The only ones interested in short term relationships are the ones who are high risk: if they are still lucky enough to be HIV negative they may still have other STI’s which are difficult or impossible to detect. So catch 22: if they are interested they are not safe, if they are safe they are not interested!

I finished by promising to look at post exposure prophylaxis. This is a complex area with so much information to consider it would take a whole article to do justice to each and every disease. So I have to keep it simple which means many questions will be unanswered. My medical students tell me wickopeadia is the best source of information, so if anything you read here surprises you, get on line and check it out!

Who needs post exposure prophylaxis?
Let’s first look at non-penetrative sex, needle sticks, blood spillage, helping a wounded stranger etc.
Oral sex is an excellent way of getting amoeba, giardia and some tapeworms, but not very risky for HIV and most other STI’s. Herpes type 1 is the big exception, and in the US, 20% of genital herpes is now type 1, mostly thought to be transmitted orally. Type 1 can be worse than 2, as it can relapse for longer. Gonorrhoea is known to infect tonsils, though I have never seen it. I have never heard of HPV, HIV, Hep B, Chlamydia, LGV chancroid or syphilis being passed on orally. Though if there are sores in the mouth there has to be a theoretical chance of HIV and HepB being transmitted.
As there is no proof of PEP being effective in Herpes, I would say there is no need for PEP after oral sex unless there is obviously sores and bleeding
Needle sticks have been well researched, and PEP against HIV is essential, preferably within hours. I’ve taken it myself. Hep B vaccine within a few days of a needle stick is also important.
Blood spillage is a very common concern. Scientifically we can say with confidence that intact skin is an excellent barrier, and there is very little evidence of HIV being transmitted even with blisters, cuts, sores etc on your hands. Babies do not get HIV from their mothers after breast feeding is over, yet there is constant intimate contact between mother and child. Hep B is more infectious, so again after simple spillage I would recommend Hep B vaccination if you are not already covered. Unfortunately science goes out the window when you wake up with a bad dream at 4.00am and I know loads of worried good Samaritans who got covered in blood who don’t sleep for 3 months. So if you are worried, take the HIV PEP: there may not be a lot of point, but it is not going to do any harm.
Wearing a condom. This is not a justifiable reason not to take PEP. Condoms slip, leak, break and come off. At best they reduce the risk of some STI’s by 10 times. This may sound good, but what it really means is that 10 times with a condom = once without. If condom use encourages people to take risks 10 times more often, then you can legitimately say that condoms do not help reduce the epidemic. In a situation where the prevalence of HIV is 2,000 times higher than in an average European university, then it means it is safer to have sex with 200 university students in Hull without a condom than 1 man here with. Research in the USA found no difference in HPV rates between those using condoms and those who do not. I am not saying don’t bother with condoms: they have been shown to be very effective in preventing HIV and some other STI’s in regular couples, and in one off encounters, but “effective” does not mean “safe”. It means safer, and in a high risk situation safer is not safe enough.
Knowing your partner’s status.
This is not a legitimate reason for not using PEP. First of all, when was the test? Was it done in the incubation period? Are you sure it was actually done? To me the only reliable test is one where both partners have it done together with one of the visible tests, done right in front of them so each can clearly see the other’s test result. “I had a test last month and it was negative” is about as valuable as a politician’s promise. Men lie: ask any magistrate. Men lie about sex: ask any woman.
In my opinion PEP is for anyone who wakes up in the morning having had sex with anyone who is not your long term properly risk assessed partner. (A very long winded pseudo jabber for what in my day we called a spouse)
So let us look at what PEP is and what it can achieve.

1. Pregnancy. This is probably the least serious complication of sex, but the one most women worry about first! An interesting thought: if women actually believe condoms work, why do they take the pill? Think about it: logically taking the pill means you know condoms don’t work. In fact we have a special word for couples who use condoms for contraception: we call them parents. If you come in within 72 hours, the post coital contraceptive pill (PCC) will reduce the chance of a pregnancy to close to zero. After 72 hours probably no point.
2. HIV. PEP taken within 72 hours reduces the risk of HIV transmission to close to zero. 72 hours is the outside of the box: obviously as with PCC, the closer to the incident the better. At present the cheap available “duovir” is as good as any with very few side effects. If you are already HIV positive, then duovir for a month is not a good idea, as it will help create resistance. For that reason a quick HIV test taking 2 minutes is not essential but a reasonable prerequisite before PEP
3. Chlamydia. Azythromycin 2 tabs of 500 mg taken together any time afterwards will prevent or cure Chlamydia
4. Gonorrhoea. Cefixime 2 tabs of 250 mg taken together any time afterwards will prevent and treat.
5. Hepatitis B. Starting the vaccine as soon as possible will prevent Hep B, even up to 2 weeks later. You will need another dose after a month and a third after 6 months.
6. Other diseases. The above 5 work and are the “package” offered to anyone day or night automatically. An addition can be doxycyclin 1 capsule daily for a month. Great drug, it prevents or treats 11 common diseases, making it a good choice for malaria prophylaxis up country. Used as a PEP it can prevent or treat with variable efficacy chlamydia, syphilis, chancroid, LGV and others too rare to mention, as well as improving your acne.

Herpes virus and Human papilloma virus, the cause of warts and cancer of the cervix cannot be prevented by PEP. It is so common you can almost guarantee that if you have sex with someone who has had sex with someone else before, you are at high risk of HPV. We see a lot of genital warts and herpes in short term visitors, because they are visible. However most infections are invisible, so the actual incidence must be a lot higher.
Summary
PEP works, it is cheap, easy, available. No need for any examination or tests, simply follow the protocol. Our nurses provide it 24/7, you do not even need to see a doctor if you really don’t want to!
If you have come to Africa intending to get an STI or if you are a young Ugandan girl and your aim in life is to get an STI as soon as you leave school, then it is easy and almost guaranteed if you allow short term relationships. If you did not come here with that intention, then keep your knickers on, it is the only guaranteed prevention.
Next Eyes will look at some of the diseases in detail beginning with HPV.