Primary care clinicians have reported gaps in familiarity, comfort, and prescribing experience with HIV pre-exposure prophylaxis (PrEP), which may contribute to limited access.¹ However, the Centers for Disease Control and Prevention (CDC) states that any licensed prescriber can prescribe PrEP; specialization in infectious diseases or HIV medicine is not required.²

We provide comprehensive, judgment-free sexual health care that includes HIV prevention, evidence-based bacterial sexually transmitted infection (STI) risk reduction, and management of recurrent genital herpes.

HIV Pre-Exposure Prophylaxis (PrEP)

PrEP is medication taken by people without HIV to reduce their risk of acquiring HIV. When taken as prescribed, oral PrEP reduces the risk of acquiring HIV through sex by approximately 99%.² Two commonly used daily oral options are described below.

Truvada or Generic F/TDF

Truvada combines emtricitabine with tenofovir disoproxil fumarate, commonly abbreviated F/TDF. Generic equivalents are available. Daily F/TDF is recommended for people with potential HIV exposure through sex or injection drug use.²

• Advantages: Broad eligibility, extensive clinical experience, and generic availability.²
• Kidney considerations: Tenofovir can cause decreases in kidney function that are generally small and usually return toward earlier levels after the medication is discontinued. Occasional cases of acute kidney injury, including Fanconi syndrome, have occurred. Baseline and periodic kidney-function monitoring are therefore required.^2,3
• Bone considerations: Small decreases in bone mineral density can occur. Assessment may be particularly relevant for patients with a history of pathologic fracture, osteoporosis, or other significant risk factors for bone loss. The effect of these changes on long-term fracture risk remains uncertain.³
• Other possible side effects: Headache and abdominal pain were among the adverse reactions reported more frequently than placebo in PrEP clinical trials, although F/TDF was generally well tolerated.³

Descovy (F/TAF)

Descovy combines emtricitabine with tenofovir alafenamide, commonly abbreviated F/TAF. In the DISCOVER trial, F/TAF was noninferior to F/TDF for HIV prevention among cisgender men and transgender women who have sex with men. F/TAF produced more favorable changes in kidney and bone safety biomarkers than F/TDF.^4,5

These findings concern laboratory and imaging biomarkers and should not be interpreted as proof that F/TAF produces lower rates of fractures or clinically important kidney events. Medication selection should remain individualized.^4,5

• Kidney and bone considerations: F/TAF produced more favorable kidney and bone biomarker results than F/TDF in the DISCOVER trials. It is approved for patients with estimated creatinine clearance of at least 30 mL/min, whereas F/TDF requires estimated creatinine clearance greater than 60 mL/min.^2,4
• Receptive vaginal exposure: F/TAF is not currently indicated for people whose potential HIV exposure is through receptive vaginal sex because effectiveness has not been adequately studied in that population. This is an evidence limitation rather than evidence that the medication is ineffective.²
• Weight and lipid considerations: At 96 weeks, the DISCOVER trial found greater weight gain and less favorable changes in certain lipid measurements with F/TAF than with F/TDF. CDC guidance recommends monitoring weight, cholesterol, and triglycerides in patients taking F/TAF.^2,5

PrEP selection should be individualized. F/TAF may be particularly useful for eligible patients with kidney or bone concerns, but it is not automatically the preferred option for every patient. Exposure type, kidney function, bone health, weight and lipid considerations, medication coverage, and patient preference should all inform the decision.^2,4,5

Coverage and patient costs: Most private insurance and Medicaid programs are required to cover PrEP services without cost sharing, although prior authorization may be required and assistance programs vary. Coverage for the selected medication should be confirmed before treatment begins.²

PrEP Testing and Follow-Up

Before starting oral PrEP, patients generally need HIV testing, kidney-function testing, hepatitis B screening, and screening for gonorrhea, chlamydia, and syphilis. A baseline cholesterol and triglyceride assessment is recommended for patients starting F/TAF.²

Patients taking daily oral PrEP should receive follow-up at least every 3 months for repeat HIV antigen/antibody and HIV-1 RNA testing, adherence support, clinical assessment, and prescription renewal. Kidney-function and STI-screening intervals are individualized according to age, baseline kidney function, symptoms, sexual exposures, previous STI history, and the PrEP medication being used.²

Doxycycline Post-Exposure Prophylaxis (Doxy-PEP)

Doxy-PEP is a patient-managed strategy for reducing the risk of certain bacterial STIs after sex. The recommended dose is doxycycline 200 mg as soon as possible and no later than 72 hours after oral, vaginal, or anal sex, with no more than 200 mg taken during any 24-hour period.⁶

Randomized clinical trials found that Doxy-PEP reduced syphilis and chlamydia infections by more than 70% and gonorrhea infections by approximately 50%. Protection against gonorrhea has been less consistent and may vary with the prevalence of tetracycline resistance across populations and settings.^6,7

CDC recommends discussing and offering Doxy-PEP through shared decision-making to gay, bisexual, and other men who have sex with men and transgender women who were diagnosed with syphilis, chlamydia, or gonorrhea during the previous 12 months. Evidence is currently insufficient for a broad CDC recommendation in other populations, so prescribing outside this group requires individualized evaluation of potential benefits, uncertainties, and risks.⁶

Doxy-PEP should be provided as part of comprehensive sexual health care rather than as a substitute for screening. Patients should receive STI testing at exposed anatomical sites at baseline and every 3 to 6 months, along with reassessment of ongoing need, medication tolerance, potential drug interactions, and antimicrobial-resistance considerations.⁶

Valacyclovir for HSV-2 Suppression

For people with frequent recurrences of symptomatic genital herpes caused by HSV-2, daily suppressive antiviral therapy reduces outbreak frequency by approximately 70% to 80%. Suppressive therapy can also improve quality of life for many people with frequent recurrences.⁸

CDC-recommended suppressive regimens include valacyclovir 500 mg once daily or valacyclovir 1 g once daily, among other antiviral options. The 500-mg daily regimen may be less effective for people who experience 10 or more recurrences per year, for whom another suppressive regimen may be more appropriate.⁸

In an 8-month randomized trial involving immunocompetent, heterosexual, monogamous couples in which one partner had symptomatic HSV-2 and the other did not, overall HSV-2 acquisition occurred in 1.9% of partners in the valacyclovir group and 3.6% in the placebo group. This represented an absolute reduction of 1.7 percentage points and an approximately 48% relative reduction. Symptomatic acquisition was reduced by approximately 75%, and detectable genital viral shedding was also substantially reduced.⁹

Suppressive medication lowers but does not eliminate HSV-2 transmission risk. It should be combined with disclosure, avoidance of sexual activity during outbreaks or warning symptoms, and barrier protection when appropriate. Episodic treatment is most effective when started during the prodrome or within one day of lesion onset.^8,9

A Comprehensive Sexual Health Approach

Prevention plans are individualized rather than assembled from a one-size-fits-all checklist. Depending on clinical history, exposure pattern, laboratory results, and personal preferences, care may include:

• People with ongoing potential HIV exposure: An appropriate PrEP regimen, adherence support, repeat HIV testing, and regular STI screening.²
• Appropriate Doxy-PEP candidates: Post-exposure doxycycline together with anatomical-site STI screening every 3 to 6 months and ongoing assessment of benefits and risks.⁶
• People with recurrent symptomatic HSV-2: Daily suppressive valacyclovir or patient-initiated episodic treatment, depending on outbreak frequency, transmission concerns, and treatment goals.⁸
• Partners with different HIV statuses: A person with HIV who takes antiretroviral therapy and achieves and maintains an undetectable viral load has no risk of sexually transmitting HIV, a principle known as Undetectable = Untransmittable, or U=U.¹⁰ PrEP may still be chosen by the partner without HIV for additional reassurance, potential exposures outside the relationship, or periods when viral suppression is uncertain.^2,10

Our goal is to provide judgment-free, evidence-based sexual health care that helps patients protect themselves and their partners through proactive prevention, appropriate screening, and individualized treatment rather than waiting to treat infections after they occur.

Medication eligibility, dosing, laboratory testing, and follow-up must be individualized by a qualified clinician. No medication prevents every STI, and ongoing screening remains important.

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References

1. Petroll AE, Walsh JL, Owczarzak JL, McAuliffe TL, Bogart LM, Kelly JA. PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists. AIDS Behav. 2017;21(5):1256-1267. doi:10.1007/s10461-016-1625-1. PubMed
2. Centers for Disease Control and Prevention. Clinical guidance for PrEP. Updated April 30, 2026. Accessed June 21, 2026. CDC HIV Nexus
3. DailyMed. Truvada: emtricitabine and tenofovir disoproxil fumarate tablet, film coated [prescribing information]. National Library of Medicine. Updated July 16, 2025. Accessed June 21, 2026. DailyMed
4. Mayer KH, Molina JM, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020;396(10246):239-254. doi:10.1016/S0140-6736(20)31065-5. PubMed
5. Ogbuagu O, Ruane PJ, Podzamczer D, et al. Long-term safety and efficacy of emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV-1 pre-exposure prophylaxis: week 96 results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet HIV. 2021;8(7):e397-e407. doi:10.1016/S2352-3018(21)00071-0. PubMed
6. Bachmann LH, Barbee LA, Chan P, et al. CDC clinical guidelines on the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention, United States, 2024. MMWR Recomm Rep. 2024;73(2):1-8. doi:10.15585/mmwr.rr7302a1. CDC MMWR
7. Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. N Engl J Med. 2023;388(14):1296-1306. doi:10.1056/NEJMoa2211934. PubMed
8. Centers for Disease Control and Prevention. Genital herpes. Sexually Transmitted Infections Treatment Guidelines, 2021. Last reviewed September 21, 2022. Accessed June 21, 2026. CDC STI Treatment Guidelines
9. Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. 2004;350(1):11-20. doi:10.1056/NEJMoa035144. PubMed
10. Centers for Disease Control and Prevention. Clinical care of HIV. Updated April 16, 2026. Accessed June 21, 2026. CDC HIV Nexus