Sexual health
Sexual health is important for your overall well-being. This includes preventing sexually transmitted infections (STIs), practicing responsible actions, engaging in open communication with your partners, and receiving proper sexual education.
Take care of your sexual health by regularly getting screened for STIs or blood infections to preserve your well-being and contribute to healthy and respectful relationships.
Since the service is currently being deployed, we are offering it exclusively at the HOMA location for the time being.
PrEP information
Pre-Exposure Prophylaxis (PrEP) for HIV is a treatment that reduces, but does not eliminate 100%, the risk of contracting HIV.
The prevalence of HIV among the MSM (Men who have sex with men) population in Quebec is approximately 13.5%. It is estimated that about 1.3% of MSM acquire HIV each year in Quebec.
The ENGAGE study conducted in Montreal in 2018 revealed that 86% of MSM were aware of PrEP, but only about 16% had taken it in the last six months.
No, hence the importance of practicing safe sex. It is reassuring to have an additional sense of security regarding the risk of acquiring HIV, but it does not protect against other STIs.
To date, two oral tablet medications are approved in Canada. These are Truvada (available in generic form) and Descovy (no generic available). An injectable formulation of cabotegravir (Apretude) may soon be available.
Truvada can be taken continuously or on-demand for cisgender men and transgender women.
Descovy is eligible for cisgender men only and is prescribed for continuous use only.
Continuous use:
-
For cisgender men/transgender women, start taking seven days before potential risk.
-
For cisgender women, start taking 21 days before potential risk (takes longer for PrEP to reach vaginal tissue).
-
Recommended for travel/vacation.
-
Mandatory in co-infection with hepatitis B.
On-demand use:
-
For cisgender men/transgender women: Take two (2) tablets 2-24 hours before potential risk, then one (1) tablet once a day for two days.
-
Any form of sexual activity without a condom carries a risk of acquiring HIV. Some of these acts are considered high-risk, while others have negligible risks in certain contexts.
HIV is transmitted through contact with biological fluids: semen, pre-ejaculate fluid, vaginal/anal secretions, blood, and breast milk. Risks are also increased by mucosal lesions, active STIs/STDs, bleeding/menstruation, etc.
When a person living with HIV consistently takes their prescribed treatment and maintains a viral load below 200 copies per milliliter of blood, as measured every 4-6 months, the risk of transmission becomes negligible. There is no evidence of HIV transmission during oral, vaginal, or anal sex without a condom when the load is undetectable!
Adapted from « Canadian Guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis »
These are vague symptoms that resemble a cold/flu or mononucleosis. Therefore, it is important to carefully assess the risk of HIV before concluding that these symptoms are due to a primary HIV infection.
Taken from the PrEP Management Guide for Quebec:
Like any treatment, the effectiveness of PrEP depends on adherence to the treatment. The HIV retrovirus mutates extensively and can develop resistance to treatments - confirmed with Truvada's FTC and cabotegravir (Apretude). It is therefore important to follow the prescribed dosage and avoid being impaired in any way (alcohol, recreational drugs, etc.) during a high-risk sexual encounter.
According to studies, the risk reduction was as follows:
-
iPrEX OLE Study: Almost 100% (at least four (4) tablets per week)
-
Prévenir ANRS: Almost 100%
-
IPERGAY / OLE: 86% / 97%
-
DISCOVER: 99%
-
PROUD Study: 86%
The results for injectable cabotegravir appear promising:
-
HTPN 083: 66%* reduction when taking injectable cabotegravir compared to Truvada-TDF/FTC (not placebo)
-
The public health insurance plan (RAMQ) only covers the generic version of Truvada, which is TDF/FTC. You would need to pay approximately $90 per month for continuous use.
Private insurance plans may cover a larger portion of the cost and potentially even cover Descovy.
Firstly, these two treatments contain different medications. Truvada contains tenofovir (TDF) and emtricitabine (FTC). On the other hand, Descovy contains an alternative form of tenofovir (TAF) and also emtricitabine (FTC).
Both treatments are equally effective, but since Descovy has not been studied for "as-needed" use, it can only be prescribed for continuous use. Additionally, Descovy can only be prescribed for cisgender men and transgender women.
Although these treatments are safe, the elimination of tenofovir occurs through the kidneys and can lead to renal insufficiency and sometimes Fanconi syndrome. This complication results in a decreased reabsorption of filtered phosphorus by the kidneys. To compensate for this increased loss, the body tries to rebalance phosphorus levels in the bloodstream by sourcing it from our bones. As a result, there is a loss of bone mineralization (osteopenia) and the bones become more fragile. It is therefore essential to exercise caution in individuals with renal and bone problems before starting the treatment. It is also important to limit factors that can lead to a decrease in renal function, such as long-term use of non-steroidal anti-inflammatory drugs (Advil-Motrin/ibuprofen, Celebrex/celecoxib, Naprosyn/naproxen, Arthrotec/diclofenac, Indocid/indomethacin), aspirin, smoking, hypertension, diabetes, etc. TAF, on the other hand, has the advantage of being metabolized differently by cells, resulting in lower risks of renal and bone problems.
TAF may have a slightly more disadvantageous metabolic profile compared to TDF, meaning that the risk of dyslipidemia (high cholesterol) and hepatic steatosis (fatty liver) should be carefully evaluated in at-risk individuals. Weight gain may occur with the use of PrEP based on TAF.
Furthermore, Descovy is not indicated for people on anticonvulsant treatment (carbamazepine, phenytoin, primidone, etc.) due to the interaction with TAF, which reduces the effectiveness of PrEP.
Moreover, for individuals infected with hepatitis B virus (HBV), the use of PrEP should be thoroughly discussed with a healthcare professional. Tenofovir is also a treatment for this virus, and there is a real risk of developing resistance to tenofovir in HBV if the use is not appropriate. Such resistance could "reactivate" HBV in a person with chronic infection. As a result, as-needed dosing is contraindicated, and PrEP should only be taken continuously.
The most common side effects include headaches, muscle pain, fatigue, and digestive disorders. It is important to talk to your pharmacist and/or doctor before discontinuing the treatment.
When taking Truvada, it is important to avoid, whenever possible, non-steroidal anti-inflammatory drugs such as Advil-Motrin/ibuprofen, Celebrex/celecoxib, Naprosyn/naproxen, Arthrotec/diclofenac, Indocid/indomethacin, as well as aspirin.
Previously, PrEP was recommended for certain individuals at higher risk of acquiring HIV. Since 2021, the CDC (Centers for Disease Control and Prevention) recommends PrEP for anyone who desires the treatment after discussing it with their healthcare provider, which has been very well received.
Of course, each person knows their situation best, and as healthcare professionals, we are aware that for various reasons, some information may not be disclosed to us. We encourage open and non-judgmental discussions to provide you with the best advice and help you make the best decision for your health. Feel free to ask us any questions you may have!
When initiating the treatment, it is recommended to schedule a follow-up appointment one (1) month later. Subsequently, follow-up appointments every three (3) months are necessary, which is why PrEP prescriptions are typically limited to a maximum of three (3) months at a time, and no refills will be issued without medical reassessment by a physician or nurse practitioner.
The follow-up appointment will include:
-
Reassessment of risks
-
Verification of medication adherence
-
Counseling on STIs (sexually transmitted infections) and risk reduction
-
STI testing at all exposed sites
-
Blood and urine tests to monitor biological parameters and conduct serological screening for STIs
-
And many other aspects!
These follow-up appointments are crucial to ensure the effectiveness and safety of the PrEP treatment and to provide comprehensive care and support.
-
PEP information
Post-exposure prophylaxis (PEP) for HIV and hepatitis B (HBV) is a treatment that reduces but does not eliminate the risk of developing an infection with HIV and HBV after a high-risk exposure. Currently, there is no PEP available for hepatitis C (HCV).
If you believe you have had a high-risk exposure (HIV, HBV), it is considered a medical emergency that should be addressed promptly!
The prevalence of HIV among the population of men who have sex with men (MSM) in Quebec is approximately 13.5%. It is estimated that about 1.3% of MSM acquire HIV each year in Quebec.
The ENGAGE study conducted in Montreal in 2018 revealed that 86% of MSM were aware of PrEP, but only about 16% had taken it in the past six months.
Any form of sexual activity without a condom carries a risk of acquiring HIV. Some of these acts are considered high-risk, while others have negligible risks in certain contexts.
HIV is transmitted through contact with biological fluids: semen, pre-ejaculate fluid, vaginal/anal secretions, blood, and breast milk. Risks are also increased by mucosal lesions, active STIs/STDs, bleeding/menstruation, etc.
When a person living with HIV consistently takes their prescribed treatment and maintains a viral load below 200 copies per milliliter of blood, as measured every 4-6 months, the risk of transmission becomes negligible. There is no evidence of HIV transmission during oral, vaginal, or anal sex without a condom when the load is undetectable!
Adapted from « Canadian Guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis »
Adapted from the "Guide pour la prophylaxie et le suivi après une exposition au VIH, au VHB et au VHC" from January 2019 - Publications du Québec.
PEP (Post-Exposure Prophylaxis) for HIV should ideally be initiated within 72 hours following the high-risk exposure, with the first 12 hours being the most effective. If more than 72 hours have passed since the exposure, it is not recommended to start PEP.
PEP for HBV (Hepatitis B Virus) can be initiated within seven (7) days (for percutaneous exposure) and 14 days (for sexual exposure) following the high-risk exposure, with the first 48 hours being the most effective.
Thoroughly clean the affected area with water and soap, and then make an appointment with a healthcare provider.
DO NOT: brush, apply rubbing alcohol, apply pressure or "squeeze out the blood."
No particular measures. Make a medical appointment.
Several factors come into play when deciding to initiate PEP. Please make an appointment with a healthcare provider for a comprehensive risk assessment.
Like any treatment, the effectiveness of PEP depends on adherence to the regimen. Additionally, the earlier PEP is initiated, the higher the chances of its effectiveness. There is no data on the effectiveness of the suggested PEP regimen specifically, but it is a highly effective regimen for treating HIV.
For HIV, all regimens consist of a 28-day treatment. The one recommended by the Quebec guide is Truvada (or its generic) in combination with Isentress. However, there are other options such as Truvada (or its generic) with Tivicay, Biktarvy (3 drugs), or Genvoya (4 drugs).
For HBV, the regimen depends on the type of exposure and the immune status of the source and the exposed person. It may include an injection of immunoglobulins (antibodies) and HBV vaccination. If a person has an antibody count (anti-HBs) greater than 10, no PEP or follow-up is required.
For HCV, serological follow-up is recommended.
The most common side effects include headaches, muscle pain, fatigue, and digestive disorders. It is important to consult your pharmacist and/or doctor before discontinuing the treatment.
When taking Truvada, it is important to avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil-Motrin/ibuprofen, Celebrex/celecoxib, Naprosyn/naproxen, Arthrotec/diclofenac, Indocid/indomethacin, as well as aspirin, as much as possible.
Isentress can interact with other medications such as antacids (Maalox, Gaviscon). It would be preferable to use other types of antacids such as Zantac and Pepcid or prescription-only proton pump inhibitors. Additionally, alcohol consumption should be avoided with Isentress.
After undergoing PEP for HIV, it is important to use condoms and refrain from sharing sex toys or other objects such as toothbrushes or razors for a period of three (3) months after treatment. While PEP can delay seroconversion at the end of treatment if it is unfortunately ineffective, obtaining a positive HIV result can take up to three (3) months. Therefore, caution should be exercised, and it is crucial to attend the follow-up appointment after three (3) months.
During PEP, blood tests should be conducted two (2) weeks after starting the treatment and at four (4) weeks if the initial results were abnormal. As mentioned, a blood test three (3) months after treatment is also necessary.
Finally, taking PEP can serve as a red flag or a wake-up call to reflect on your risk behaviors and engage in a discussion with your healthcare professionals. Consideration should be given to regular screening every three (3) months following the completion of PEP.
STI information
STI means "Sexually Transmitted Infection", which refers to an infection that can be transmitted sexually or through blood, whether or not symptoms are present.
Everyone who asks or wants!
It is important to individualize the testing frequencies based on risk factors. Depending on these factors, testing may be as frequent as every three (3) months.
Yes. It depends on the timing of the sample collection relative to the sexual encounter. There can be false negatives. Each STI has its own window period, which is the time from a considered risky exposure (date of the last risky sexual encounter) to obtaining a positive result on the specific screening test. It is important not to confuse the incubation period, which is the time between the start of an infection/the date of the risky encounter and the onset of symptoms.
If you do not have symptoms and you undergo a screening test during the window period, it will be necessary to repeat the test at the end of the window period to ensure a true negative result.
This summarized table provides approximate window periods for some common STIs. The actual window periods may vary and be shorter or longer.
Some STIs are treated with single-dose or multiple-dose antibiotics, while others require antiviral medications. In the case of the most common STIs, it is important to wait at least seven (7) days after single-dose treatment or complete the full course of multiple-dose treatment before engaging in sexual activity again to avoid transmission. Additionally, if there were symptoms present, they should also be resolved along with the time criteria. For STIs that require special attention, your healthcare professional will provide guidance on how to properly follow the treatment plan.
It is important to notify your partners to break the chain of transmission. If you are able to contact them yourself, you can do so. If you are unable to contact them or would like assistance, you can contact the PVSQ (Partners Notification Service of Quebec) at: https://pvsq.org/partners-notification/
-
All partners prior to: the completion of a multidose treatment and/or within seven (7) days of a single-dose treatment.
-
Positive for gonorrhea and/or chlamydia: 60 days before the onset of symptoms or the date of the test.
-
Positive for LGV: 60 days before the onset of symptoms or the date of the test.
-
Positive for primary syphilis: three (3) months before the onset of symptoms or four (4) months + one (1) week before the test.
-
Positive for secondary syphilis: six (6) months before the onset of symptoms or eight (8) months before the test.
-
Positive for early and late latent syphilis: one (1) year before the test.
-
Positive for chancroid: 14 days before the onset of symptoms.
-
Positive for HIV: three (3) months before the last negative test or since the onset of risky behavior.
-
Positive for trichomoniasis: current partners only.
-
Positive for granuloma inguinale (Klebsiella granulomatis): 60 days before the onset of symptoms.
-
Positive for HPV and/or herpes: the effectiveness of partner notification has not been demonstrated, but informing partners would be the prudent and ethical thing to do.
-
Positive for molluscum contagiosum: 14 days before the onset of symptoms.
-
Manufacturer's monograph for the molecules.
The studies mentioned in the various sections.