PreP Visit

24 yo M here for f/u for PreP treatment.

Reports overall good compliance w/truvada, misses approximately 2 doses/month. Tolerating well w/no noticeable side effects. Does note that he has anxiety that seems worse when he misses truvada dose. Also w/ a mild papular, occasionally pruritic, non-painful rash on bilateral arms and legs that may have progressed since initiating truvada therapy.

He does not suspect that he has an STI, but notes occasional continued mucous in stools despite being treated for rectal Chlamydial infxn at last visit. Also notes "white crusting" at the head of his penis, worse in the mornings. Feels this may be yeast infection but also wonders if it is related to being uncircumsized. Finally, patient has question about hypothetically discontinuing truvada in the context of being sexually active w/an HIV pos partner.

Sexual activity: 2 new partners since last visit, one new partner. No STI's, HIV in any partners that patient is aware of. Reports 95% condom usage, attributes occasional noncompliance to concurrent alcohol usage.

100% MSM
Oral - Penile insertive - endorses
Oral - Penile receptive - endorses
Anal - Penile insertive - endorses
Anal - Penile receptive - endorses

Previous STI's:  Rectal CT x 2, Oral Gonorrhea x 1

Social:
Vapes daily
Approx 4 cigarettes/month (usually when drinking alcohol on weekends)
Occasional chewing tobacco
Occasional binge drinking (up to 8 drinks)


24 yo M w/ high risk MSM sexual behavior on PreP w/overall good tolearance and compliance presenting w/continued mucous in stool. Will proceed w/full STI testing and refill patient's truvada prescription for 90 days.

- In regards to his question about discontinuing truvada usage, patient was counseled to never discontinue therapy on his own and to make an appointment to be seen in ID clinic. Informed that there is minimal data regarding PreP in the setting of being sexually active w/HIV partners who have an unknown viral load. To minimize his risk, he should always use condoms, remain on strict regimen of truvada therapy, and make an appointment to be seen if he has a sexual encounter that concerns him.
-Counseled that the white crusting he sees is likely due to smegma as a result of being uncircumsized. Do not suspect this is a result of infection.
- Refilled 90 day Truvada supply
- GC/CT NAAT Throat and Rectal swabs
- UA w/ GC/CT NAAT
- Labs: HIV, Syphilis, BMP
- F/u in 3 months for Truvada refill