Case 75: Ben Ramsay

INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please conduct this consultation as you would in your clinical practice. There is no need to conduct an examination.

The following information is on his summary sheet:

• Past medical history

• Rectal gonorrhoea 2000

• Medication

• Nil recorded

• Allergies

• Nil known

• Immunisations

• Nil known

• Social history

• Homosexual

• Smokes five to ten cigarettes per day.

INSTRUCTIONS FOR THE PATIENT, BEN RAMSAY

You are a 33-year-old engineer who recently ended a long-term relationship with your partner Tim. You think of yourself as pretty sensible and your friends know you as ‘Mr Safe Sex’ from all the reminders you’ve given over the years, but have found being back on the single scene difficult. You had unprotected receptive anal intercourse once after using methamphetamine at a music festival and a condom broke last month. You had a negative STI check six months ago. Despite going out more and burning the candle at both ends you’ve not had any infections recently. You’re happy to have whatever tests the doctor suggests today.

Some of your friends have started taking PrEP and after these two episodes you think this might be a good idea. You’ve heard the rates of new HIV cases are starting to go down with PrEP on the PBS and have some questions for the doctor:

• Would I be eligible for PrEP?

• Are there any tests I need to have before I start?

• What’s the best way to take it? Some friends just take it if they know they are going to have a big weekend of drugs and sex.

• What side effects can you expect?

• How often will you need to see a doctor and get tests while taking PrEP?

The following information is on your summary sheet:

• Past medical history

• Rectal gonorrhoea 2000

• Medication

• Nil recorded

• Allergies

• Nil known

• Immunisations

• Nil known

• Social history

• Homosexual

• Smokes five to ten cigarettes per day.

INSTRUCTION FOR THE FACILITATOR

Please provide a hard and/or electronic copy of the Australian Medicines Handbook or Therapeutic Guidelines.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Demonstrate a non-judgemental empathic response to his request for PrEP

Listen carefully to his ideas and concerns

Exclude symptoms suggestive of recent STI

Assess his current risk of HIV and other STIs

Check details of PrEP using drug resource available and discuss ...