Closing Plenary - Is there a role for STI prophylaxis in Australia? Panel Presentations and Discussion

As part of the closing plenary, there was a panel on the role for STI prophylaxis and it's potential use in Australia. The concept of bacterial STI prophylaxis is similar to that of PrEP in preventing HIV infection, however the use of antibiotics instead of anti-virals (of course).

The consideration of this raises several differing points of view among panel members from a number of backgrounds. I myself initially considered the use of antibiotics in an age of increasing resistance to our current frontline antibiotics to be a potential issue. This was an eye opener into what could be a potentially very effective tool for prevention of bacterial STI's.

Facilitated by

Associate Prof. David Templeton, Senior Staff Specialist, RPA Sexual Health Clinic, HARP Unit, Kirby Institute.

Panel Members

Craig Cooper, CEO Positive Life NSW.

Dr Bridget Haire, Research Fellow, Kirby Institute, UNSW.

Dr Jeffrey Klausner, Prof of Medicine, Division of Infectious Diseases University of California.

Prof David Lewis, Director of Western Sydney Sexual Health Centre, NSW.

Chris Williams, Co-founder of PrEP'd for Change, Victoria.

Dr Kathryn Daveson, Staff Specialist, Canberra Hospital, ACT.

As with my previous reporting to panels, I will not attempt to assign particular quotes to people, lest I lose their ability to articulate their point, being from their particular backgrounds and expertise. Rather I will paraphrase the panel and draw attention to particular themes raised.

Pro

That there is great potential for a range of populations ie. MSM, but should be used in combination with other treatments.

Con

There may be issues with accessibility for clients to medications (rural/remote, clinics, ? GP's) and feasibility of executing programs effectively (time sensitive large scale dosing, organisation and adherence).

Pro

Targeted groups with Doxycycline could be effective. It has been proven to be safe for use (ie. treating acne in teenagers). There has been no documented resistance to Chlamydia or Syphilis (to doxycycline). The potential for doses post high risk episode has potential (ie. single dose 200mg doxycycline).

Con

From an antibiotic stewardship point of view, this can have issues. Already significant change in bacterial resistance to antibiotics, noted in some strains of STI's. Largely, Australia is yet to see this but it is becoming more of an issue.

Pro

There is a lot of interest from people in the PrEP community to opt into this type of treatment. Treatments such as this would help to diminish the stigma associated with STI infections.

Con

Outside of Sexual Health, antimicrobial resistance has already become a significant issue. Skin and soft tissue infections are becoming more significant and risks of sepsis from resistant bacteria causing significant issues in other areas of health.

Okay, I'll change my rule on quotes because there were two that were great.

"We think we're smarter than the bugs but we're not!" and (if you're concerned about microbial resistance "STOP EATING FACTORY FARMED MEAT AND FISH".

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This brings me to the end of my reporting from the ASHM HIV & AIDS Conference in Canberra, 2017.

I would like to thank ASHM for the opportunity to have attended this conference and recognise the efforts of all the organisers and presenters this conference. It was a fantastic conference with much learnt and I look forward to the conference next year in 2018 to be held in Sydney.

Thank you.