STD increase: Blame anti HIV medicines?

A lot of headlines are touting the increase in STD diagnoses in the USA. AFP via Manila Bulletin:

In US, sexuallly transmitted infections hit new highs

But, like the Catholic "abuse" crisis, the elephant in the room is "MSM" or homosexual sex in men.

Between 2013 and 2017, syphilis diagnoses spiked 76 percent, going from 17,375 to 30,644 cases. Men who have sex with men made up almost 70 percent of syphilis cases.' 

Over those four years, gonorrhea cases increased 67 percent — from 333,004 to 555,608 cases. Gonorrhea diagnoses nearly doubled among gay men — going from 169,130 cases in 2013 to 322,169 last year.

translation: about 60 percent are in gay men.

Increases in gonorrhea among women “are also concerning,” said the CDC report, with cases going from 197,499 to 232,587 in a single year from 2016-2017.

they go on to discuss Chlamydia, but you know, with the newfangled idea you don't need yearly pap smears (where we docs routinely did Chlamydia testing) I wonder if some cases are missed.

they go on to lament that gonorrhea now is getting resistant to antibiotics like Zithromax (which also can treat Chlamydia, which often is missed or false negative test).

But not in the article:

It may not be an increase in gay MSM sex, but because of a decrease in the use of protection.

You see, if you take anti HIV retroviral medications, your viral load goes down and the rate of transmission of HIV goes way down too. So the fear of catching HIV is lower, meaning that there is probably less "safe sex" protection being done.

But I can't find the original report at the CDC so this is only an assumption.

two medicines in one pill for blood pressure? Back to the 1980s

guess what? A single pill with two drugs treats blood pressure better than two pills.

SciDaily report:

The guidelines recommend starting most patients on two blood pressure lowering drugs, not one. The previous recommendation was for step-wise treatment, which meant starting with one drug then adding a second and third if needed. This suffered from "physician inertia," in which doctors were reluctant to change the initial strategy despite its lack of success. At least 80% of patients should have been upgraded to two drugs, yet most remained on one drug. 

well, it's not "lack of success" but that there is partial success, and we figure that was good enough.

so now they think putting two pills together might work better... and this is related to why docs figure one pill was good enough: Because patients object to taking a lot of pills, or forget to take them correctly:

 It is now recognised that a major reason for poor rates of blood pressure control is that patients do not take their pills. Non-adherence increases with the number of pills, so administering the two drugs (or three if needed) in a single tablet "could transform blood pressure control rates," state the guidelines.

the problem? We used to have these combinations back in the 1980s, but some "expert" at the FDA outlawed them, saying that it was more scientific to give separate pills so we could individualize the doses. But we docs knew about the patients not taking pills, but never mind: The experts had spoken.

Ebola in Africa

the latest ebola epidemic isn't making a lot of headlines.

LINK

The Ebola outbreak in the Democratic Republic of the Congo's (DRC's) North Kivu district continues to grow, amid new healthcare worker infections and concerns that regional violence is making surveillance and detection challenging for international aid workers. According to an update released late yesterday by the DRC's healthy ministry, Ebola cases now total 96 (5 new cases), with 69 confirmed. In addition, 55 people have died. The 5 new cases and 5 newly recorded deaths are all in Mabalako health zone.