Lisa, A 20 year old female patient presents with 2 sexual partners in the past 8 months with which she has had unprotected sex. She has never had a pap exam. She presents to review STD screening with the KnowNOW doctor. She describes normal menstruation yet has been spotting between periods. She denies any vaginal discharge, pain during sex or any genital sores.
After review with a KnowNOW doctor, Lisa was tested for all the STD’s available. She went to a local lab site and had urine and blood test done. Three days later the chlamydia urine test comes back positive. Lisa checks in with KnowNOW and she sees a follow-up doctor for free via video-conferencing. She is treated with azithromycin 1 Gram and it was suggested her partners be evaluates tested and treated as well. A prescription is sent to her local pharmacy via e-prescription.
Usually chlamydia has no symptoms. This is what has contributed to the high cases in the United States, over 1.6 million in 2016.
Jeremy presented to the KnowNOW website with a sore on his penis for one week. Stan has had three sexual partners in the past year. He states not using condoms with his last partner 3 weeks ago. He had penile-rectal sex. Jeremy had an HIV test two months ago that was negative.
Jeremy took a photo of his lesion and showed it via video-conference to the KnowNOW doctor. The lesion on the penis was described as round and non-painful. Patient was sent to a lab next to his home for blood tests including HIV and Syphilis. The test came back positive for Syphilis RPR and FTA-ABS positive for syphilis. Jeremy logged on to the website and was able to see another KnowNOW doctor again for a free follow-up since his tests were positive.
Jeremy was referred to a neighborhood clinic for an injection of Benzathine penicillin G 2.4 million units. His three partners are contacted and suggested to come in for treatment.
Syphilis first stage is a painless sore in the genitals mouth or rectum. Syphilis is usually treated with a high dose penicillin injection. That’s all it takes one injection. Sexual partners should be treated as well. Syphilis can lead to severe long terms health problems if left untreated. These include damage to the brain, nerves, eyes, or heart.
Tamara presents with three days of a painful rash on her left lower lip. The rash is on the border of her lip and extends to her chin. She has taken valcyclovir medication before with improvement. She currently has no insurance coverage. Tamara has used over the counter Abreva cream to no improvement.
Tamara shows the KnowNOW doctor via video-conference the lip rash and the doctor agrees that the rash looks like a herpes rash. The KnowNOW doctor knows Tamara has current medical insurance coverage. Tamara is started on Acyclovir 400mg five times a day for five days and suggested to follow-up with team if not improving. Her medications are sent to the local pharmacy via e-prescription.
Rarely do any creams work for oral or genital herpes even though many are sold as over-the-counter remedies. The best treatment is an anti-viral tablet that is taken orally like acyclovir or valacyclovir. The difference in cost can be between $100+ (valacyclovir, Valtrex) and $15 (acyclovir) , This may be worth it even though the acyclovir tablets have to be taken more often.
Mario presents for Pre-Exposure Prophylaxis (PrEP) treatment. He has had over 6 partners in the last 9 months and many of them he states he has had sex without a condom. All his partners are males. He states both oral and rectal sex. Mario would like to know more about PrEP as he has heard about this medication from friends. Mario’s last sexual partner was four weeks ago. He states getting HIV tested 4 months ago and was negative.
Mario is seen via video-conference with a KnowNOW doctor and his history is obtained. He is sent to a local lab site for HIV testing, Syphilis, Chlamydia and Gonorrhea testing. Since he wants PrEP he is also sent for kidney and liver testing, as well as Hep B testing. Mario’s test come back five days later he logs onto KnowNOW and sees that all his test results are negative. He gets to see a KnowNOW doctor again for free. The doctor reviews the lab tests and prescribes Truvada (Tenofovir/Emtricitabine) with two refills. He is sent to a primary care doctor in his neighborhood with instruction to return to KnowNOW if Truvada is not prescribed. It is suggested to Mario that he has to take the medication daily and have good adherence to protect him from getting HIV.
You can only take PrEP if you are HIV negative, Hepatitis B negative, and have a kidney and liver function screen that is normal. Our KnowNOW doctors will give you two refills and suggest you try and follow-up with a local primary care provider. Truvada has to be taken daily for the medication to protect you from acquiring HIV.