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|IMPORTANT: Read about our new EHR HERE.|
|And read the EHR Q&A HERE.|
|We recommend a full physical examination at the time of the initial visit, or as soon thereafter as practicable. This includes completion of a comprehensive health history data base, and the obtaining of vital signs by our medical assistant, followed by a review of the health history form with the practitioner, and an examination.|
|In following the guidelines of most major preventive medicine organizations, we recommend testing for fecal occult blood annually after age 50 if you have not had a screening colonoscopy.|
|For gay men and others at high
risk for hepatitis infection, we recommend
testing to assess previous exposure to hepatitis
A and B. If these tests show no evidence of
exposure, we can administer the appropriate
hepatitis vaccines. For a brochure that explains the importance of
hepatitis A and B vaccines for gay men,
We offer routine vaccinations against influenza (September through December), Streptococcus pneumoniae pneumonia, diphtheria, tetanus (lockjaw) and pertussis (whooping cough). We also test for tuberculosis exposure (TB skin test).
We recommend herpes zoster (shingles) vaccine to persons 50 and over who are not immune compromised. Because of special refrigeration requirements to store this vaccine, we do not carry it in our office but can provide a prescription for certain retail pharmacies where herpes zoster vaccine is administered.
For young gay men who have never been sexually active or have been minimally active, we recommend the series of human papillomavirus (HPV) vaccines (Gardisil). Although we do not carry this vaccine, it may be obtained through the Travel Clinic at the San Francisco Department of Public Health, 101 Grove Street, San Francisco, CA 94102.
|We offer vaccinations against most infections recommended by the CDC, except for yellow fever.|
|We prescribe Viagra,
and Cialis, orally
administered treatments for erectile dysfunction (ED,
sometimes referred to as impotence). Viagra is supplied as 25
mg, 50 mg, and 100 mg tablets, Levitra as 2.5 mg, 5 mg, 10 mg and 20
mg tablets, and Cialis as 5 mg, 10 mg and 20 mg tablets. The medication should be
taken approximately one hour before sexual activity.
Viagra should not be taken for at least two hours after a
fatty meal, because fat will interfere with absorption of
Erection of the penis involves release of nitric oxide during sexual stimulation. Viagra, Levitra, and Cialis work by enhancing the effect of nitric oxide. Cialis has a longer duration in which the drug is active than Viagra or Levitra.
Side effects of Viagra, Levitra, and Cialis include headache, flushing, upset stomach, and a temporary difficulty with distinguishing blue from green colors. Inhaled nitrites ("poppers") should not be used with Viagra, Levitra, or Cialis, because dangerously low blood pressure may occur with the combination.
|Although we do not perform
most laboratory tests in our office, we are conveniently located
to several laboratories, including LabCorp, Quest Diagnostics and Hunter Laboratories. Routine screening for gay men, such as
syphilis serology and gonorrheal and Chlamydial
smears, can be performed at these laboratories.
As of April 10, 2012, our electronic health record (EHR) "go live" date, we have been unable to order laboratory tests at California Pacific Medical Center (CPMC) as CPMC has decided not to create an interface between their laboratory and our EHR vendor, athenahealth. Sutter Health, the parent organization of CPMC, is working together with other health care systems on a regional health information exchange solution. Once this regional solution is implemented, and provided that athenahealth is able to interface with it, it should allow our patients once again to utilize the laboratory facilities of CPMC, including those at the Davies Campus.
|We recommend routine testing for
HIV if you are at risk. Tests must be ordered
on the record and may be billed to your insurance
company. The results come
back in 3 to 5 days and we require that HIV test
results be given to you in person, rather than
over the telephone.
If you have had a possibly high-risk exposure to HIV, due to unprotected anal or vaginal sex, a broken condom, ejaculation in the mouth or blood contact, please call us as soon as possible (preferably less than 72 hours after contact) to discuss your exposure. Depending on the nature of the exposure, we may recommend that you begin post-exposure prophylaxis (PEP), to reduce your risk of HIV disease.
|The iPrex study was a clinical
trial of 2,499 sexually active HIV negative men who have sex with men
(MSM) that took place at sites in San Francisco, California, Lima,
Peru, and other cities in Brazil, Ecuador, South Africa and Thailand.
Trial participants were randomized to receive either
tenofovir-emtricitabine (Truvada) or placebo. At the end of the trial,
there was a reduction of 44% in the number of new HIV infections among
the participants receiving Truvada as compared to those receiving
placebo. The FDA has now approved Truvada for preexposure prophylaxis
(taking one Truvada pill a day every day) for sexually active people
at risk for HIV.
If you are a sexually active gay or bisexual man (or a heterosexually active man or woman at risk for HIV) and would like information about PrEP, please consult Dr. Owen or Carl Stein at your next visit to our office to determine if you might be a good candidate for PrEP and to discuss the risks and benefits.
|Our patients participate in a number of studies, particularly in HIV drug expanded access trials, some of which are conducted through our office. Most of the trials to which we refer patients, however, are conducted through university, hospital-based and independent clinical research organizations. Here is a link to an online search for the HIV clinical trials in the San Francisco Bay Area that are open to enrollment. For more information about these research organizations, please follow the links below.|
|In collaboration with The Buncke Clinic, an internationally renowned group of microsurgeons at the Davies Campus of CPMC, we are pleased to be the first practice to participate in a pilot study of for treating HIV related facial lipoatrophy (wasting) through stimulating the body's own stem cell response. Volunteers for this trial must either never have been treated previously for facial lipoatrophy or may have been treated with Sculptra, with the last treatment occurring at least 3 months ago. Volunteers should know that they are likely to have facial asymmetry for at least 6 months, as it is important to know if the treatment is effective by injecting only one side of the face and using the untreated side for comparison. Effectiveness will be judged by both ultrasound measurements of the face and by serial photographs. Contact Dr. Bill Owen or Carl Stein, PA-C, for further information about this trial.|
|Dr. Jay Lalezari has been at the forefront in investigating a number of cutting-edge therapies for HIV disease and opportunistic infections in recent years, through Quest Clinical Research.|
|The Community Consortium of Bay Area HIV/AIDS Providers, founded by Dr. Donald Abrams, includes most of the providers providing HIV care in the San Francisco Bay Area. The Community Consortium has a number of trials involving both antiviral and immunological research, many of which are national trials sponsored by the Community Programs for Clinical Research in AIDS network (CPCRA).|
|San Francisco General Hospital is a world-renowned site for many of the AIDS Clinical Trials Group (ACTG) national trials, directed by Dr. Diane Havlir, along with a number of industry-sponsored trials, led by Dr. Annie Luetkemeyer.|
|We are also fortunate to have a second ACTG site in the Bay Area at Stanford University Medical Center under the direction of Dr. Andrew Zolopa. Stanford is also a well-known and respected center for HIV/AIDS research.|
|Dr. Fritz Bredeek is relatively new to our community but has an HIV research background in Southern California and in Tucson, AZ. He also offers several open clinical trials at Metropolis Medical Group.|