus) is the virus, AIDS (Acquired Immune Deficiency Syndrome) is the syndrome caused by untreated HIV. Everybody with AIDS has HIV, but not everyone with HIV has AIDS.

The reason for the reversal in terms is treatment options. When HIV was first found, there were no treatments so AIDS was inevitable. Nowadays, medication can permanently prevent HIV from progressing to AIDS, so AIDS is much less common than HIV.

> In the early days of AIDS (wasn't called HIV back then)

You might be thinking of “GRID” (gay related immuno deficiency), the original name of AIDS when it was believed it only affects gay people. Once the virus causing the illness was identified it was called HIV.

PreP actually reduces the chances of acquiring other viral STDs to varying degrees.

Although we have to admit the moral hazard element too: by altering the risk calculus, it does seem to have helped weaken cultural norms around condom use and risky sexual behavior. Business is booming for bacterial infections.

Personally I’d say that’s a pretty good tradeoff: fear, stigma, and death for a different problem that’s more an annoyance than a mortal threat right now.

I think another overlooked portion is that we shouldn't be using meds (for infectious diseases) to enable fun (which seems common with sex). Eventually those meds will lose effectiveness, that's just evolution. Then the people who really do need them will be out of luck.

>Condoms are less effective at HIV prevention

lol what

https://www.cdc.gov/hiv/risk/condoms.html "condoms are highly effective in preventing HIV"

https://pubmed.ncbi.nlm.nih.gov/9141163/ 1997, "reexamination of HIV seroconversion studies suggests that condoms are 90 to 95% effective when used consistently"

https://www.cdc.gov/hiv/prevention/condoms.html "Most condoms are effective in preventing HIV and certain other STIs"

Nobody said condoms were not effective, only that PrEP is MORE effective than condoms, which appears to be true.

https://www.cdc.gov/hiv/risk/prep/index.html

>PrEP reduces the risk of getting HIV from sex by about 99%.

Last I checked 99 was greater than 95.

He didn't say "less effective than PrEP", he said "less effective", and PrEP wasn't the hereditary context of his statement.

Yes it was. The person I responded to is asking why the person considering switching to injectable PrEP doesn't “just use condoms”

You need to improve your reading comprehension.

What do you need me to explain to you?

I want you to explain how condoms are less effective at preventing HIV transmission.

They are indeed less effective than PrEP which is what the entire comment chain is about.

"doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea)"

This is how you end up with super STD's

...And your odds of making it through that pharma-minefield with zero side effects are not encouraging.

Worse still--large scale casual sex is a great way to introduce new, novel and un-contemplated STDs into the population. STDs are opportunistic that way, just ask Mr. triple-resistant Gonorrhea.

It's decidedly not the way I want it to be, but that's just how it works. For casual sex to be safe I think its more like "Hi, please spit into this tube so we can get busy" and red means HIV, Green means Monkeypox, comprehensively.

It's not just about casual sex though is it. There are many people in long term monogamous relationships with a partner who has an STD, but who don't want to catch it themselves. Vaccines and medications can allow them to have active sex lives while staying healthy and in some cases even help women go through pregnancy and childbirth while preventing the spread of an STD to the child. For these people minor side effects (and at times even more severe ones) can be entirely worthwhile.

Or perhaps maybe a future for occupational health. My wife is a nurse. Needle sticks happen. When it does, she has to get tested, full works. The hospital pays for that and the treatment. Maybe with a shot that lasts a year rather than the current 2-3 months(?), hospital staff can just opt that route then the test and treatment. Apparently the treatment is rather gnarly.

The odds are perfectly fine lol. If you think spitting into a tube before sex is preferable to being immune, I think you have a huge misunderstanding of casual sex

Inefficacy against HSV is interesting. I had no idea. Why is it ineffective?

Oral sex is a big reason. Michael Douglas got tongue cancer* from HPV.

Actually it appears the 9-polyvalent HPV vaccine protects against multiple cancers but insurance won't pay for it once your outside the age window.

* originally he said "throat cancer" at the advice of his agent!

[edited: wityl pointed out I’d typed HSV for some reason]

You are thinking of HPV, HSV is herpes.

There is no vaccine, it doesn't cause cancer (that we know of, at least not like HPV), and spreads via skin contact on the genital area.

Since fluids are not required for HPV or HSV and it's present on the area that a condom won't cover, condoms aren't effective for either.

Yes it was a brain fart — fixed!

HSV-1 and -2 transmit through contact from skin location to skin. Including through asymptomatic shedding. Only sometimes is that location covered by a condom - in location and in timing.

See also: Wrestlers' "Herpes gladiatorum" which is just HSV-1. Which demonstrates how HSV-1 survives for transmission far more easily or broadly than just genital contact. Is there "HSV-2 gladiatorum"? Apparently it's usually HSV-1 but probably yes - neither HSV-1 or HSV-2 are really location specific.

I looked through the literature and it seems that condoms are quite effective at preventing HSV infection when used, especially from male to female (on the order of 99%), and less so for female to male (around 60-70%). I would suspect the reason for failure is behavioral. People probably don't apply the condom until after most of foreplay is over and HSV-2 can be transmitted during "outercourse".

Pardon my puritanism, but this seems like an awful lot to put your body through to get your rocks off and engage in this sort of indulgence.

The vaccines are just common sense for everybody. If you’re worried about “putting your body through” vaccines I suggest asking yourself what exact you are worried about on a molecular/cellular level. PrEP blocks HIV’s transcription to DNA so that it can’t take hold - it is cleared by your kidneys like a zillion other molecules in your body. DoxyPEP is the most broad acting, and least popular, item on the list.

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