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HIV & PrEP

Symptoms, Causes & Treatment

Everything you need to know about HIV and PrEP: how HIV is transmitted, how it is treated, and how PrEP and PEP prevent new infections.

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I'm not someone who posts reviews regularly, but I have to say the process was super smooth. Booked a same day appointment with a clearly experienced and friendly doctor…
Yardie Grandmaster
Excellent service - quick, professional, and really convenient. The doctors are thorough and the whole process is smooth from start to finish. Highly recommend.
Mohammad Hassan
What our patients say
4.7 out of 5
Easy and efficient! … I am on the mend and so glad this service exists.
Pete Garvey
Excellent. Started to feel unwell and needed to see Dr before going on holiday. Couldn't get' GP appointment in time. I was 'seen' within 30mins of signing up. Just picked up a prescription. Very impressed with the Dr Victoria White.
Iann de Courcy
Fantastic service received from the gp service. Easy to book consultation… Would definitely use again :- )
Jay
Fantastic service. Easy to sign up and instructions were very clear. My doctor, Dr Shakil David Alam was amazing; listened to my issues, gave me in depth advice and really helped me out. Would definitely reuse - the speed of the service was impressive. Thank you Dr Shakil.
Babac Pashazadeh
I'm not someone who posts reviews regularly, but I have to say the process was super smooth. Booked a same day appointment with a clearly experienced and friendly doctor…
Yardie Grandmaster
Excellent service - quick, professional, and really convenient. The doctors are thorough and the whole process is smooth from start to finish. Highly recommend.
Mohammad Hassan
Overview

What Is HIV?

Human immunodeficiency virus (HIV) is a virus that attacks the immune system, specifically the CD4+ T cells (also known as T-helper cells) that are essential for fighting infections. Without treatment, HIV progressively weakens the immune system over years, eventually leading to acquired immunodeficiency syndrome (AIDS) -- a stage at which the body can no longer defend against opportunistic infections and certain cancers.

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With modern antiretroviral therapy (ART), people living with HIV can expect a near-normal life expectancy and quality of life. When treatment successfully suppresses the viral load to undetectable levels, HIV cannot be transmitted sexually. This principle is known as Undetectable = Untransmittable (U=U) and is supported by robust scientific evidence endorsed by major public health bodies worldwide.

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In the UK, an estimated 106,000 people are living with HIV, of whom approximately 5,000 are undiagnosed. Early diagnosis and prompt treatment are critical -- both for the health of the individual and for preventing onward transmission.

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HIV is not a death sentence. It is a manageable, chronic condition. Stigma and misinformation remain significant barriers to testing and treatment, and tackling these is essential to ending new HIV transmissions.

Symptoms

What Are the Symptoms of HIV?

HIV symptoms depend on the stage of infection. Early recognition of seroconversion illness enables earlier diagnosis and treatment.

HIV Symptoms

Primary HIV infection (seroconversion): flu-like illness 2–4 weeks after exposure — fever, sore throat, rash, swollen glands · Chronic HIV: fatigue, weight loss, recurrent infections, night sweats · AIDS-defining conditions: PCP pneumonia, CMV retinitis, toxoplasmosis, Kaposi's sarcoma

common
HIV: When to Seek Urgent Help

Any new HIV diagnosis requires same-day specialist referral · Possible HIV exposure within 72 hours — PEP must be started immediately · Signs of AIDS-related illness (severe weight loss, persistent cough, visual disturbance) · Fever in a known HIV-positive person not on ART

serious
HIV Exposure Within 72 Hours — Get PEP Now

If you have had a possible HIV exposure within the last 72 hours, attend A&E or a sexual health clinic immediately to access PEP. Do not wait for symptoms — PEP only works if started promptly. Every hour matters.

Causes & Risk Factors

What Causes HIV & How Is It Transmitted?

HIV is caused by the Human Immunodeficiency Virus, which is transmitted through specific body fluids. Understanding transmission routes is essential for prevention and reducing stigma.

HIV Mechanism: CD4 Depletion

HIV (Human Immunodeficiency Virus) infects and destroys CD4+ T-helper lymphocytes. Progressive CD4 depletion impairs cellular immunity, causing susceptibility to opportunistic infections and AIDS-defining cancers.

HIV Transmission Routes

HIV is transmitted through blood, semen, vaginal fluids, rectal secretions, and breast milk. Routes include unprotected sex, sharing needles, blood-to-blood contact, and mother-to-child transmission.

HIV Disease Progression

Without treatment, HIV progresses through primary infection, clinical latency (can last 10+ years), and AIDS. ART suppresses viral load to undetectable levels, preventing progression and transmission (U=U).

Sexual Transmission Routes

STIs are transmitted through unprotected vaginal, anal, or oral sex. Some (herpes, HPV, syphilis) can spread through skin-to-skin contact even without penetration or visible symptoms.

Asymptomatic Nature of STIs

Many STIs, particularly chlamydia, gonorrhoea, and early HIV, cause no symptoms at all. Regular testing is the only way to detect them — waiting for symptoms means delayed treatment and onward transmission.

Condom Effectiveness & Limits

Condoms reduce STI transmission by 85–98% when used consistently and correctly. They are less effective for infections spread by skin contact (herpes, HPV, syphilis) where lesions extend beyond the condom-covered area.

Key Risk Factors

Sharing injecting equipment (HIV/Hep C)
Male sex with men (MSM)
Not on PrEP or ART (HIV)
Sub-Saharan African origin (HIV endemic)
Known HIV-positive partner without ART suppression
Unprotected vaginal, anal, or oral sex
Multiple sexual partners
No regular STI testing
Previous STI diagnosis
Sex work involvement
Inconsistent condom use
New sexual partner
Diagnosis

How Is HIV Diagnosed & Monitored?

The 4th generation HIV antigen/antibody combination test can detect HIV from 10–28 days after exposure. A negative result at 28 days is highly reassuring; a final test at 45–90 days is recommended after significant exposures. HIV testing is free, confidential, and available from sexual health clinics, GPs, and online.

Test
What It Detects
When Used
HIV Antigen/Antibody Combination Test (4th Gen)
HIV p24 antigen from 10 days; HIV antibodies from 28 days
All STI screens; HIV testing after possible exposure
CD4 Count & Viral Load (HIV)
Immune status (CD4) and HIV replication (VL); guides ART initiation and monitors treatment
All new HIV diagnoses; every 3–6 months on ART
HIV Resistance Testing (Genotype)
Mutations conferring ART drug resistance
All new HIV diagnoses before starting treatment; virological failure on ART
Full STI Screen (Urine + Swabs + Blood)
Chlamydia, gonorrhoea, syphilis, HIV, Hep B, Hep C from one visit
Annual screen for all sexually active people; after unprotected sex
Hepatitis B Surface Antigen & Antibody Panel
Active Hep B infection, immunity status, and need for vaccination
Annual screen in MSM and PWID; all new HIV diagnoses
Syphilis Serology (TPPA, RPR, VDRL)
Treponemal and non-treponemal syphilis antibodies; stage and activity
Suspected syphilis; annual STI screen; all HIV-positive patients; pregnancy
Treatment Options

How Is HIV Treated?

All HIV-positive individuals should start ART regardless of CD4 count. Modern regimens are simple, well-tolerated, and highly effective at achieving viral suppression.

Antibiotic
Typical Use
Standard Course
Antiretroviral Therapy (ART / HAART)
All HIV-positive individuals regardless of CD4 count; suppresses viral load to undetectable
Daily; lifelong; typically single-tablet regimen
PEP (Post-Exposure Prophylaxis)
HIV prevention after known or likely HIV exposure (unprotected sex, needlestick)
28-day course started within 72 hours of exposure
PrEP (Pre-Exposure Prophylaxis)
HIV prevention in high-risk individuals (MSM, discordant partners, PWID)
Daily or on-demand (2-1-1 protocol); ongoing
Azithromycin 1g + Ceftriaxone 1g IM (STI Dual Therapy)
Confirmed gonorrhoea (ceftriaxone) + presumptive chlamydia co-treatment (azithromycin)
Single day treatment; contact tracing and test of cure for gonorrhoea at 2 weeks
Doxycycline (Chlamydia / Syphilis)
First-line chlamydia treatment; alternative to penicillin for syphilis
100mg twice daily for 7 days (chlamydia); 14–28 days (syphilis latent)
Penicillin G (Benzathine) IM (Syphilis)
Gold-standard syphilis treatment at all stages; only option in pregnancy
Primary/secondary: single 2.4 MU IM; late: 3 weekly doses

Supportive Measures

ART requires consistent daily adherence to maintain viral suppression. Missing doses risks rebound viraemia and resistance. Most people on modern single-tablet regimens achieve complete viral suppression within 3–6 months and maintain it indefinitely with adherence.

Living Long-Term with HIV

HIV requires lifelong treatment but produces no symptoms when well-controlled. Annual monitoring includes CD4, viral load, kidney function, liver function, lipid profile, and bone density. HIV-positive people on suppressive ART have the same life expectancy as the HIV-negative population and cannot transmit HIV to sexual partners.

When to Seek Help

When Should You Seek Help for HIV?

Seek Emergency Care (999 / A&E) If:

Possible HIV exposure within 72 hours — attend A&E or sexual health clinic immediately for PEP · Signs of AIDS-defining illness (severe breathlessness, vision loss, confusion) · Fever in a newly diagnosed HIV-positive person not on treatment.

See a Clinician the Same Day If:

You have had unprotected sex and want an HIV test · You want to start PrEP · You have a new HIV diagnosis and need referral · You are HIV-positive and your viral load is detectable · You are pregnant and HIV-positive.

Prevention

How to Prevent HIV

HIV is preventable. Multiple highly effective tools are now available that, used consistently, can stop HIV transmission entirely.

PrEP for High-Risk Individuals

PrEP (Truvada or Descovy) is available free on the NHS at sexual health clinics for eligible high-risk individuals. It is over 99% effective when taken as prescribed. Regular HIV and kidney function testing is required during use.

U=U: Undetectable = Untransmittable

If you are HIV-positive and on effective ART with an undetectable viral load, you cannot transmit HIV to sexual partners (U=U — Undetectable = Untransmittable). This is one of the most important advances in HIV medicine.

Test Annually (or More Often)

Annual STI testing is recommended for all sexually active people. Those with multiple partners should test every 3 months. Free NHS testing is available at sexual health clinics, online via SHGM/SH:24, and from GP surgeries.

Use Condoms Consistently

Use condoms consistently for vaginal, anal, and oral sex with new or casual partners. Dental dams reduce transmission during oral-vulval contact. Lube reduces condom breakage and anal mucosal trauma.

Partner Notification Is Essential

Notify all recent sexual partners when diagnosed with an STI so they can be tested and treated. Partner notification can be done directly or anonymously through the sexual health clinic (contact tracing service).

Vaccines: HPV & Hepatitis B

HPV vaccination prevents 90% of cervical cancer and most genital warts. Hepatitis B vaccine is recommended for all MSM, PWID, and sexual health clinic attendees not previously vaccinated.

Getting Treatment

Speak to a Clinician About HIV Testing and PrEP

Through The GP Service, a licensed clinician can provide HIV risk assessment, arrange HIV testing, prescribe PrEP for eligible individuals, and refer to an NHS HIV clinic for ART.

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Frequently Asked Questions

HIV & PrEP FAQs

Can you live a normal life with HIV?

Yes. HIV is now a manageable chronic condition, not a death sentence. With antiretroviral therapy (ART), people with HIV can live long, healthy lives with a normal life expectancy. ART suppresses the virus to undetectable levels in the blood, meaning it cannot be transmitted sexually (Undetectable = Untransmittable, or U=U). Most people on modern ART take a single tablet daily and experience minimal side effects. HIV does not prevent you from having children, working, or having a fulfilling life. In the UK, HIV care is excellent and free on the NHS. The biggest barrier to good outcomes is late diagnosis — testing early is life-saving.

What is PEP and how do I get it?

PEP (post-exposure prophylaxis) is a 28-day course of antiretroviral drugs that prevents HIV infection after a potential exposure. It must be started within 72 hours — the sooner the better. PEP is available from A&E departments, sexual health clinics, and some GUM clinics 24/7. It is free on the NHS for NHS patients. PEP is not a substitute for PrEP or condoms and should be used only in genuine emergencies (unprotected sex with a known HIV-positive person not on suppressive ART, condom failure, sexual assault, or needlestick). After completing PEP, an HIV test at 45 days and 3 months confirms whether infection was prevented.

How often should I get tested for STIs?

STI testing is recommended annually for all sexually active people. Those with new or multiple partners should test every 3 months. Testing is free at NHS sexual health clinics and from online services (SH:24, SHGM). You do not need symptoms to be tested — most STIs cause no symptoms. A full STI screen covers chlamydia, gonorrhoea, syphilis, HIV, hepatitis B, and hepatitis C. Specific sites tested (urine, swabs, blood) depend on your sexual practices. Results are usually available within 1–2 weeks. Positive results trigger automatic partner notification advice.

Can STIs be cured?

Not all STIs are curable, but all are treatable. Bacterial STIs — chlamydia, gonorrhoea, and syphilis — are fully curable with antibiotics when diagnosed promptly. Viral STIs — HIV, herpes, HPV, and hepatitis B — cannot be cured but can be effectively managed. HIV is controlled with ART to the point of undetectability. Herpes is managed with antivirals that suppress outbreaks. HPV often clears naturally within 1–2 years in people with healthy immune systems. Genital warts can be treated and removed, though the underlying HPV virus may persist. The key message: all STIs are manageable with prompt diagnosis and treatment.

What happens if chlamydia is left untreated?

Without treatment, chlamydia can persist silently for months or years, causing progressive damage to the reproductive tract. In women, untreated chlamydia causes pelvic inflammatory disease (PID) in 10–15% of cases, leading to tubal factor infertility, chronic pelvic pain, and ectopic pregnancy risk increased 6–10-fold. In men, chlamydia causes epididymo-orchitis, which can impair sperm production and quality. Reactive arthritis (formerly Reiter's syndrome) — involving joint inflammation, eye inflammation, and urethritis — is a rare but recognised complication. These complications are entirely preventable with prompt diagnosis and a simple 7-day course of doxycycline.

Is gonorrhoea still treatable?

Gonorrhoea is increasingly difficult to treat due to rising antibiotic resistance. The current UK first-line treatment is a single intramuscular injection of ceftriaxone 1g. A test of cure is required 2 weeks later to confirm eradication. Azithromycin is no longer recommended routinely due to resistance. Multidrug-resistant gonorrhoea has been identified in multiple countries, including the UK. If you have been treated for gonorrhoea and symptoms persist, return to the clinic immediately — do not take additional antibiotics without guidance. Treatment of all recent sexual partners is essential to prevent reinfection.

Why is syphilis dangerous in pregnancy?

Syphilis in pregnancy can cause miscarriage, stillbirth, premature birth, and severe congenital syphilis in the newborn (causing bone, liver, brain, and skin disease). All pregnant women in the UK are offered a syphilis blood test at their first antenatal appointment. Treatment with benzathine penicillin G during pregnancy is safe and highly effective at preventing mother-to-child transmission. If you are pregnant and believe you may have been exposed to syphilis, seek urgent testing and treatment. Contact tracing of all recent partners is mandatory. Untreated syphilis in pregnancy is one of the most preventable causes of neonatal death.

Is PE treatable?

PE affects approximately 20–30% of men at some point — making it the most common male sexual dysfunction. Many men suffer in silence due to embarrassment, assuming it is shameful or untreatable. In reality, PE is a well-recognised medical condition with highly effective treatments. Dapoxetine (a short-acting SSRI licensed specifically for PE) can more than triple ejaculatory latency time in clinical trials. Behavioural techniques (stop-start, squeeze) are effective for lifelong PE. Combining medication with psychological or couples therapy produces the best outcomes. Most men with PE who seek treatment experience significant improvement.

Medical Disclaimer: The information on this page is provided for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay seeking it because of something you have read on this page. If you think you may have a medical emergency, call 999 or your local emergency services immediately.