Safe Sex

[Gentleman17]

I am not a health professional. I am simply trying to gather the facts.

I welcome comments (especially those referencing a reliable source) on what I've gathered below.

There is an excellent and authoritative summary table of risks from various sexual activities at http://www.sfcityclinic.org/stdbasics/stdchart.asp

THE BOTTOM LINE (as best I can decipher, from my reading):

Gonorrhea, syphilis, chlamydia, and human papilloma virus (HPV) can be transmitted in both directions by unprotected fellatio. Facials can infect the eyes with gonorrhea or syphilis. Cunnilingus is very unlikely to transmit anything in either direction (except when there are open sores, e.g. syphilis or herpes, but half of us have herpes anyway). Kissing, even with lots of deep tongue, is extremely unlikely to transmit anything, even if one person has pharyngeal gonorrhea. Finger fucking is safe (assuming no cuts or open sores). Inserting the penis into the vagina or anus (without a condom) can transmit all STD's including HIV, the anus being much more risky. Even with a condom, anal/vaginal intercourse is not risk free, although the risk is tiny. All of the above are less safe or unsafe if either partner is bleeding or has sores or recent cuts or wounds.

[A few basic facts vis a vis the above: Gonorrhea and syphilis are bacterial infections that are usually cured by antibiotics. Chlamydia is also antibiotic curable but often goes undetected. HPV and HIV are virus infections that are not curable. Anti-HIV medications, given early enough to HIV+ people, extend lifespan and postpone the development of AIDS.]

Opinion: I used to think it was a bad thing for sex workers to give BBBJ (uncovered fellatio). Now I conclude that it is not so bad for the sex workers, given that the main risk is a treatable bacterial infection (gonorrhea or syphilis) as long as they get tested regularly and treated when infected. Since I really*really don't want to bring anything home, I've decided to always cover for fellatio. I'm happy to learn that deep kissing and cunnilingus are relatively safe as long as there are no obvious open sores. I have on occasion cut open a condom to make a barrier for use in cunnilingus. From now on I don't think it is necessary, unless you have a cut or sore in your mouth or on your lips. Of course if you have a sore throat or cold sore, I would avoid kissing anyone until you're well again.

MORE DETAILS WITH SOURCES

Licking the anus (rimming) has never been known to transmit HIV. However, it can transmit a variety of nasty diseases unless the person being rimmed has washed very thoroughly beforehand. Licking or sucking objects that have penetrated the anus is very unsafe -- don't do it! http://www.sfcityclinic.org/drk/oralsex5.asp

People with multiple sex partners should get vaccinated for Hepatitis A and B, both of which are serious and uncurable and can occasionally be transmitted by sex. There is no vaccine or cure for Hepatitis C (which is very serious) but recent studies found that it is almost never transmitted by unprotected sex -- it is transmitted by blood or sharing needles.

A study of 301 female sex workers in Israel in 2001 found that 9% had pharyngeal gonorrhea. None had sore throats. "In two thirds of the cases, oral sex (fellatio) was the most probable route of acquiring the disease. Because there is a general misperception that STIs cannot be transmitted by oral sex, these individuals either engaged in unprotected oral sex solely or had unprotected oral sex followed by protected vaginal intercourse. A similar observation was reported from Japan, where cases of gonococcal urethritis [in male clients] acquired by oral sex with new, expanding types of sex workers who offer only nonvaginal, usually unprotected sex." http://journals.lww.com/stdjournal/F...rkers_.10.aspx

More on oral sex: http://www.medhelp.org/posts/STDs/Or...ea/show/360541 http://std.about.com/od/riskfactorsf...sexsafesex.htm http://www.medhelp.org/posts/STDs/fe...s/show/1028292 http://www.medhelp.org/posts/STDs/cu...SW/show/951678 http://www.medhelp.org/posts/STDs/Ca...TD/show/694435

A study of 320 prostitutes in London for 675 person-years found Baseline prevalence: HIV 1.3%, hepatitis C 6.7%, hepatitis B 6.6%, syphilis 2.3%, HTLV-I/II 0.4%, gonorrhoea 3.0%, chlamydia 8.2%, genital herpes 16.8%. Incidence (per 100 person years): HIV 0.2, hepatitis C 0.3, gonorrhoea 5.6, chlamydia 12.6, genital herpes 6.5. Bacterial infections were mostly acquired not from clients but from boyfriends. "This study shows that it is possible to have a larger number of sexual partners and remain free from sexually transmitted infections provided that condoms are used consistently." Most but not all in the study remained free of STD's. (Item #41 at http://lib.bioinfo.pl/meid:33093).

Syphilis: >14% (>33% in another study) of cases came from unprotected fellatio. These may be underestimates b/c most people having oral sex also have vaginal/anal sex, and these percentages are for those whose only risk factor was oral sex. Syphilis can often be asymptomatic, so carriers don't know that they have it. Untreated Syphilis is very serious. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a2.htm

Gonorrhea can infect the mouth or throat (pharyngeal gonorrhea), as well as the genitals, anus, and eyes (so even facials are dangerous). Often gonorrhea is asymptomatic, so people don't know they have it. It is easy to treat when diagnosed. If left untreated, it can lead to serious health problems including infertility. Infection with gonorrhea increases susceptibility to HIV infection. http://www.cdc.gov/std/Gonorrhea/the-facts/default.htm

Even with a condom, there is a low rate of HIV transmission. The rate with a condom is highest for receptive anal sex. http://www.cdc.gov/hiv/topics/treatm.../pdf/chart.pdf

HIV infected people who are taking anti-HIV medicines have low amounts of virus, but can still infect others. http://www.cdc.gov/hiv/topics/treatm...f/brochure.pdf However studies have shown that the rate of transmission is much lower when the infected person is being properly medicated.

Chlamydia is the most prevalent STD, and can be transmitted by fellatio. It is usually asymptomatic, so people don't know that they have it. 40% of women with untreated chlamydia may get pelvic inflammatory disease, which can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed. http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm

You can get genital herpes and human papilloma virus (HPV, may cause cancer) from oral sex, or contact of your genitals with secretions from an infected person ("massage, privates to privates"). The Gardasil vaccine protects against infection with HPV, and against cancer from such infection. http://www.cdc.gov/std/Herpes/the-facts/default.htm http://www.cdc.gov/std/HPV/STDFact-HPV.htm

[Johnny Maldiva]

Well, I've managed to find a website that sells home test kits for HIV 1/2 and other infectious diseases. The prices are a little steep and it appears as if they only distribute to America and Canada (awaiting confirmation), but the products appear to be the same as those used in clinical settings. PM me for the link.

[Jaosousa]

The US Government CDC site, they don't recommend Cipro for Gonorrhea. They recommend, Cefixime, (which you can buy in Dom Rep).

From the CDC website:

"Several antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another STD, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs."

and:

"The only current CDC-recommended options for treating Neisseria gonorrhoeae infections are from a single class of antibiotics, the cephalosporins. Within this class, ceftriaxone, available only as an injection, is the recommended treatment for all types of gonorrhea infections (i.e., urogenital, rectal, and pharyngeal). The only oral agent recommended currently by CDC for treatment of uncomplicated urogenital or rectal gonorrhea is a single dose of cefixime 400 mg (1). Availability of cefixime had been limited since July 2002, when Wyeth Pharmaceuticals (Collegeville, Pennsylvania) discontinued manufacturing cefixime tablets in the United States (2). Beginning in April 2008, cefixime (Suprax®) 400 mg tablets are again available in the United States."

"Oral cefixime is now being provided by Lupin Pharmaceuticals, Inc. (Baltimore, Maryland), which received Food and Drug Administration approval in February 2004 to manufacture and market cefixime. Lupin has been manufacturing and marketing cefixime oral suspension (100 mg/5 mL) since February 2004 and cefixime oral suspension (200 mg/5 mL) since April 2007. Public health pricing will be available for the 400 mg cefixime tablets."

For Chlamydia, usually Doxycycline, 200mg for 10-15 days.

Antibiotics can be easily purchased without a prescription at pharmacies in Dom Rep.

http://www.cdc.gov/mmwr/preview/mmw..._cid=mm5716a5_e

I use the KY brand massage oil and lubricant (works as a massage oil and a lubricant) and it says on the box it is safe to use with latex condoms. Many oils and lotions are not recommended to be used with condoms.

[Johnny Maldiva]

I did a little web search and learned that the OraQuick HIV test is not sold over-the-counter and is not available for home use. Its restricted for use by trained persons. The test uses oral fluids (technically not quite the same as saliva), not blood, and to me it seems impressively reliable (see link below).

I imagine you'd need to get some training and find some sort of inside source in order to "bring it along" on your travels. It does seem to be a fairly easy test to administer (you just swab a little paddle over the subject's gums) so I think these barriers are not technical in nature... probably the reliability of the test would be far worse if it were used in a home setting by untrained persons.

But I'd think the situation might be socially awkward if you try to swab a little paddle across a gals gums... especially if you have language barriers to deal with. [Maybe you could convince her its a form of foreplay and the paddle is a sex toy. :-)]

http://www.livestrong.com/article/13...test-oraquick/

Thanks for the link, Yankee. Good points all round but I'm beginning to doubt the reliability or an oral fluid vs. blood test. The blood test seems to be the way to go. The wait time is 40 minutes for both samples to be tested but it just seems much safer.

Did some searching and found this link that answers some questions about home testing. Seems it's in consideration: http://www.thebody.com/content/art13901.html

With a test kit, you take your own sample, test the sample, and read your own result. There are currently no home-use test kits approved for the detection of any infectious agent. With a collection kit, you take your own sample, mail it to a laboratory, and get your result over the phone or in the mail. There is currently one FDA approved home-use collection kit on the market for HIV testing.

The kit they refer to above is called Home Access and you can get your results within 24 hrs after sending the collection kit off to a lab.

[Very Green]

Long time lurker, first time poster.

Catching anything freaks me out. Has anyone caught something even with a condom?

[Yankee 617]

I have no idea where to obtain any of these tests, but should they be cheap, it's worthwhile to bring along for the less healthy areas/women.

I did a little web search and learned that the OraQuick HIV test is not sold over-the-counter and is not available for home use. Its restricted for use by trained persons. The test uses oral fluids (technically not quite the same as saliva), not blood, and to me it seems impressively reliable (see link below).

I imagine you'd need to get some training and find some sort of inside source in order to "bring it along" on your travels. It does seem to be a fairly easy test to administer (you just swab a little paddle over the subject's gums) so I think these barriers are not technical in nature... probably the reliability of the test would be far worse if it were used in a home setting by untrained persons.

But I'd think the situation might be socially awkward if you try to swab a little paddle across a gals gums... especially if you have language barriers to deal with. [Maybe you could convince her its a form of foreplay and the paddle is a sex toy. :-)]

http://www.livestrong.com/article/13...test-oraquick/

[Param Ahmad]

"HSV 1 Genital After HSV 1 Oral"
by H. Hunter Handsfield, M.D.
Mar 26, 2010

It is true that having HSV of either type makes one immune, or at least highly resistant, to a new HSV infection with the same type, anywhere on the body. Therefore, your postive HSV-1 blood test and presumed oral herpes means you're never going to get genital HSV-1 [from your girlfriend who has genital HSV-1]. . . . It is true that an increasing proportion of genital herpes in recent years is due to HSV-1, largely the result of rising frequencies of oral sex. But with few if any exceptions, those catching genital HSV-1 are believed to be among the 50+% of the population without prior oral HSV-1. . . . there is another reason genital to genital HSV-1 transmission is uncommon. Both recurrent outbreaks and asymptomatic shedding are uncommon in genital HSV-1 -- so the odds are good your genital area will never be exposed to the virus, even with frequent unprotected sex [with your girlfriend who has genital HSV-1]. . . . In summary, for several reasons you can be confident you'll never catch your partner's (or anyone's) HSV-1 infection.

http://www.medhelp.org/posts/STDs/HS...l/show/1204872

---------------
"The Truth About HSV1, HSV2, and Oral Sex"
by Charlotte Grayson, M.D.
Wednesday, February 28, 2007

. . .

[Q]You have genital HSV-1 and your partner has genital HSV-2 and you have unprotected sex.
[A]There is a small risk that you will get HSV-2. However, it’s not very likely that your partner will get genital HSV-1. It’s rare for a person with genital HSV-2 to get HSV-1.


[Q]Your partner has genital HSV-2 and you perform oral sex on him or her. Will you get oral HSV-2?
[A]Not likely. Almost 100% of HSV-2 infection is genital. Part of the reason is that most people have oral HSV-1 - providing some immunity against infection against HSV-2.

http://www.healthcentral.com/genital.../hsv1-oral-sex

---------------

SURVEY
(1) If you or someone you know face-to-face acquired genital HSV-1 despite a prior oral HSV-1 infection, (disproving the statement, above, that "your postive HSV-1 blood test and presumed oral herpes means you're never going to get genital HSV-1"), please post a report or PM me.

(2) If you or someone you know face-to-face acquired genital HSV-1 despite a prior diagnosis of genital HSV-2 (despite the above statement that "It’s rare for a person with genital HSV-2 to get HSV-1"), please post a report or PM me.

(3) If you or someone you know face-to-face acquired oral HSV-2 (despite the statement, above, that "Almost 100% of HSV-2 infection is genital"), please post a report or PM me.

(4) If you or someone you know face-to-face acquired HSV-2 despite a prior diagnosis of HSV-1 (despite the above statement that having HSV-1 provides "some immunity against" HSV-2), please post a report or PM me.

(5) If you or someone you know face-to-face acquired genital HSV-1 from vaginal intercourse from someone with whom they did not also have oral sex ( contrary to the above statement that "recurrent outbreaks and asymptomatic shedding are uncommon in genital HSV-1"), please post a report or PM me.

[Johnny Maldiva]

Thanks for the link. I love DATY too... and, for me, "dental dams" eliminate the pleasure of DATY so I'd never use them.

My understanding is that HIV is transmitted primarily through the blood. So if you have bleeding sores or bleeding gums in your mouth, this will greatly increase your chances of contracting HIV through DATY. Thus, AFAIK, aside from using a "dental dam", the best way to protect against contracting HIV from DATY is to make sure you have top-notch oral hygiene. Brush & floss several times a day to ensure that you have healthy gums and teeth. Don't engage in DATY if you have any open sores inside or near your mouth/lips. Also, do NOT floss for ~10-12 hours before engaging in DATY (as flossing will likely provide open access to the bloodstream through the gums).

Further, if you shave, give yourself ~10-12 hours after shaving before engaging in DATY (to allow micro-nicks in your skin to heal). Give yourself several days to heal if you've nicked yourself badly (i.e., if you can see any blood at all).

Hi Yankee. Thanks for responding with your tips. I agree re: dental dams. Having never used one, I can't say if it'd give the woman any pleasure but without the taste, smell, feel of the real thing up against my lips it wouldn't be the same. I guess that's the only real prevention as far as swallowing vaginal fluids that may contain HIV.

Did a quick Google search and found these quick HIV spot tests from http://aids. About.com/od/hivtesting/a/rapidhiv.htm:

OraQuick / OraQuick Advanced Rapid HIV-1/2 Antibody Test. This type of HIV testing has been approved for use with venous blood, plasma, and oral fluids for the detection of HIV-1 and HIV-2. The test consists of a small test paddle. The test area on the paddle is impregnated with HIV-1 and HIV-2 proteins. The test specimen (blood, plasma, or oral fluid) is applied to the paddle (in the case of oral fluid the paddle is swabbed in the inside of the mouth) and placed in developer solution. If the specimen contains HIV, it binds with the impregnated proteins on the HIV testing paddle causing in a red line to appear. Red lines appearing in the test area and control area of the paddle indicates a positive test. All positive tests require a confirmatory blood test. The rapid test should be read no sooner than 20 minutes and no later than 40 minutes after the sample is placed in the developing solution.

Uni-Gold Recombigen HIV-1 Test. This hiv testing has been approved for us with whole blood, plasma, or serum from a venipuncture or finger stick. It consists of a rectangular cartridge with a test area, a control area, and a specimen well. The specimen is applied into the specimen well and allowed to absorb, tracking along the test strip past the control and test areas. As is true in the first two tests we've discussed, any HIV in the specimen binds to the proteins in the test area, causing a red line to appear. A test is considered positive if a red line appears in both the test area and the control area. A sample is considered adequate if the specimen well is red in color. Like all rapid tests if the test is positive a confirmatory test is required.

I have no idea where to obtain any of these tests, but should they be cheap, it's worthwhile to bring along for the less healthy areas/women.

[Yankee 617]

This is a wonderful site and there is a great pool of knowledge here, both in punting and in keeping it safer. I really encourage everyone to read about STDs/STIs and how to practice safer sex. The industry is a breeding ground for diseases...

I love to DATY but have recently found out from (http://hivinsite.ucsf.edu/hiv?page=basics-00-05) that it can transmit HIV through the mouth. Are there ways to minimize the risk of contracting viruses while DATY? Really rather not give it up...

Here's some key info from the aforementioned website, regarding HIV --

Most people with HIV infection do not look sick.

Most people with HIV infection have not been tested and don't know they are infected.

HIV is a virus that infects people by getting inside their blood cells. To avoid getting HIV, you must prevent the blood, semen, vaginal fluids, or breast milk of someone who is infected from entering your body through your mouth, vagina, anus, tip of your penis, or breaks in your skin.

Thanks for the link. I love DATY too... and, for me, "dental dams" eliminate the pleasure of DATY so I'd never use them.

My understanding is that HIV is transmitted primarily through the blood. So if you have bleeding sores or bleeding gums in your mouth, this will greatly increase your chances of contracting HIV through DATY. Thus, AFAIK, aside from using a "dental dam", the best way to protect against contracting HIV from DATY is to make sure you have top-notch oral hygiene. Brush & floss several times a day to ensure that you have healthy gums and teeth. Don't engage in DATY if you have any open sores inside or near your mouth/lips. Also, do NOT floss for ~10-12 hours before engaging in DATY (as flossing will likely provide open access to the bloodstream through the gums).

Further, if you shave, give yourself ~10-12 hours after shaving before engaging in DATY (to allow micro-nicks in your skin to heal). Give yourself several days to heal if you've nicked yourself badly (i.e., if you can see any blood at all).

[Yankee 617]

i am not a medical-related professional, but would like to share with the forum members what i read in the news paper today.
the article said that there are two vaccines, namely cervarix made by glaxosmithkline and gardasil made by merch & co, which can prevent hpv which causes virtually all cases of cervical cancer.
deon123

this is correct. gardasil prevents four varieties of hpv, two of which are oncogenic (cancer-causing) and two which cause warts. cervarix also prevents four varieties of hpv, all four of which are oncogenic. gardasil is approved for use in the usa and europe. i'm not sure whether cervarix has yet been approved for use in the usa but i think its been approved in europe. both vaccines are "prophylactic" (they must be administered prior to infection to be effective).

i believe they're working on broader spectrum hpv vaccines (i.e., vaccines that protect against more varieties of hpv). i also believe they're working on "therapeupic" hpv vaccines (which are effective if administered after you've been infected). but it may be a very long time before we see these.

the vast majority of hpv-induced cancers are caused by hpv-16. both gardasil and cervarix prevent infection by hpv-16.

hpv is the only known cause of cervical cancer. hpv causes about 30% of the cases or oral cancer. most cases of oral cancer are still caused by tobacco or alcohol use; however, with fewer people smoking, these statistics are slowly changing (with fewer cases of tobacco-induced oral cancer).

(i'm not a medical professional either.)

[Johnny Maldiva]

This is a wonderful site and there is a great pool of knowledge here, both in punting and in keeping it safer. I really encourage everyone to read about STDs/STIs and how to practice safer sex. The industry is a breeding ground for diseases...

I love to DATY but have recently found out from (http://hivinsite.ucsf.edu/hiv?page=basics-00-05) that it can transmit HIV through the mouth. Are there ways to minimize the risk of contracting viruses while DATY? Really rather not give it up...

Here's some key info from the aforementioned website, regarding HIV --

Most people with HIV infection do not look sick.

Most people with HIV infection have not been tested and don't know they are infected.

HIV is a virus that infects people by getting inside their blood cells. To avoid getting HIV, you must prevent the blood, semen, vaginal fluids, or breast milk of someone who is infected from entering your body through your mouth, vagina, anus, tip of your penis, or breaks in your skin.

[Deon123]

I am not a medical-related professional, but would like to share with the forum members what I read in the news paper today.
The article said that there are two vaccines, namely Cervarix made by GlaxoSmithKline and Gardasil made by Merch & Co, which can prevent HPV which causes virtually all cases of cervical cancer.
Deon123

Here's an interesting fact sheet from the CDC:

http://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm

Oddly, it does not mention the fact that HPV is one of the causes oral cancer. That makes me think this fact sheet is a little old. Still, it does include many interesting facts about HPV. One such fact is that HPV can cause anal cancer, but it does NOT cause colorectal cancer.

[Hiflyer99]

If you encounter a P4P lady who has sore eyes, would you still go ahead with the act?

I ask because I recently read that it is also one of the symptoms of chlamydia infection.

[Yankee 617]

Here's an interesting fact sheet from the CDC:

http://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm

Oddly, it does not mention the fact that HPV is one of the causes oral cancer. That makes me think this fact sheet is a little old. Still, it does include many interesting facts about HPV. One such fact is that HPV can cause anal cancer, but it does NOT cause colorectal cancer.

[Yankee 617]

Wow, thanks for that. I didnt even know what gardasil was. I will go to the doctor and get that taken care of.

You should know it costs about $360 to get the series of 3 shots needed for vaccination. Also, if you've already been exposed to any of the HPV variants targeted by the vaccine, its unlikely to be effective against that variant.

Read more about it here:

http://en.wikipedia.org/wiki/HPV_vaccine

I am STRONGLY in favor of this vaccine and would get it myself if I thought it would be effective. [I'm not talking about cost-effective... I'd gladly spend $360 or more if this would offer me some protection against HPV.] Unfortunately, in my case, my doctors have all basically said I shouldn't bother... maybe I'll ask them again.

If you have children (girls or boys, up to age 26, but preferably about age 10-12... before they've become sexually active) then go get them vaccinated. Its not only good for them, its good for everyone.