Home/ Blog/ Get Well/

PrEP Not a Substitute for Safe Sex

Nov 8, 2016
By Malcolm Thaler
Safe Sex

Here at One Medical we write a lot of prescriptions for PrEP, as it is highly effective at preventing HIV transmission, and there are currently at least 100,000 people on PrEP nationwide.

But a recent report of PrEP failure reminds us that there are strains of HIV resistant to Truvada.

The report described a PrEP user in New York City. He acquired HIV from a casual partner whose virus had multiple drug resistance mutations, including resistance to Truvada. The patient had been using condoms prior to starting PrEP, but stopped doing so once he started Truvada. Drug level testing in blood and hair samples was consistent with a high level of adherence to Truvada, and the patient and his partner both were certain he had been 100% adherent. This is the second case of resistant HIV in a PrEP user.

The concern with PrEP has always been that patients will stop using other safe-sex methods, and this is indeed what happened in the case above.

But our concerns go beyond the risk of acquiring a resistant strain of HIV. The incidence of STD’s is also continuing to rise – the most recent CDC data show a relentless increase in the number of cases of syphilis, gonorrhea and chlamydia infections.

If you’re using PrEP, please remember:

  • PrEP is not going to protect you from a strain of HIV resistant to Truvada unless other protective measures are used all the time for all forms of sexual activity.
  • PrEP does not protect against other STD’s; it is just an adjunct (and not a substitute) for other forms of protection, most especially condoms.
  • If you are using PrEP, you should adhere to a schedule of HIV testing every 3 months (along with a serum creatinine every six months to screen for drug toxicity) – this protects you and your partners, and should reduce the emergence of drug-resistant strains; we also encourage testing for other STD’s at these visits.

The incidence of STD’s continues to increase, and our nation’s healthcare services are severely strained trying to keep up; the cost, in both economic and human terms, is immense.

We encourage our high-risk patients, including those who have a partner who is HIV positive, to discuss the pros and cons of PrEP with their provider.

Here to keep you healthy. And informed.
Get 24/7 care over video chat from the comfort of home or wherever you go. Join today and experience primary care designed for real life, in-office and in-app.
Join Today
Malcolm Thaler

Malcolm enjoys being on the front lines of patient care, managing diagnostic and therapeutic challenges with a compassionate, integrative approach that stresses close doctor-patient collaboration. He is the author and chief editor of several best-selling medical textbooks and online resources, and has extensive expertise in managing a wide range of issues including the prevention and treatment of cardiovascular disease, diabetes, and sports injuries. Malcolm graduated magna cum laude from Amherst College, received his MD from Duke University, and completed his residency in Internal Medicine at Harvard's New England Deaconess Hospital and Temple University Hospital. He joined One Medical from his national award-winning Internal Medicine practice in Pennsylvania and was an attending physician at The Bryn Mawr Hospital since 1986. He is certified through the American Board of Internal Medicine. Malcolm is a One Medical Group provider and sees patients in our New York offices.

The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. 1Life Healthcare, Inc. and the One Medical entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.