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FAQs

Most Asked

Why should I take PrEP? Is PrEP safe?

How frequently do I need to get tested?

Will my information be confidential?

I do not have insurance, do I have to pay for testing?

Where are your clinics located? Are there any close to my house?

How can I become an IMG patient?

How do I get my prescription?

Can I walk into an IMG clinic or mobile clinic without an appointment?

Does IMG manage HIV?

Can pregnant women receive testing and care?

HIV

Why should you use condoms to prevent transmission when HIV is treatable?

Is the HIV test accurate?

Can two HIV-positive parents have an HIV-negative child?

Can you get HIV through oral sex?

What are the risks of getting HIV if you put on a condom after you've already started having sex?

HEPATITIS C

What is Hepatitis C?

Is there a cure for Hepatitis C?

Can I be infected with Hepatitis C more than once?

The short answer is yes; you can be infected again with Hepatitis C despite being treated for the disease before, according to the CDC. There are six different types of Hepatitis C, and if you test positive, you are only treated for one. You can be reinfected with another type if your habits remain the same. Therefore, taking preventive measures for the rest of your life, whether or not you have been treated for Hepatitis C before, is advisable.

Hepatitis C is a liver infection that causes inflammation, scarring, and ultimately liver failure if not treated properly. It's also a fairly common disease in both the developed and the undeveloped parts of the world. This widespread prevalence is because Hepatitis C can be transmitted to other people through multiple means.

HOW IS HEPATITIS C TRANSMITTED?
Knowing how the hepatitis C virus is transmitted can help you understand the disease better and take precautions and prevent acquiring the condition in the first place.

A blood-borne virus causes hepatitis C. Therefore, direct contact with an infected person's blood can transmit the disease quickly. Here are some scenarios that are considered high-risk activities for the transmission of Hepatitis C:

- Sharing needles for drug injections – This is one of the highest-risk activities because it involves direct blood-to-blood contact through skin penetration.
- Tattoos and Piercings – Getting tattoos and piercings also involves coming into contact with blood. The equipment used for tattooing and piercings might be infected with Hepatitis C and cause the spread of the virus to other people.
- Blood transfusion – Albeit low due to improved screening procedures, blood transfusions also carry the virus's risk.
- Health care exposure – Hepatitis C can also be acquired in a hospital setting when health care professionals do not take appropriate steps to minimize the transmission of the virus. For example, improper sterilization of medical equipment, reusing the same equipment, not having a separate set of equipment for Hepatitis C positive patients, and improper disposal of hospital waste.
- Vertical transmission – The virus can also be transmitted from the mother to the baby before and during birth.

Can I take Hep C medications along with my HIV medications?

What are the possible side effects of a combined treatment for HIV/HCV coinfection?

STDs and STIs

How do you get tested for an STD?

Should a woman douche after a condom breaks to prevent a STD?

What is an STD or an STI?

How is an STD treated?

There are several treatments available for STDs. While most STDs that are caused by bacteria and other pathogens are curable, some are much more difficult to treat than others due to antibiotic-resistant strains. STDs caused by viruses are generally incurable and the person has to live with the disease for the rest of their life. However, there are treatments available that can suppress the symptoms enough to allow a relatively healthy lifestyle for patients with such diseases.

MEDICATIONS TO TREAT STDs
STDs can be treated with antibiotics or antiviral drugs depending on the causative pathogen. There are also vaccines available that provide immunity to some STDs. In addition, several prophylaxis regimens exist that can help protect you from acquiring the disease in the first place.

If you are experiencing any of the symptoms of an STD, or if you have reason to believe that you were exposed to one, contact your doctor immediately. Early detection and prompt treatment can increase your chances of successful treatment. Additionally, always use safe sex practices to minimize your risk of acquiring an STD by minimizing exposure.

ANTIBIOTICS
Antibiotics are extremely effective against STDs caused by bacteria and even parasites. Gonorrhea, syphilis, chlamydia, and trichomoniasis are all examples of STDs that are usually cured by antibiotics. Generally, antibiotics often cure the infection they are effective against in a dosage varies.

Your doctor may prescribe you antibiotics according to international guidelines. Following the given prescription according to the schedule is extremely important for the elimination of the disease. If you have trouble following the schedule of a treatment regime, your doctor may advise a simpler alternative schedule for you to follow.

It is important to abstain from sexual intercourse at least seven days after you’ve completed your antibiotic course. This interval ensures complete eradication of the infection before it can be passed to another person through sex. Retesting is also an important factor to consider after the completion of your treatment. Retesting informs your doctor of your health status as well as the efficacy of the treatment employed.

ANTIVIRALS
STDs caused by viruses are harder to treat. They are also hard to completely cure as most viruses continue to live inside the host forever once an infection has taken place. However, there are several treatment options available to minimize the symptoms of the infection. Minimizing the symptoms ensures a relatively healthy state for the patient who has viral STDs.

HIV, HPV, Herpes, Hepatitis B, and Hepatitis C are some of the examples of STDs caused by viruses. All of these are incurable but there are effective treatment regimes available against them. Antiviral therapy is available against Hepatitis B and Herpes. This treatment is very effective in lowering the viral load in a patient and allowing daily activities to continue. Antiretroviral therapy works well against HIV. Additionally, your doctor may prescribe creams, or even minor surgeries, to counter genital warts and sores, cold sores, and other such complications caused by these diseases.

VACCINES & PROPHYLAXIS MEDICATION
Vaccination against a disease prevents the disease process from ever initiating in a person. HPV, Hepatitis A, and Hepatitis B have an effective vaccine that works well to protect from these conditions. There is no vaccine for other STDs, such as those caused by bacteria and parasites, at the moment.

Prophylaxis medication helps prevent the onset of infection after a possible exposure. PrEP, or Pre Exposure Prophylaxis, for HIV is a medication regime that prevents infection when taken daily before a possible exposure to HIV. Similarly, nPEP – or Post Exposure Prophylaxis – is another medication regime that prevents HIV infection after a possible exposure to the virus if initiated within 3 days of HIV exposure.

What antibiotics treat sexually transmitted diseases?

CAN ALL STDs BE TREATED USING ANTIBIOTICS?
Sexually Transmitted Diseases (STDs) or Sexually Transmitted Infections (STDs), caused by bacteria, such as syphilis, gonorrhea, and chlamydia, are generally easier to treat and are often curable when treated with the right antibiotics. Those caused by viruses, though manageable, are often not curable. These include Herpes and HIV/AIDS and are treated using antiviral drugs instead of antibiotics.

WHEN AND HOW ARE ANTIBIOTICS ADMINISTERED?
Antibiotic therapy is a mainstay in treating sexually transmitted diseases. Depending on the type of infection your healthcare provider may decide what antibiotics are required. These may then be administered through various means of treatment.

- A single injection,
- A course of pills taken over a few days
- And as a cream/ointment locally applied to the infected area.

DO I STILL NEED TO KEEP TAKING ANTIBIOTICS IF MY SYMPTOMS HAVE RESOLVED?
Antibiotic resistance is a phenomenon where bacteria develop resistance to a certain class of antibiotics. One reason for this resistance development is the non-completion of an antibiotic course. Generally, when a doctor prescribes an antibiotic, they recommend the dose required to completely kill the bacteria. However, most people simply stop taking their medications once their symptoms subside. This gives the remaining bacteria a chance to “learn from their mistakes”, literally, and develop resistance for the next time the same antibiotic is used. Abstain from sex until you test negative to avoid spreading reinfection.

Resistance to antibiotics is real and a prevalent threat in the entire world. It is necessary to complete your antibiotic course for the duration that it is prescribed. Moreover, a resistant infection can be far harder to treat. Even if your symptoms have resolved it is essential that you complete the course of antibiotics as prescribed

WHAT ANTIBIOTICS ARE COMMONLY USED TO TREAT STDs?
The antibiotics prescribed depends on what infection you have. The various antibiotics prescribed for different bacterial STDs are:

- Azithromycin, Doxycycline, and Erythromycin for Chlamydia.
- Ceftriaxone, Cefixime, Ciprofloxacin, and Ofloxacin for Gonorrhea. (In the event of ceftriaxone allergy, Gemifloxacin and azithromycin can be prescribed instead.)
- Ceftriaxone with doxycycline or azithromycin for Gonorrhea and chlamydia
- Penicillin G for Syphilis. Penicillin allergy warrants an exchange with Azithromycin, Doxycycline, Tetracycline or ceftriaxone

PrEP and nPEP

What is PrEP?

What is nPEP?

nPEP stands for non-occupational Post Exposure Prophylaxis. As the term suggests, the goal of nPEP is to prevent HIV infection after you have been exposed to the virus. The nPEP is recommended only for HIV-negative people with a history of HIV exposure in the last 72 hours. Currently, in the United States, Truvada is the only approved drug to be used in the nPEP regime.

Non-occupational HIV exposure refers to exposure to infected blood and other body secretions outside of healthcare settings. nPEP is useful in cases where HIV exposure has occurred due to sexual contact, needle sharing, vertical transmission in mothers, and blood transfusions.

nPEP VS PrEP
It is important to understand the difference between nPEP and a similar prophylaxis regime known as PrEP. nPEP is a treatment regime designed to prevent HIV infection after exposure to HIV has occurred. There is of course a time limit during which nPEP is effective against the virus – i.e. within 72 hours of the exposure for 28 consecutive days.

PrEP on the other hand refers to the prophylaxis treatment given to people who are HIV negative and are at a greater risk of being exposed to HIV. So the difference lies between the times of usage for both of these treatment regimes. PrEP is administered before exposure has occurred, while nPEP is useful within 72 hours after exposure to HIV has taken place. Both of these drugs, however, work towards the same goal: to prevent HIV infection.

IS nPEP RIGHT FOR YOU?
nPEP only works after HIV exposure, within a time limit that never exceeds 72 hours. Therefore, nPEP has very clear guidelines for its use as set forth by the CDC. If you are wondering whether or not you need nPEP, here are a few things to consider.

The nPEP regimen is right for you if you are HIV-negative and you believe you might have been exposed to HIV due to:

- Unprotected intercourse with an HIV-positive person
- Unprotected intercourse with someone whose HIV status is unknown
- Sharing injecting needles with others
- Criminal sexual assault

These guidelines are extremely important as they can prevent worst-case scenarios in extreme cases, such as getting HIV infection after a sexual assault – as happens in many rape cases. Your doctor can provide you with additional information on whether nPEP is the right choice for you or not.

How is nPEP different from PrEP?

nPEP is a post-exposure regime while PrEP is a prophylactic regime, but both work to prevent HIV infections. Naturally, both of these regimes have a lot in common. However, there are still some major differences between the two that are extremely important to understand.

nPEP is different from PrEP in mainly three ways:

- The intended time of use
- The drugs available and how to take them
- And the effectiveness of the therapy

WHEN TO USE nPEP AND PrEP?
Since both nPEP and PrEP provide prophylaxis against HIV, both need to be taken before an HIV infection has taken place. However, both these treatment options have different times of usage.

nPEP is a post-exposure prophylactic drug regime. This means that nPEP needs to be taken only after an HIV exposure has occurred. Usually, nPEP is given to patients by doctors in an emergency situation such as after getting exposed to HIV during unsafe sex and sharing injecting needles. Additionally, PrEP is also useful for patients who have been diagnosed with another STD in the past 6 months.

PrEP is most useful before exposure to HIV has occurred. This means that PrEP can be used regularly as daily protective medication for use against HIV. In fact, PrEP is one of the best methods to protect yourself from acquiring an HIV infection when your risk of exposure is high.

Factors that increase your risk of exposure include:

- Having multiple sexual partners
- Having unprotected intercourse
- Living with an HIV-positive partner
- Sharing drug needles
- Sharing personal hygiene products such as toothbrushes

WHAT DRUGS ARE AVAILABLE IN BOTH nPEP AND PrEP?
Generally, drugs overlap between the two regimes. However, their method of administration is different. nPEP involves taking a combination of three drugs daily for at least 28 days after getting HIV exposure. These three drugs include Tenofovir, Emtricitabine, and either Raltegravir or Dolutegravir.

PrEP on the other hand includes a different mode of administration. There are generally two ways PrEP can be taken. Everyday PrEP involves taking a single pill daily for as long as protection from HIV is required. This is the traditional method of administering PrEP and is approved for all people who make the cut for PrEP criteria.

Will PrEP still protect me from HIV even if I don't take it every day?

PrEP works to prevent HIV infection in people who are at risk of exposure. It works to prevent HIV infection in HIV-negative people if taken daily before possible exposure. Taking this medication according to schedule is very important to achieve maximum protection. Maximum protection for women occurs 21 days after consistently taking PrEP daily and 14 days for men. However, sticking to rigorous drug schedules isn’t for everyone. Most people end up missing doses regularly.

Although PrEP offers some protection against HIV even when not taken regularly, it is highly advised to take PrEP for 21 days then to continue one per day for as long as necessary. The level of protection is directly proportional to the level of adherence to the drug schedule. Irregularity in drug schedule leads to reduced efficacy of the treatment and possible HIV infection. It is most effective after 7 days for anal protection and 21 days for vaginal and blood-to-blood protection.

WHAT HAPPENS IF I DON’T TAKE PrEP EVERYDAY?
Doctors generally advise taking PrEP every day for maximum protection. This recommendation is backed by research data on the efficacy of PrEP when taken regularly. Thus, it is advised to take medicine for as long as you require protection against the virus. Traditionally, you are advised to take these drugs as long as you're sexually active. To reach maximum protection, PrEP is taken every day for 21 days. Afterward, you are required to take the pill every day for as long as you need protection against HIV.

The traditional daily approach is backed by science. Research suggests that PrEP is 99% effective in protecting against HIV when taken every day. Conversely, the efficacy drops down to 96% and 76% when you take these drugs four days a week and twice a week respectively. The directly proportional relationship between taking PrEP every day and increasing prophylactic protection against the virus is clearly evident. However, these statistics also show that missing medication up to 5 days per week will not nullify the effect of the drug. The treatment will be much less effective. This risky method can lead to HIV infection.

What happens after I finish my nPEP regimen?

nPEP can protect you from HIV infection if you take it promptly after getting exposed to HIV. Once started, nPEP needs to be taken for 28 days. This schedule involves taking two pills a day for 28 days in order to prevent HIV infection.

However, the story doesn’t end after 28 days. Even though nPEP offers great protection against HIV when taken promptly, HIV testing still needs to be done after completion of the treatment to ensure maximum protection. Your doctor may schedule an appointment 4 weeks after your exposure to HIV, which would also be the date your nPEP regime comes to an end. Afterward, depending on your health situation, you might have at least two more appointments with your doctor for further testing. These are scheduled at 3 and 6 months from the date of HIV exposure respectively.

WHAT HAPPENS IF MY TESTS COME BACK POSITIVE AFTER TAKING nPEP?
Although nPEP provides adequate protection against HIV, the level of protection is not absolute. The strength of protection also decreases as more time passes after exposure. This is because delay gives the virus enough time to build up in the body of the patient. Once the viral load is high enough in the blood, a full infection ensues. At this point, there is very little that nPEP can do to prevent the infection.

If your HIV tests come back positive after completion of your nPEP regime, it means that the therapy did not work. Having a positive HIV status can be scary since there is no cure for the disease. However, there are still enough medications that can help you keep the virus at bay and let you live a normal, healthy life.

Antiretroviral therapy (ART) is highly successful against HIV. Studies have shown these drugs to be extremely effective in controlling the symptoms of HIV. ART lowers the viral load in the blood to a minimum. Eventually, the viral load drops down to an insignificant number. This is when we say that the viral load is “undetectable”. Once you’ve achieved an undetectable viral load, you can live a symptom-free life even with HIV for the most part.