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Recently in STDs Category

Ball pain can't wait!

Dear guys,
I got a frantic call this week from "Thomas," who had severe pain in his left ball, and pain when peeing. I told him to drop everything and haul ass to the ER--ball pain can't wait! Thomas followed up with me a couple days later, and confirmed my suspicions: he had epididymitis that was caused by an STD. After talking with Thomas, I realized that I don't talk about epididymitis enough....so, loyal readers, here's what I can tell you about this "itis."
Happy Reading,
Dr. Dick

First and foremost, if you have pain or swelling in your ball(s), don't ignore it! Ball pain can be caused by a number of conditions, and some of them need immediate treatment to prevent permanent damage. If your pain is severe, go to the emergency room ASAP.

The epididymis is a coiled tube at the back of the testicle that stores and carries sperm. When this tube gets inflamed, it's called EPIDIDYMITIS.

This "itis" is often caused by bacteria. Bacterial sexually transmitted diseases like gonorrhea and chlamydia are common causes. Epididymitis can also be caused by:
• A urinary tract infection or prostate infection
• A backflow of urine into the epididymis--often caused by heavy lifting or straining
• A groin injury

SIGNS AND SYMPTOMS OF EPIDIDYMITIS:
• Swollen, red, or warm scrotum
• Pain and tenderness in the testicle
• Pain when you pee or the urge to pee a lot
• Pain with sex or when you cum
• Lump on the testicle
• Lymph nodes in the groin that are bigger than normal
• Pain in the lower abdomen/pelvic area
• Blood in the semen
• Fever (not as common as the other symptoms)

GET CHECKED:
Get seen by a medical provider so you know what's up. Your medical provider will probably do a variety of tests to identify the cause of your ball pain. Most likely the visit will include:
• A physical exam
• A urine test
• A blood test
• An STD test
• Possibly a rectal exam to check for an enlarged or tender prostate

TREATMENT:
• Antibiotics are used to treat epididymitis that's caused by bacteria
• If the cause of the epididymitis is an STD, your sex partners need to get treated too
• Take the entire course of antibiotics, as recommended by your medical provider, otherwise, the infection might not clear up completely, or you could develop resistance to the antibiotics
• You and your partner(s) should avoid all-types of sex until seven days after you have completed the full course of antibiotics. If you must have sex, use condoms and other barriers to reduce contact with sexual fluids
• Many people start to have less pain after 2-3 days of taking the antibiotics, but it might take several weeks for the tenderness to disappear completely

Epididymitis can be pretty painful. Here are some tips for faster healing:
+ Rest in bed when you can
+ Lie down so that your scrotum is elevated. This helps blood flow out of the testicle,
which will reduce swelling and pain
+ Apply ice packs to the scrotum based on your medical provider's recommendations
+ Wear an athletic supporter. This can help reduce jostling!
+ Avoid heavy lifting/straining
+ Avoid sex that could cause pain to your ball(s)! Ouch!

POSSIBLE COMPLICATIONS:
If you don't get treated for epididymitis, you could develop:
• An abscess in the scrotum. An abscess is a hard, red, painful lump filled with pus. Abscesses are serious and need medical attention!
• Reduced level of fertility (this is not very common, but it is possible)
• Epididymo-orchitis: when the inflammation spreads to the testicle

TO PREVENT STDS THAT CAN CAUSE EPIDIDYMITIS:
• Use condoms for anal and vaginal sex
• Use an oral sex condom when going down on a penis
• Use a dam for rimming
• Talk to your partners about your STD and HIV statuses, and how you want to keep each other safe
• Get tested every 2-3 months for STDs, AND get treated if an STD pops up

Here's to healthy balls!

Dr. Dick


The "Ins and Outs" of Booty-Bumping

Dear Readers,

Do you know the ins and outs of booty-bumping? While it may seem like a piece-of-cake, booty-bumping (keistering) is not harmless! Here's some important info to help you have a bummer-free experience:

WHAT IS IT?
• "Booty-bumping" refers to putting drugs in the anus (up the butt) as a way to get high. The drug solution is absorbed through the lining of the intestines (gut).

WHAT ARE THE RISKS?
• TISSUE DAMAGE: We know that crystal-use shrinks your blood vessels. So when
you booty-bump crystal, you shrink the blood vessels in the anal cavity. This means
there's less blood to nourish that tissue. With repeated booty-bumping, the blood
supply to the inner lining of the butt is cut off and the tissue dies from lack of
nutrients.
• SCAR TISSUE: When the tissue in the anus gets damaged, scar tissue can build
up. If scar tissue builds up, your hole may become smaller, which can make
pooping and anal sex painful!
• HIV/STDS: Booty bumping likely increases your risk of getting HIV or other sexually
transmitted diseases (STDs) by causing small tears and other changes to the
tissue in your rectum.

REDUCE THE HARM-STEP BY STEP
1) KEEP IT SPOTLESS:
• Start with a clean surface free of dirt and debris.
• Wash your hands with soap and water before preparing your hit.
• Use fresh water and a clean container for mixing your hit.

2) DON'T GET SCREWED:
• Use a brand-new syringe with a screw-off needle. Breaking the needle off of a
syringe can create dangerous sharp edges that can tear you up!
• After you remove the needle, feel the tip of the syringe with a clean finger to ensure
there are no sharp edges. Discard the needle in a Sharps container.
• Before you booty-bump, put some Vaseline (petroleum jelly) on your finger and
coat the inner lining of the rectum. This can help create a protective seal and
prevent water-soluble crystal meth from doing as much damage to the tissue in the
anal cavity.
• Carefully do your booty-bump, then throw the syringe and plunger in a Sharps
container. Wash your hands to clean away germs.
• Some guys like to insert a vitamin E capsule (with water-based lube) in their butt
after booty-bumping to help the tissue heal.

3) NO ENTRY:
• Booty-bumping can create small tears in the tissue of the anus and rectum (in and
around your hole). These tears make it easier for infections like HIV and STDs to
get into your body.
• Carefully clean the skin around your hole after booty-bumping.
• Use a condom and lube if you have anal sex after booty-bumping.
• Use a dam if you rim your partner after they booty-bump. You can get hepatitis A
and Shigella through fecal-oral contact (poop getting in your mouth).
• Get vaccinated for hepatitis A & B.
• Use elbow-length latex or nitrile gloves if you fist after booty-bumping. Dispose of
the gloves in a Sharps container after use.

4) OTHER TIPS:
• Booty-bumping can cause muscle contractions that give you a strong urge to
poop (like when you use an enema or douche). Be aware that you may get
intestinal cramps!
• Avoid enemas. Using an enema before booty-bumping can dehydrate you. Enemas
can also create small tears in the delicate lining of the anus and rectum. If you must
use an enema, plain warm water is the safest option.
• Give your butt a break. Try not to booty-bump very often! Switch between booty-
bumping and other methods (like smoking or snorting).
• See a medical provider if you have any concerns about your ass after you booty
bump.
• Don't use alone: have someone with you so you can take care of each other if
something goes wrong.
• Hydrate! Water and 100% juice are good options.


-Dr. Dick

Pain in the Ass

Dear Dr. Dick,
My new man and I made an adult decision to get tested together. First, we both tested positive for the clap. He also wanted to check on an issue he'd been having back there (blood and mucus when he went #2). Turns out he has proctitis! We both took antibiotics for the chlamydia....and the doc said the pills should also help his proctitis clear up. This is the first I've ever heard about proctitis. Doc, can you give me some mo' info pretty please?
-Guy

Dear Guy,

Sorry to hear about your boo. Proctitis is the shits! In a nutshell, Proctitis means "inflammation of the rectum." Proctitis is a GI (gastrointestinal) syndrome that can cause the following symptoms:
• Pain in the anus and/or rectum (ouch!)
• Tenesmus (a painful feeling of needing to poop, even if your bowel is cleaned out)
• Discharge and/or bleeding from the rectum
• Diarrhea
• Pain when pooping
• Anal itching

WHAT CAUSES PROCTITIS?
Among MSM (Men who have Sex with Men), some of the common causes of proctitis are:
• STDs like gonorrhea, chlamydia, LGV (Lymphogranuloma Venereum), syphilis and genital herpes
• Shigella (check out my article on shigella for more info)
• Inserting harmful substances into the rectum, including some types of enemas

Other causes of proctitis can include:
• Bowel problems like IBS (Irritable Bowel Syndrome), Crohn's disease, and ulcerative colitis
• Some medications
• Radiation treatment for cancer
• Infections like salmonella


Symptoms of proctitis can be mistaken for other illnesses. If you have symptoms of proctitis, it's recommended that you see your medical provider. They may want you to have one or more of the following tests:
• Stool sample (testing your poop for disease-causing bacteria)
• Proctoscopy (carefully inserting a scope in your butt to examine your rectum)
• Rectal culture (carefully inserting a cotton swab in your butt to collect cells from the rectum. The sample is analyzed in a lab to check for bacteria and germs that could be causing proctitis)
• Sigmoidoscopy (a scope with a camera at its end is gently inserted into the anus, and then moved through the rectum and lower colon to examine the tissue)

HOW DO I GET RID OF PROCTITIS?
The goal of treatment for proctitis is to reduce inflammation and symptoms, and to get rid of infection (if an infection is causing the proctitis!). Proctitis usually goes away when the cause of the problem goes away. Medication is prescribed based on the type of infection you have. If an STD like chlamydia or gonorrhea is causing the problem, treating the STD with antibiotics will usually clear the proctitis. If a viral STD is causing the problem, antivirals may be prescribed to help reduce proctitis symptoms. In addition, medicines to reduce inflammation may be provided in the form of creams, suppositories, or enemas.

IF YOU'RE GETTING TREATMENT FOR PROCTITIS:
• Avoid having sex until the proctitis symptoms go away
• If you have proctitis due to an STD, make sure that you and your partner(s) get treated before having sex again. If you do have sex while getting treated for STDs, use condoms to reduce the risk of re-infection.

REDUCE HARM:
• Condoms can help prevent proctitis, because they can prevent the spread of STDs
• The lining of the anus and rectum are delicate. Prolonged, rough crystal sex can cause trauma to this area. If you develop proctitis due to rough anal sex, consider "easing up" until your symptoms improve
• Good quality lube can help prevent friction and trauma to your anus. Check out my article Well-Oiled Machine for lube safety tips


In good health,

Dr. Dick

Gonorrhea with the wind

Dear Dr. Dick,
I've been hearing some water cooler gossip about gonorrhea going berserk. I heard there's a new strain that you can't cure with antibiotics. What do I need to do, aside from wearing a full-body condom when I P n' P?
-Worried for my Willie

Dear Willie,

I understand your fear. No one likes the thought of a "super bug"-- especially one that can spread through sex.

While gonorrhea hasn't gone bananas, there have been concerns about gonorrhea becoming harder to treat. As a result, providers now always treat gonorrhea with two different types antibiotics to ensure the patient gets cured, AND, to prevent drug resistance. Here in King County, there have been 25 cases of drug-resistant gonorrhea since February 2014. All of the cases have been in MSM (Men who have Sex with Men).

What's the big deal?? Untreated gonorrhea can cause serious and long-term health problems. Here's a little Gonorrhea 101:

Gonorrhea is a bacteria that spreads easily through anal and vaginal sex, and oral sex (including rimming). In MSM, it can infect the urethra, rectum, and throat.

Symptoms usually show up 2-7 days after a person gets exposed to the bacteria, but many people - especially guys with infections in the throat or rectum -- don't get symptoms. When people do get symptoms, they are:

• A "drip" (discharge) that comes out of the penis, vagina, and anus
• Pain or burning when you pee
• Itching around the urethra (where you pee from)
• Painful or swollen balls
• Irritation around the anus (hole)
• Bleeding and/or pain when you poop
• If gonorrhea is in the throat, it can feel like you have a sore throat

WHAT CAN YOU DO TO PREVENT GONORRHEA?

TESTING ONE.TWO.THREE.
One of the best ways to prevent gonorrhea is to get tested. Guys who have sex with guys are encouraged to test for gonorrhea, chlamydia, syphilis, and HIV every 3 months--unless they're in a mutually monogamous relationship where both partners have been tested and know their statuses. At the least, test for these STDs once per year.

If you test positive for gonorrhea, connect with your medical provider right away to start treatment. It's important to take the antibiotics exactly as prescribed, and to finish the course of treatment. Don't take antibiotics that you buy online or on the street, or that aren't prescribed for you. Your sex partner(s) need to get treated too, so the bacteria doesn't keep passing back and forth. Keep it in your pants while you're taking the antibiotics---or use condoms if abstaining from sex isn't an option. Get tested again 3 months after you complete treatment for gonorrhea.

*If you are between regular STD tests, and think you have symptoms of gonorrhea, visit your medical provider right away!

RUBBERS
Rubbers continue to be one of the most effective ways to prevent sexual bugs. Don't like "male" condoms? An insertive ("female") condom can be placed in the anus up to 8 hours before sex. Non-latex and less mess!
insertivecondom.jpg

HIV PrEP & PEP
Untreated gonorrhea can increase your chances of getting or spreading HIV. Consider the following:

PrEP
Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV. It's important to keep in mind that PrEP alone won't stop you from getting infected with HIV.
It's strongly recommended that guys who take PrEP also do the following:
• Use condoms every time for anal and vaginal sex
• Talk to their partners about their HIV status and using protection
• Get tested regularly for STDs, and get treated if an STD pops up
• Get tested every 2-3 months for HIV
• Take their PrEP meds every day
• Use brand new needles and works every time they inject
TALK TO YOUR MEDICAL PROVIDER if you are interested in PrEP. For more info about PrEP, check out my article That Little Pill.

PEP
If you're negative for HIV, and think you might have come in contact with HIV through condomless sex, a condom break, or a needle stick, you might consider getting on PEP (Post-Exposure Prophylaxis). PEP can lower your chances of getting infected with HIV. How does it work? You take a 28-day course of HIV medication to decrease the chance that the virus will settle in your body.
If you feel you might have been exposed to HIV, go to the emergency room at Harborview within 24 hours of the exposure, to get a prescription for PEP. You can also see your primary care provider, if they can see you immediately. PEP works best when started right away, and will not be prescribed for you after 72 hours (3 days). For more info on PEP, check out my article Feelin' Peppy.
Let's hope that this will be a case of gonorrhea with the wind! Take care,

-Dr. Dick

Data and information source: Gonorrhea Health Advisory, Public Health - Seattle & King County, July 20, 2015 http://www.kingcounty.gov/healthservices/health/communicable/hiv/prevention/gonorrhea.aspx

SMEAR CAMPAIGN!?

Dr. Dick,
My roommate had his man check-up the other day, and the doc did an anal Pap. What's an anal Pap!?
- Anal Andy


Dear Andy,

Thanks for your great question! The anal Pap collects a sample of cells from the anus. This is similar to the "female" Pap smear which looks for abnormal cells on the cervix. The purpose of the Pap test is to check for cell changes caused by HPV (Human Papilloma Virus)--the virus that can cause genital and oral warts, and certain types of cancers.

Most MSM (Men who have Sex with Men) who are HIV-positive have HPV in the anal canal, and over half of MSM who are HIV-negative have HPV in the anal canal. So why aren't all gay men getting anal Paps? For a couple of reasons! First, lots of gay men have HPV infection that never causes health problems or cell changes. Even if they do have cell changes, most of these changes return to normal within two years. Secondly, in part because these cell changes may be temporary, medical providers aren't sure what to do with an abnormal anal pap.

In fact, the medical community is divided on whether anal Paps should be done at all. There isn't enough data yet, and there are currently no nationally endorsed guidelines for performing anal Paps. As you might have guessed, most insurance policies don't cover them. Still, the anal Pap may be an important test for some patients. If you have a history of receptive anal intercourse, or if you have HIV and your medical provider finds masses when doing a digital anal exam (checking inside the anus with a gloved finger), they might do an anal Pap.

HOW DOES AN ANAL PAP WORK? A cotton swab moistened with water is carefully placed 2-3 inches into the anus. The swab is rotated 360 degrees while slowly being removed over a period of 15-30 seconds. Cells from the swab are then analyzed in a lab to check for cell changes. If abnormal cells are found, your medical provider might perform more tests, or recommend treatment.

There are other options for screening for pre-cancers and cancers linked with HPV. Your medical provider can perform a digital rectal exam (inserting their finger in your rectum to feel for masses) and a visual inspection with anoscopy (that means inserting a small clear plastic scope that is about 4 inches long into the anus to look at the mucosa). If they find a mass or abnormality they will send you for either high-resolution anoscopy or to a colorectal surgeon. Another option for screening is high-resolution anoscopy. This is similar to regular anoscopy but the medical provider uses a large microscope to look for abnormal cells; they also apply a liquid that helps the abnormal cells show-up better for inspection.

Remember, HPV is very common. Still, there are some things you can do to reduce your chances of getting HPV:

PREVENTION

HPV VACCINE
• HPV is an extremely common STD. If you are 26 or younger, get vaccinated. The Gardasil vaccine is approved for men and women aged 26 and under. If you are older than 26, or know that you've had HPV in the past, the vaccine may still be an option for you to help prevent getting infected with a different strain of the virus. Talk with your medical provider for more information.
USE AN ORAL SEX CONDOM
• Oral sex condoms are non-lubricated and flavored. Add some water-based or silicone-based lube inside the condom to increase sensation for your partner. Put some flavored lube on the outside of the condom to make it a juicier experience for you.
• Deep throating can hurt the tissue of your throat, which can make you more likely to pick up an STD. Use an oral sex condom if you are deep throating.
TRY A DAM FOR RIMMING
• Dams are made of latex or polyurethane (for our friends who have latex allergies), and placed over the anus or vagina to shield one another from fluids, sores, and skin-to-skin contact. You can also get Hepatitis A and intestinal parasites from rimming, because you might touch feces (poop) with your mouth. Like condoms, dams should be used once, and then thrown away.
GET TESTED FOR STDs
• Having HIV increases the risk of HPV infection, and vice versa. Make testing a regular part of your healthcare. If you test positive for an STD, connect with a medical provider right away for treatment. Click for a list of testing sites in King County: Testing in Seattle/King County
TALK TO YOUR PARTNER(s)
• Talk to your partners about what, if any kinds of protection you want to use, and the last time you were tested. It may seem awkward at first, but you might be surprised how well-received the conversation is.
WATCH YOUR DRINK
• Alcohol, tobacco, and drugs can increase the risk of HPV. Consider harm reduction strategies for reducing use of these products. Even cutting out one drink per evening can make a difference for your health!

Take care,

Dr. Dick

For more HPV basics, check out my article Bumping and Grinding.

Sh-sh-sh Shigella

Dr. Dick,
The other night one of my roommates starting having out of control diarrhea. At first the guys and I thought it was hilarious...but when he started seeing blood, we took his ass to the ER. He didn't get better so they kept him overnight. Turns out he has something called Shigellosis! The doc gave him some antibiotics, and told him to be careful because he was still contagious. Now we're all paranoid that we're going to get it. We share everything: pipes, partners, you name it...
-Scared Shitless

My Dear Friend,
I'm sorry you're scared shitless. It sounds like your roommate has a nasty case of the runs! Shigellosis is a contagious diarrheal disease caused by Shigella bacteria. Anyone can get Shigellosis, but it's especially common among guys who have sex with guys. In fact, several shigellosis outbreaks in this population have happened around the world in recent years. Here's what you should know:

YOU AND THAT BOOTY
Shigella bacteria spreads easily through poop. Rimming and putting your mouth on dirty skin of the butt, groin, balls, and dick can spread the bacteria easily.

Shigellosis can also spread when an infected person doesn't clean their hands after using the bathroom, then prepares food or drinks for someone else. The bacteria can also spread for up to two weeks after a person is no longer sick with shigellosis symptoms.

SYMPTOMS
Symptoms include diarrhea (sometimes bloody); fever, and stomach cramps. Some people also get what's called Tenesmus, a painful urge to poop even when the colon (bowel) is cleaned out.

If you start having symptoms of shigellosis, it's very important to see a medical provider so they can find out for sure what's wrong. People with compromised immune systems (like through HIV infection) may have more severe symptoms that last longer than normal. Your medical provider might ask you to provide a sample of your poop so that it can be tested for specific bacteria.

CARING FOR YOURSELF
For most people infected with shigella, symptoms usually go away in five to seven (5-7) days. Drinking lots of fluids and resting are important ways to care for yourself. Avoid over the counter drugs to slow down the diarrhea (e.g. loperamide) as these can prolong symptoms. If you can, take a break from partying, which will run your immune system down further.

Sometimes the diarrhea is severe enough that you will need a prescription for antibiotics. Take the antibiotics exactly as directed! *Do not try to treat yourself with antibiotics that you buy online or on the street. Treatment requires a specific type of antibiotics, under the care of a medical provider. If you do receive antibiotics and do not feel better in a couple of days, tell your medical provider as there have been reports of antibiotic resistant shigella.

Most people who get shigellosis infection make a full recovery, but sometimes it can take months for a person's poop schedule to get back to normal. Reinfection with the same type of shigella bacteria usually won't happen to a person for several years. However, a person can get infected with one of the other types of shigella (there are four strains of the bacteria).

PREVENTING SHIGELLOSIS
There is no vaccine for shigellosis. Safer sex practices and careful handwashing are some of the best ways to prevent this bug.
• Try a dam for rimming: Dams are made of latex or polyurethane (for our friends who have latex allergies), and placed over the anus or vagina to shield one another from fluids, sores, and skin-to-skin contact. You can also get Hepatitis A and intestinal parasites from rimming. Like condoms, dams should be used once, and then thrown away.
• Oral sex condoms are non-lubricated and flavored. Add some water-based lube inside the condom to increase sensation for your partner. Put some flavored lube on the outside of the condom to make it a juicier experience for you.
• P n' P can spread shigellosis like wildfire. Stock up on supplies like dams and condoms before you jump into the ring. Use your own pipe and keep all other paraphernalia to yourself.
• Having sex while you have diarrhea isn't a good idea (and frankly doesn't sound like much fun). Avoid having sex if you have diarrhea, and try to wait for at least one week after symptoms are gone, to ensure that you aren't contagious anymore.
• If you do have sex while you have symptoms, use condoms for sex; dams for rimming; and gloves/fisting gloves for fisting and fingering.
• Wash your hands with soap and warm water after sexual activity. This is important after touching items like sex toys, condoms, etc; after using the toilet; and before preparing and handling food and drinks. Clean sex toys before use, according to manufacturer's instructions.
• Tell your sexual contacts about your infection, so they have some information if they start getting symptoms. Shigellosis can be rough on the body, and connecting with a medical provider is important!

Be well!
Dr. Dick

More info from Public Health--Seattle & King County :
Sex and shigellosis_04-15.pdf

Community alert_final.pdf

The H Word...

Dear Readers,

Your plumber might have it....your roommate might have it....your former fuck buddy might have it...even the dick doctor might have it!

You might have guessed that I'm talking about herpes--the H Word that doesn't get talked about enough (in my opinion). People shy away from the H Word, when it's actually super common. Did you know that an estimated 90% of Americans have been exposed to Herpes Simplex Virus Type 1 (HSV-1)? That's a butt-load of people!

I got diagnosed with genital herpes when I was in my teens, and I remember being confused and super embarrassed. But over the years, I've learned a lot about it, treated lots of patients, and learned how to live with the virus. Herpes can't be cured, but it can be managed with a little TLC.

Here's a little herpes self-care 101...

WHAT CAUSES OUTBREAKS?
Outbreaks can happen at any time, but they may be more likely to happen when:
• You first get the herpes virus from a partner (outbreaks generally get less common after you've had the infection for more years).
• You have a compromised immune system, from HIV infection or from taking medications that suppress the immune system, like chemotherapy.
• You have an infection with HSV-2 compared to HSV-1.

Some people notice situations that seem to bring on outbreaks. These can include:
• Fatigue (tired/exhausted/too much P & P).
• Stress (emotional, mental, or physical).
• Getting too much sun.
• Irritating your penis or vagina (longer, rougher, crystal sex. ouch!).
• Menstrual periods (our female-bodied friends).

OH SHIT! I'M HAVING AN OUTBREAK!...
An outbreak of herpes blisters can be painful. Try the following:

Medical Treatments:
• Take medication for herpes. This is especially important if you are having your first outbreak. Many people with herpes either take medication every day to avoid having outbreaks or have medication on hand to start as soon as they think they are beginning to have an outbreak.
• An over-the-counter pain reliever like acetaminophen (Tylenol), can reduce pain. Use only as directed!

Caring for Herpes Sores:
• Dip a washcloth in cool water, wring it out, and place it on the sores. Do this several times per day, to reduce pain and itching (keep this washcloth to yourself, so you don't spread the virus).
• Wash sores gently with soap and water, then pat dry. Put on loose-fitting cotton underwear, and loose-fitting pants. Leave the sores uncovered--bandages may slow the healing process!
o Wash your hands with soap and water before and after touching sores; touching your eyes or genitals; and touching a contact lens.
• Leave the sores alone. Touching or picking at them will slow the healing process. Don't put a lotion or ointment on sores unless your medical provider has prescribed it.
• Sex can irritate the sores, and expose your partner(s) to infection. Give your genitals, anus, or mouth a rest when you have blisters. If you do have sex, use a barrier like a condom to reduce the chance of spreading herpes. Use water-based lube to reduce friction that can irritate the skin, leading to an outbreak.

Care For Yourself:
• Treat yourself to a nap, a warm bath, or a movie (porn optional). Your self-care is important!
• Try to eat balanced, healthy meals. Your body will thank you!
• Try to get a good night of sleep every night.
• Try a meditation or relaxation exercise. Some people experience additional emotional stress when they have an outbreak.
• Use sunscreen to reduce stress to your skin.
• Have a heart-to-heart with a friend/loved one who can offer you emotional support.
• Did you know there are in-person and online support groups for individuals who have herpes infection?
• Think about couples counseling. You can talk about sex and intimacy, and learn about reducing the risk of transmission to your partner.

KEEP COVERAGE ON-HAND:
• Condoms and oral barriers like dams provide the most coverage and protection against skin-to-skin contact that can spread herpes. Check out my article Mouthing Off, for more oral sex safety tips.
• Use water-based lube to reduce friction during sex. Friction can irritate the skin in the genital area, which can lead to an outbreak.
• People who have HSV-2 can also reduce the likelihood of transmitting HSV-2 to a partner by taking antiviral medications. Antivirals can also make outbreaks less painful and happen less often. Medications can reduce outbreaks by up to 80%. Some of these medications are meant to be taken every day, others are meant to be taken at the first sign of a herpes outbreak. Talk with your medical provider to see if antivirals are right for you.
• Having herpes can make it easier to spread or get HIV. That's because herpes sores can bleed or create tiny breaks in the skin or mucous membranes--making it easier for HIV to get in/out.

SAFER USE:
• You may feel camaraderie passing the pipe around, but sharing can spread herpes. Consider getting your own pipe, or if you are going to share, discreetly wiping it off with your sleeve or an alcohol wipe.
• If you're using, you may get run-down from lack of sleep, poor nutrition, and dehydration. Try to plan out your use. Seattle Counseling Service offers FREE one-on-one assessments for guys who want to cut back or quit crystal, or just talk about options.


Be kind to yourself and each other. In good health,

Dr. Dick

Acting Rash-edly

Dear Dr. Dick,

Can I get shingles from sex? I'm trippin' cause my former sweetheart had shingles back in September--and I know shingles is a form of herpes. I've been checking my jewels and lips 24/7, but as far as I can tell, I haven't seen anything. I'm really worried about shingles, but I'm ready to mingle. Any info is much appreciated. Thanks Dr. D!

- Anonymous 

Dear Anonymous,

Put your pretty head at ease. While Shingles IS one of the herpes viruses, it's NOT the same form of virus that causes genital herpes or oral herpes.

Shingles (Herpes Zoster), is actually caused by the chicken pox virus (Varicella Zoster). When a person gets the chicken pox, the virus never leaves the body. It lies dormant (asleep), and can reactivate years later, causing shingles. I like to think of it as a "viral resurrection."

SYMPTOMS

Shingles typically causes a painful rash in a small area on one side of the face or body--and can occur with headache, upset stomach, and chills. It can also affect the eye and cause vision-loss. Most people get just one outbreak of symptoms in their lifetime, but rarely, a person can have a second or third.

People with compromised immune systems are more likely to get shingles; have shingles that affect larger areas of skin; or have multiple outbreaks of shingles. Folks who are diagnosed with shingles should get tested for HIV infection since shingles can be an early sign of HIV infection.

GET POKED

The risk for shingles starts to increase at around age 50, but you can reduce your risk by getting the shingles vaccine. The vaccine provides about 50% protection against getting shingles; is available to people aged 50 and over; and is recommended for people aged 60 and older. It's even recommended that people who've had a shingles outbreak get the vaccine to help prevent more outbreaks.

HIV INFECTION & THE SHINGLES VACCINE

People with HIV infection and low CD4 counts should not get the shingles vaccine. People with HIV who have high CD4 counts should talk with their medical provider about the risks and benefits of the vaccine, and if it's a good option for them.

SHINGLES IS NOT AN STD

To answer your question: NO, shingles isn't a sexually transmitted disease, and it doesn't cause genital or oral herpes. But, a person who hasn't had chicken pox or the chicken pox vaccine can get chicken pox from touching a shingles blister. Chances are though, you've already had chicken pox. Studies show that over 99% of Americans aged 40 and older have been exposed to the virus.   

HERPES & SEX

The herpes viruses that you've been stressing about are Herpes Simplex Virus 1 (HSV-1) and Herpes Simplex Virus 2 (HSV-2). As a rule, doctors use to say that HSV-1 caused cold sores, while HSV-2 caused genital herpes. However, it's know known that HSV-1 can also infect the genital area, and HSV-2 can infect the mouth. In MSM (Men who have Sex with Men), HSV-1 is a common cause of genital herpes. 

HSV-1 and 2 are spread through oral, anal, or vaginal sex with someone who has one or both of the viruses. Typical symptoms are one or more blisters on or around the genitals, anus, or mouth. The blisters break and leave painful sores that can take weeks to heal. Folks who have HSV-2 often get a fever, body aches, or swollen glands when they are first infected. Some people never have symptoms, while others have repeated blister outbreaks over the course of their lifetime.

KEEP COVERAGE ON-HAND

Even when someone with HSV-1 or HSV-2 has no symptoms, they can still pass the virus--because the virus can hang out on the skin in the genital and anal area, and on the mouth. Condoms and oral barriers like dams provide the most coverage and protection against skin-to-skin contact that can spread herpes. Check out my article Mouthing Off, for more oral sex safety tips.   

People who have HSV-2 can also reduce the likelihood of transmitting HSV-2 to a partner, by taking antiviral medications. Antivirals can also make outbreaks less painful and happen less often.

GET TESTED

The only way to know for sure if you have HSV-1 or 2 is to get tested by a medical provider. The best way to make a diagnosis is to see a medical provider when you are having an outbreak and have them test a swab taken from a sore.  There are also blood tests for HSV-1 and 2, but they aren't usually a standard part of the STD test panel, so be sure to ask for them. 

This was just a herpes snapshot, so stay tuned for my Herpes Special next month. I hope that I shed some light on your rash of questions. In good health,

-Dr. Dick

 

 

 

 

 

 

What's that coming down the chimney?

To my loyal readers,

It wouldn't be right to wish you happy holidays without imparting some safe sex advice. So before Santa slides down your chimney, take a minute and review my top ten holiday tips:

1) WRAP THE PACKAGES:
• Good things come in wrapped packages, so keep condoms close. When you give away your package, you might even tie it off with a pretty little bow.
• Whether you have one partner or four, use a new condom for every sex act. Make condoms part of foreplay, and be a smooth operator by learning to put one on with your mouth.

2) GREASE UP YOUR SLED:
• Just avoid oil-based lubes like Vaseline, cooking oil, and lip balm. Use water-based lube to reduce friction that can damage tissue of the anus, penis, and rectum.
• Put some sensual lube inside the condom before you pinch the tip and roll it down. If you're having marathon crystal sex, don't be afraid to pause and add more. Even Santa needs to stop from time-to-time to grease-up his sled.

3) CHECK YOUR CHIMNEY:
• A buildup in your chimney can make it more difficult for Santa to arrive. Test every 3 months for HIV, chlamydia, gonorrhea, and syphilis. If you test positive for an STD, connect with your medical provider right away for treatment. Find a testing provider here: http://www.kingcounty.gov/healthservices/health/communicable/hiv/resources/testing.aspx#test

4) PREPARE TO RECEIVE:
• Gracefully accepting gifts is just as important as gracefully giving them. Insertive "female" condoms, also known in NEON as "booty bags," "back packs," and "bottom bags" are a great alternative to traditional male condoms. Here's why:
• You can put one in your butt hours or minutes in advance. Since crystal can make it hard to remember to use a condom, you'll already be covered when it's time to play.
• No boner required! This means less pressure and more fun all around for you and your partners.
• You get to be in charge of your health. It's no secret that it can be difficult to talk to a partner about protection. Saying "I'm going to put a condom in," can help start an important conversation.
• Booty Bags provide extra protection against HIV and other STDs. Since the outer ring and the end of the condom bag stay outside the anus and lie against the surrounding area, you get extra coverage from fluids and sores.

5) STOKE THE FIRE:
• Rather than diving right in to the winter wonderland, fuel your passions with a steamy pre-hookup discussion. What are your likes and dislikes when it comes to sex? What will you use for protection? When was the last time you got tested?

6) ENJOY THE MISTLETOE:
• Stand, sit, or lie under the mistletoe after your holiday romp. Show your partner some holiday love rather than falling asleep right away.

7) PrEPPERMINT:
• Been hearing buzz about a little something called PrEP? Guys who are HIV-negative who are at high-risk for getting HIV can take PrEP. It involves taking a pill once a day, every day, to help reduce your chances of getting infected with HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. Studies show that PrEP can reduce your chances of getting infected with HIV, however, taking PrEP does not guarantee that you won't get HIV.
• PrEP isn't meant to replace rubbers. Since PrEP doesn't protect against other STDs, condoms and regular STD tests are important. Guys on PrEP also need regular screenings for HIV, and blood tests to monitor kidney and liver function.
• Talk to your doctor or medical provider if you're interested in starting PrEP. For a list of PrEP providers in King County, please visit
http://www.kingcounty.gov/healthservices/health/communicable/hiv/prevention/prep.aspx

8) PEPPERMINT:
• PEP: PEP can also lower your risk of getting HIV. PEP is a 28-day regimen of HIV medication that can be taken after a possible exposure to HIV. If you feel you might have been exposed to HIV, go to your doc or to the Harborview Emergency Room within 24 hours of the possible exposure. Treatment is more effective when started right away, and won't be prescribed to you after 72 hours.

9) REMEMBER YOUR HOLIDAY GLOVES:
• Fisting? Use elbow-length gloves and lots of water-based lube. Then, remember to wash your hands thoroughly with soap and water after your escapade.

10) TINKER TOYS:
• Sharing may not be caring in certain situations. Although it's not very likely, it is possible to spread STDs through sex toys. Put a condom on a sex toy if you're sharing or don't know if it's sparkly-clean.
• Some guys tell me they clean their toys with hand sanitizer, but, Purell simply won't remove all of the bacteria and germs. Carefully clean sex toys according to the manufacturer's instructions.

On behalf of NEON, I wish you the happiest and warmest of holiday seasons.

-Dr. Dick

Going to the Candy Shoppe

Dear readers,

Before you lick any lollipops this Halloween, check-out my update on syphilis, the oh-so-sneaky bacteria that can spread through oral sex.  

In King County, syphilis seems to really like MSM (Men who have Sex with Men). In fact, last year MSM totaled 87% of all cases. Syphilis spreads from person to person via a chancre (pronounced shaynk-er)--a firm, small, painless sore that shows up 10-90 days after infection. This is the primary stage of syphilis, and it's fully treatable with antibiotics. A chancre can appear on the tongue, lips, anus, rectum, penis, urethra, vagina, and cervix.

Chancres don't usually hurt, so an unsuspecting mister often won't notice the sore, particularly when it's in their anus.  Other times, a person will mistake the sore for a harmless skin bump or a cut. After 3-6 weeks, the chancre will go away on its own. *NOTE: A chancre is not the same thing as a canker sore--the tender sores people get in their mouths.

If untreated, syphilis will enter the secondary stage. This causes a spotty rash that usually appears 3-6 weeks after the chancre appears, though some people get a rash while they still have a chancre. The rash can affect different parts of the body, like the trunk and back, but more commonly, the palms of the hand and soles of the feet. The rash can look very different from person to person...I've even talked to guys who didn't notice a rash. Other symptoms can include fever; swollen lymph glands; weight loss; patchy hair loss; headaches; sore throat; muscle aches; and feeling really tired. About 5% of men will develop loss of hearing or loss of vision at this stage of infection.  If not treated, these problems can be permanent.

The rash and most of the other symptoms of secondary symptoms will go away with or without treatment. Without treatment, a person enters the latent stage, which can last for years. Before there were good antibiotics, about 15% of people who didn't get treatment during the latent stage progressed to develop symptomatic late stage syphilis. This is rare now, but some people can develop brain and spinal cord damage and heart problems.

Since syphilis likes to hide and the symptoms can sometimes be mistaken for other problems, many guys don't know they're infected. If you develop a sore on your butt, dick, or in your mouth, or have a rash or a fever, see a doctor.  It's important to tell your doctor that you have sex with men and that you are concerned about syphilis.  When possible, it's best to see a medical provider who is experienced in treating syphilis, like the people at the STD clinic at Harborview, or a doctor who sees a lot of MSM (Men who have Sex with Men). Also, regular testing every three months is one of the best ways to prevent the serious complications of syphilis.

A blood test is the most accurate way to test for syphilis, as antibodies appear in the blood shortly after infection. Even after successful treatment, low levels of antibodies may stay in a person's blood for months or years. Medical providers can also take a sample from a chancre to test for syphilis.

If you test positive for syphilis, connect with your medical provider right away for treatment. It's very important for your partner(s) to get treated too. *It's risky to try to treat yourself with antibiotics that you buy online or on the street. Effective syphilis treatment requires medical care and a specific antibiotic!

OTHER TIPS....

SCAN BEFORE YOU BOB FOR APPLES:

+ If you're going down on someone, do a quick (and playfully discreet) scan of their package. If you see something you're worried about, consider an oral barrier, or suggest another activity. *Just remember, some STDs can spread even if there are no symptoms! 

WRAP IT:

+ People can get re-infected. Having syphilis doesn't make you immune to getting it again.

+ Condoms, dams, and insertive condoms all provide a shield against syphilis sores. Add some water-based lube on the skin side to increase sensation for your partner. Put some flavored lube on the outside to make it a juicier experience for you. 

+ Deep throating can hurt the tissue of your throat, which can make you more likely to pick up an STD. Consider using an oral sex condom if you're deep throating.

IF YOU'RE NOT GOING TO WRAP IT:

+ Avoid brushing or flossing before giving head. This can cause tiny tears in the tissue of your gums and cheeks. Tears provide a nice opening for infections to enter. If you want fresh breath before or after giving head, rinse or gargle with mouthwash. *Mouthwash will NOT prevent you from getting or spreading an STD.

+ Don't give head after going to the dentist. Dental tools can cause tiny tears in your mouth and lips.

IF YOU HAVE HAD SYPHILIS IN THE LAST YEAR:

Guys with syphilis are often at very high risk for HIV infection.  If you've had syphilis in the last year, think about what you can do to better protect yourself.  If you are currently HIV negative, consider talking to your doctor about pre-exposure prophylaxis (PrEP).  PrEP won't protect you from syphilis, but taking it consistently can help protect you from HIV.

Enjoy the candy bowl!

-Dr. Dick

SNIPPED!

Dear Dr. Dick,
As someone who just recently entered the gay dating scene, I haven't been with too many guys. Still, I was a little surprised when during my last hookup, "Mac" dropped his pants and revealed that he wasn't snipped. How is it that I've never seen an uncircumcised dick in real-life? (It was beautiful by the way). Anyway, I've heard that if you're not snipped, it's easier to get an infection in your dick, because it doesn't stay as clean. Any insight would be much appreciated.
-Snipped in Seattle

Dear Snipped
,
Like a circumcised dick, an uncircumcised dick is as clean as its owner wants it to be. With that said, research shows that circumcision--surgical removal of some or all of the foreskin from the penis (usually done during infancy), can provide certain protective benefits during sex. However, these benefits probably mainly affect guys who have vaginal sex.

Men who are circumcised have a reduced chance of getting HIV, HPV and herpes from FEMALE-bodied partners during vaginal sex. They are also probably less likely to spread HPV to their partners and circumcision protects their female partners from bacterial vaginosis. Circumcised men also have a reduced chance of cancer of the penis.

So what's the deal with the foreskin? Foreskin is lined with mucosa (moist tissue), that may make it easier for HIV to get in the body. Here's why:

Foreskin may be more likely to tear during sex, creating more entry-ways for infection. In addition, foreskin may be more susceptible to HIV infection than other tissues of the penis; there may be more target cells for HIV (cells that HIV invades, like T-Cells) in the mucosa of the foreskin.

Does circumcision reduce HIV transmission in guys who have sex with guys? Studies show mixed results. Most studies - including research done in Seattle - suggest that circumcision doesn't protect MSM (Men who have Sex with Men) against HIV. At least in part, this likely reflects the fact that most MSM in the U.S. are versatile, and the risk of getting HIV is highest when men bottom. Being circumcised doesn't protect you from getting HIV through your rectum. Some studies suggest that circumcision is protective in MSM who only top, but that is not certain. More research needs to be done on this important topic. Still, there are many ways to reduce the likelihood of HIV transmission during sex:

HIV-MEDICATIONS:
If the insertive partner is HIV-positive and taking antiretroviral therapy consistently and correctly, they are less likely to transmit HIV to a partner.

If one partner is HIV-negative and taking PrEP (Pre-Exposure Prophylaxis), they have additional protection against HIV taking hold in the body. http://projectneon.org/learn/drdick/hiv/that-little-pill/ If you decide to take PrEP, it is important to take your medication every day, to assume that the PrEP is not really effective for the first 2-4 weeks you are taking it, and to realize that PrEP is not 100% effective.

CONDOMS/BARRIERS:

"Male condoms," insertive "female" condoms, oral sex condoms, and dams all provide a barrier against contact with genital fluids. Use water-based lube with condoms to prevent friction that could tear skin or the condom.

TESTING:

Test every 3 months for HIV, chlamydia, gonorrhea, and syphilis. If you test positive, connect with your medical provider right away for treatment. Getting treatment keeps you healthy and reduces your chance of transmitting an infection to a partner. Many agencies in Seattle offer FREE testing: http://www.kingcounty.gov/healthservices/health/communicable/hiv/resources/testing.aspx


*A NOTE ON CLEANLINESS:
hygiene is especially key for uncircumcised males. Men who aren't snipped should gently pull back the foreskin during a bath or shower, and clean and dry the area well, to prevent infection.

Take care,

Dr. Dick

Ass Backwards

Dear Dr. Dick,

The other day I sat down to go #2, and felt something nasty on the toilet seat. Naturally, I got a little freaked out and scrubbed my ass with antibacterial soap. Dr. D, could I have caught an oozy STI from one of my roommates? WTF?

Mr. Clean

Dear Mr. Clean,

Getting an STI from a toilet seat is VERY UNLIKELY, because STI bugs don't live long outside the toasty human body. You would have to try very hard to make this happen, and even then, your risk would still be small.

To get an STI from a toilet seat, you'd have to:

+ Put your dick directly onto the toilet seat immediately after someone gets up, in the exact location where they left a puddle of genital fluid or blood. Does this sound like something you'd do?
+ Sit down on a toilet immediately after a person leaves a sufficient quantity of blood on the toilet seat, and you have a cut or sore that you aim right onto the blood. HIV dies when it comes in contact with air--living at most for about 30 seconds outside the body.

HERPES:
Herpes is spread through direct skin-to-skin contact. Although herpes blisters can appear on the butt or thigh, the virus dies quickly when it's out of the body. Thus, it would be difficult to get from a toilet seat.

PUBIC LICE "CRABS":
While it is technically possible, it is very difficult to catch public lice/crabs from a toilet seat. These bugs don't live long away from a warm body, and they are unable to attach themselves to the slippery, non-porous surface of a toilet.

SYPHILIS:
Syphilis is spread through direct skin-to-skin contact, and cannot be spread though toilet seats.

CHLAMYDIA AND GONORRHEA:
Bacterial STIs like chlamydia and gonorrhea do not live long outside of the warm mucous membranes of the vagina, penis, anus, and mouth.

*There is one exception to this list: trichomoniasis, an infection caused by a protozoan parasite, can live outside the body up to a couple of hours. Trich spreads most often through vaginal sex, (vagina-to-penis or vagina-to-vagina), and infects the vagina most frequently. It is not very common among men who only have sex with men, and is not found very often in the anus. Trich has been known to survive on wet towels and bathing suits, especially in women. It is possible that trich could survive for a short time on the toilet seat. That said, even trich is probably almost never spread from toilet seats. For more info on trich: Critters In My Culo

KEEP IT CLEAN
It wouldn't hurt to do a deep clean of your shared spaces every once in a while.
+ Clean all bathroom surfaces using an all-purpose cleaner.
+ Use your own hand and body towels, and wash them regularly.
+ Blood can spurt with injecting! If you or your roommates use in the bathroom, clean up after yourselves. Hepatitis C can live 16 hours to 4 days on surfaces, and Hepatitis B can survive outside the body for up to 7 days.

Now please, relax and take a seat!

Dr. Dick


Sealed with a Kiss


Dear friends,

I promised I'd give you an update on Oral HPV (human papilloma virus)--the term used to describe HPV that has infected the mouth and throat. Yes, even this sensual pleasure-zone can get bitten. Here's some more info:

In the US, evidence suggests that oral HPV might be the cause of a growing number of oral cancer cases, especially in guys. In fact, oral HPV is 3 x more common in male-bodied folks.  

Oral HPV is spread through skin-to-skin contact during oral sex and rimming, (mouth-on-genitals or mouth-on-anus). Evidence also suggests that deep "French" kissing can spread oral HPV---but more research is needed to understand how likely this is.

About 7% of people in the US have oral HPV, though most people who get infected clear it from the body before they ever have symptoms or health issues. Low-risk strains of oral HPV can cause warts on the lips, and in the mouth and throat. These warts are rare and tend to appear more often in people who have weakened immune systems, due to HIV infection.

SYMPTOMS OF ORAL WARTS:

  • One or more raised warts on the lips or in the mouth.
  • Warts can be smooth and flat, spiked, or pebbly like cauliflower.
  • Warts usually do not hurt, unless they've been injured in some way. 
TREATMENT:
  • Warts can be removed by a medical provider through cryosurgery (freezing with liquid nitrogen), and surgical or laser removal.
  • Warts on the lips can often be treated with a medication that is applied directly on the affected areas.

Do not try to treat oral warts yourself with over-the-counter medications!

High risk strains of HPV can cause cancers of the oropharynx (called oropharyngeal cancer)---which is the back of the throat including the base of the tongue and the tonsils. About 1% of people who have oral HPV have a high-risk strain that can lead to oral cancers. Every year in the US, about 5,600 men get oropharyngeal cancer---however, many of these cases are related to tobacco and alcohol use, especially chewing tobacco and snuff.

Currently there is no routine test to check for HPV infection in the mouth and throat. If you are concerned about any of the following symptoms, visit a dentist or healthcare provider.

Symptoms of Oropharyngeal cancer can include:

  • Sore throat or ear pain that doesn't go away.
  • Pain or trouble swallowing or breathing.
  • Non-stop coughing.
  • Hoarse voice or voice changes that last more than 2 weeks.
  • Weight loss.
  • Lump or mass in the neck.
TREATMENT:
  • Cancers of the oropharynx can be treated with surgery, radiation therapy, and chemotherapy.

 PREVENTION:

  • A protective barrier might just be your best protection. Use an oral sex condom for oral sex on a penis, and use a dam for oral sex on a vagina or anus. Even though these barriers don't cover up the whole area, they offer more protection than going bare. Add some flavored lube to spice things up. Project NEON distributes oral health kits with these supplies; stop by Seattle Counseling Service to pick one up.
  • Under 26? Get vaccinated for HPV. The HPV vaccine is approved for males and females aged 9 to 26 and protects against the four strains of HPV that cause the majority of genital warts and certain cancers. It IS possible that the vaccine can help prevent cases of Oral HPV, but more medical research is needed to know for sure.
  • Be kind to your mouth. STIs and HIV can spread more easily when you don't take care of your mouth. Click for my Mouthing Off? Info card.
  • If you have a concern, get it checked out by a dentist or healthcare provider.
  • Get regular health check-ups. Uninsured? Sign up for health insurance with the Affordable Care Act. Washington Health Plan Finder

Thank you for the great question! Be well,

-Dr. Dick

 

 

 

 

 

 

 

 

 

 

Bumping & Grinding

Dear Dr. Dick,

The other day my sexy stud of a lover was giving me a penetrative deep tissue massage and found a wart-like bump near my hole! I'm embarrassed to get it checked, but more importantly, I'm afraid to have the wart virus. Don't warts cause anal cancer?

Seymour Butts

Dear Seymour
,

Your booty-bump could be a number of things, from a hemorrhoid, to a skin tag--or as you suspect, a wart. No matter what, you'll feel better once you get checked. Medical providers are used to seeing all sorts of butt issues---so relax, unclench, and try to think of the exam as just a normal checkup.

The "wart virus," HPV (Human Papilloma Virus), is VERY common. Almost everyone will get at least one strain of HPV in their lives. If your bump does turn out to be HPV, try not to feel embarrassed or ashamed. HPV doesn't discriminate--it just wants to live in a warm and happy home.

Here's some more HPV info:

There are over 100 strains of HPV, and over 40 of those strains can infect the genitals, the mouth, and the throat. These strains are spread through oral, anal, and vaginal sex, and can also be spread through non-penetrative sex (rubbing genitals together, or mouth-to-genital contact).

Low risk strains of HPV can cause warts, and high risk strains can cause certain types of cancers. So to answer your question, warts don't turn into cancer; the strains that cause warts and the strains that cause cancers are different.

SYMPTOMS:

Most people clear or control HPV and never develop symptoms or health issues. Often people develop warts that they don't notice that go away on their own. If warts pop up, they are usually pink or flesh-toned, flat or raised, or look like cauliflower. They vary in size and usually affect the genital area (cock, balls, hole, urethra, vagina, labia). Sometimes people get warts in their mouth or throat, but it doesn't happen as often as getting warts in the genital area.

High-risk strains of HPV can lead to cancer of the cervix, vagina, vulva, penis, and anus. In women, almost all cases of cervical cancer are caused by HPV. That's why there's a routine screening test recommended for women, called a Pap test.

There's no routine, widely recommended screening test for men. A visual scan for warts is the standard way to check for HPV. Some experts recommend that all men who have sex with men have an anal exam every year (finger in the butt), and others recommended an anal Pap to check for cell changes that could be caused by high-risk strains of HPV. At this time, there is no national recommendation that guys who have sex with guys undergo anal Paps, and the issue is still controversial. A large national study of anal Paps is about to start that should tell us if the tests are helpful, harmful, or neither.

High risk strains of oral HPV can cause cancers of the head and neck. These cancers are 3 x more common in men than in women. Currently there is no routine screening recommendation for oral cancer. *Stay tuned for next month's article on oral HPV.

TREATMENT:

Some warts go away on their own. If warts become a pain in the ass, they can be removed by a medical provider, often with minimal pain or discomfort. You might be given a prescription for a gel, cream, or ointment to use on the warts at home. Other times, a medical provider may freeze or surgically remove warts. Do not try to treat genital warts on your own with over-the-counter medication!

PREVENTION:

Use condoms and lube for anal and vaginal sex. Insertive "female" condoms provide some extra protection from skin-to-skin contact that could spread HPV.

Use an oral sex condom for oral sex on a penis, and use a dam for oral sex on a vagina or anus. Add some flavored lube to spice things up.

If you have a concern, get it checked out! STD Clinic.

Get regular health check-ups. Uninsured? Sign up for health insurance with the Affordable Care Act. Washington Health Plan Finder

Under 26? Get vaccinated for HPV. The HPV vaccine is approved for males and females aged 9 to 26 and protects against the four strains of HPV that cause the majority of warts and certain cancers. This is THE SINGLE BEST WAY to prevent HPV infection.

Thank you for the great question! Be well,

-Dr. Dick

Double-Bagging


Dear Dr. Dick,

My absolutely amazing and gorgeous partner of three months is poz, and I' m not. We use condoms for anal sex, but I still kind of worry about getting HIV. Dr. Dick, I want to be with this man, and this man only! So, I'm wondering, is double bagging a way to make sex even safer than just using one condom?

Double Mint

Dear Double Mint,

Double-bagging seems like it would work to keep fluids in check---much like the double bag you might receive with a saucy order of take-out. However, double-bagging during sex just isn't necessary and can actually make the ride less safe. Here's why:

Wearing two condoms on your dick, or wearing one condom while your partner uses an Insertive "Female" Condom, will cause a lot of friction that can cause the condoms to break. The friction will also cause the lube on both condoms to dry up more quickly, even if you keep adding more. This can lead to condom breakage, which can expose you to infection.

When you use a condom EVERY TIME you have sex, and use it CORRECTLY, you can greatly reduce your chances of HIV, STIs, and pregnancy (for those who have female-bodied partners of course). Condoms fail most of the time due to human error. Check out my Condom Basics for safety tips.

It sounds like staying negative is important to you and your health. If you want to lower your chance of getting infected with HIV, here are some things you can do in addition to using your favorite rubbers:
Test every 2-3 months for HIV and STIs like chlamydia, gonorrhea, syphilis, and herpes. If you test positive for an STI, connect with a medical provider right away for treatment.
• Talk with your partner often about your plan to keep each other safe.
• Use water-based lube with condoms to prevent tearing your delicate flower.
• Use condoms for anal, vaginal, and oral sex, and use a dam for rimming.
Talk to your partner about his taking HIV medications. U.S. National HIV treatment guidelines now recommend that everyone with HIV take antiretroviral therapy (medicines that fight HIV). Those medications will help your partner stay healthy. They can also help protect you from getting HIV from him. Large studies have proven that HIV medications are over 90% effective in preventing heterosexual HIV transmission. We don't know exactly how effective HIV meds are in protecting men who have sex with men, and they might be less effective in preventing HIV transmission through anal sex compared to vaginal sex. Still, the meds probably help a lot and it would be best if your partner was on meds and had an undetectable viral load (a blood test showing he has no HIV in his blood).
• Think about getting on PrEP (Pre-Exposure Prophylaxis). Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. TALK TO YOUR DOCTOR if you are interested in PrEP, and read more about it in my article That Little Pill.
PEP (Post-Exposure Prophylaxis) can also lower your risk of getting HIV. PEP is the use of an HIV drug after a possible exposure to HIV. If you feel you might have been exposed to HIV (like if a condom breaks or you get a needle stick) go to the emergency room at Harborview within 24 hours of the exposure. PEP works best when started immediately, and will not be prescribed after 72 hours.
• If you're using crystal, and worried about remembering to use a condom, try an insertive condom. You can put one in up to 8 hours before sex!
• If you and your partner use together, keep your points and injection equipment separate. Don't share or reuse.


Remember: go with the single bag. Have fun, and be safe!

-Dr. Dick

Critters in my culo?

Dear Dr. Dick,
I happily sleep with girls and guys. The other day my lady friend went to the doctor and they told her she has trich! I guess the doc told her that more girls get it than dudes. Could I have it, or should I not be too worried?
- Concerned on Cap Hill

Dear Concerned,

You're the first guy to ask about trich in a long time. Thanks for your question! It's awesome that your partner told you about her trich diagnosis. Yes, since she's been infected with trich, you might have caught it too. But the only way to know is to go to your doc to get it checked out. You might feel overwhelmed or scared, but you'll be happy to hear that trich is easily CURED with antibiotics. Here's some more info:

Trich, short for trichomoniasis, is an STI caused by a protozoan parasite (a microscopic single-celled critter), and is actually the most common curable STI. In the US, about 3.7 million people have the infection--but about 70% of them have NO SYMPTOMS. Thus, there are lots of folks running around with the infection who can pass it on to others.

Trich infects the vagina most frequently, and is spread most often through vaginal sex. It's not very common for trich to take up residence in the anus or mouth, but it is possible. One study found that about 70% of men with infected female partners were infected with trich. Trich is quite uncommon though among men who only have sex with other men.

Symptoms usually show up between 5-28 days after getting infected with the parasite. Guys who get infected with trich might have discharge from their penis; feel a burn after they pee or cum; or have an itch or irritation inside their dick. Symptoms in female-bodied folks can include a thin discharge with a strange smell that can be clear, white, yellowish, or greenish; discomfort when peeing; and itching, burning, redness, or soreness of the genitals. Having trich can make sex feel less-than-good for anyone who's infected, because the genitals can become inflamed and sore.

Like any STI, trich can increase your chance of getting another infection, like HIV. If you are poz, having trich can also make you more likely to pass HIV on to a partner. This is because the genitals can become inflamed, which makes it easier to get or spread HIV. Trich is far and away the most common curable STI in women with HIV, so women with HIV should definitely get tested. Have an honest conversation with your partner(s) and encourage them to get tested, or go get tested together. There are lots of options for testing on Capitol Hill. Click here for more info: Where To Get Tested.

Your medical provider will check you for signs of infection, may complete a laboratory test to confirm if you are infected with the trich parasite, and should treat you if you are. As with other curable STIs, doctors usually treat the sex partners of people who have a known infection without waiting for the results of their laboratory tests.

While getting treated for trich:
• You shouldn't have sex again until your symptoms are gone (about a week). Otherwise, you and your partner(s) could reinfect each other.
• If you're unable to abstain from sex while getting treatment, use condoms and other barrier methods like dams.
• Avoid getting your drink on while taking the antibiotics. Alcohol can cause unpleasant side effects.
• All of your sex partners should get treated too. *You and your partners should only take antibiotics that are prescribed by a medical provider. Taking someone else's antibiotics or buying them on the street can spell disaster for your health.

Above all, you owe it to yourself to get checked out.

Best wishes,

Dr. Dick

Ho! Ho! Ho! Ho! Ho! Advice for a naughty elf

Dear Dr. Dick,

Around the holidays, it's kinda hard for me to make ends meet. I'm not working right now, so you can guess how I earn my stash. Since I might be sleeping with an extra guy or three, what can I do to keep my candy cane minty fresh?

Sincerely,

Naughty Elf


Dear Elf,

Guys trade sex for a lot of reasons---money, drug withdrawals, a couch to sleep on, or just needing a good fuck. While trading sex can be a quick (or not-so-quick) way to make ends meet, there are real safety concerns to think about. Keeping your candy cane fresh is just the beginning when it comes to safety.  

Guys who trade sex are more likely to:

  • Be victims of abuse and assault
  • Have unprotected sex
  • Feel depressed or suicidal
  • Get exposed to HIV and other STIs

You are a human being with needs, feelings, and rights. If you're trading sex, take time to take care of yourself---physically, emotionally, sexually, and mentally. Read on...

Sex

One issue you might face is a partner who doesn't want to wrap it---and if you're desperate, you might give in. Talk about protection and the types of sex you'll have before you start to play. You might say "we'll be safer and more relaxed if we use a condom," or "I'm not comfortable bare-backing." If you feel pressured into doing something you're not comfortable with, ask yourself if it's worth the price.   

When you have marathon crystal sex, your dick and anus can become raw and bleed---raising your risk of getting HIV and other STIs. Condoms and lots of lube are your best bet for protection. If you're a diehard top, you might end up a bottom when trading (or other way around). Try an insertive condom (we like to call them "Magnums for your ass"). They aren't tight on the dick and you can put one in up to eight hours before sex. For more info: Too Big to Fit in Here

Oral Sex

  • Ever put a condom on with your mouth? If you're smooth you can do it without your partner ever noticing.
  • Don't brush or floss before giving oral sex.
  • Wash your hands after sex, removing a condom, and touching sex toys. Cover a sex toy with a condom before use to shield yourself from germs.
  • Use gloves for fisting. Elbow-length gloves are the safest because they offer the most protection. Use gloves only once and wash your hands after taking gloves off
Testing/Vaccinations
  • Make sure you're vaccinated for hepatitis A and B.
  • One study found that guys who trade sex are more likely to get STIs. Test for HIV and other STIs including syphilis, chlamydia, and gonorrhea, every 2-3 months.
  • You might also like to test yourself at home. Project NEON is giving away FREE HIV Home Test Kits. Pick one up from a peer educator or call 206.323.1768.  It's best to use the home tests as an extra test, not as a substitute for actual blood testing since the home tests are not as accurate as the testing done in a clinic or at one of our sister agencies like Gay City.
This info only skims the surface when it comes to safety. Look for part two next month, which will cover self-care and physical safety.

Be well,

Dr. Dick

 

Britney Speared

Dear Dr. Dick,

Is it safe to fuck with a penis piercing? My wicked Prince Albert is just about healed...

-Britney Speared

Dear BS,

There isn't much known about the safety of penis piercings and how they might affect your risk of getting HIV or other STIs. Therefore, the best way to reduce your chances of these infections is to care for your piercing and practice safer sex.  

LET IT HEAL

  • A penis piercing is an open wound until it heals. An open wound is a perfect entry way for STIs like HIV. Follow your piercing aftercare instructions so the wound heals right.
  • Experts say you should wait to have sex until the wound is healed. Dried blood and other fluids can spread infection, and the piercing might also travel (move from its original position) during sex--especially rougher, longer crystal sex. Ouch!
  • Watch for signs of infection. Warning signs of infection can include bad-smelling discharge, redness, pain, swelling, and fever. Visit your doc if you think you have an infection.

KNOW YOUR RISKS

Possible problems from piercing are:

  • Bacterial infection.
  • Bleeding.
  • Nerve damage.
  • A buildup of scar tissue at the site.
  • The piercing site might become hypersensitive (very sensitive).
  • Reaction to the jewelry (your body may reject the piercing).
  • Interruption of your urine flow when you pee. 
  • Hepatitis B, C, and HIV from piercing equipment that's not properly sterilized.

USE A CONDOM

Oral Sex

Be careful during oral sex. A piercing can cause tissue damage if you're deep throating---and can lead to broken teeth and choking. Use a condom or avoid deep-throating altogether.

Some evidence suggests that if you're pierced, you may have a greater risk of getting HIV when someone gives you head. Protect yourself and your partner(s) by using an oral sex condom. Leave space at the tip of the condom so that it's not stretched tight over the jewelry (this could tear the condom).

Anal and Vaginal Sex

The tissue in the vagina and anus are delicate and easily damaged. Condoms and lots of lube will help reduce friction and prevent the jewelry from tearing or damaging the skin. Some guys take the piercing out for sex if it causes discomfort. Just be sure to put a condom on before you dive in, because bacteria and fluids can still get in the piercing site even when it's healed.

If crystal is in the mix, prepare ahead of time with a stash of condoms and lube. If you see or feel any signs of infection, get it checked out by a doc ASAP. Thank you for your shlong-tastic question!

 

-Dr. Dick 

Great (s)Expectations

Dear Dr. Dick,

I'm newly out and am dying to go to a sex club. Only thing is, I'm not sure what to do when I'm there. Dr. Dick, I just want to get fucked. Can you help a guy out?

Tired Of being Patient


Dear TOP (NOT),

You're not alone. Some consider bathhouse sex to be a whole different ballgame. Just like with anything else, enter carefully and go in easy. Here are some basic tips guys should remember:

JUST PUT ON A CONDOM:

A lot of guys tell me when they go to a sex club, they assume everyone has a sex bug. We know that people don't always tell the truth, and we know that some people don't know their HIV and STI (sexually transmitted infection) statuses. You might feel weird thinking every guy has an STI, but it takes the guesswork out of using condoms. Chlamydia, gonorrhea, syphilis, herpes, and other STIs are easily spread through oral and anal sex. You don't have to fuck with a guy if he won't use a condom. Remember, you're in control. It's your body.

  • Use a condom for every sex act. Condoms can wear out before you do, especially if crystal is in the mix. Put on a new condom if the condom dries out, when you switch positions, or if something just doesn't feel right. Pull out hard so that you don't spill fluids.
  • Take charge. Ever heard of insertive condoms? (also called "FC2 Female Condoms"). These are condoms that are put into the anus.  A lot of guys like them because they aren't constricting on the dick. Think of them as Magnums for your ass. For more info: Too Big To Fit In Here.
  • Use lots of lube. Lube keeps things slippery and can prevent tearing the skin in and around your hole. Water and silicone-based lubes are safe to use with condoms--but stay away from oil-based lubes or household products like cooking oil or Vaseline. These can break down condoms.

HYDRATE YOURSELF:

Saunas and steam rooms can be dangerous if you stay in them too long. Limit your visit to 20 minutes. Drink plenty of water or Gatorade before and after the sauna, and avoid alcohol.

Keep your drink in sight and don't set it down. Roofies (date rape drugs) are easy to slip into the drink of an unsuspecting cutie.

BE ALERT & AWARE:

People can be sneaky when they want something from you--whether it's money, sex, or your stuff. Don't be too friendly or trusting. Be polite, but don't be a Naive Nancy.

DON'T HAVE EXPECTATIONS:

Just because you show up doesn't mean you'll find somebody to hook up with. This can be frustrating, especially when you're horny as hell. Keep things in perspective. Have a plan B. Be good to yourself, and practice self-care. Maybe your first time will just be an opportunity to enjoy the sauna.

WHEN YOU GET THERE:

  • Get to know the space, including the exits. 
  • Don't bring in firearms or drugs. You will get searched at the door.
  • Lock your stuff up in a locker, and don't bring valuables. If you get a room, lock your door anytime you leave.
  • Take a shower so you're squeaky clean. While the occasional guy gets off on dirty, most won't appreciate it.
  • It's ok to ask for a new room. For example, if you get in your room and discover your friend or boss is in the room next door, you might want to switch.
  • Check out on time to avoid late fees.
  • If a guy harasses you physically or verbally, report it to the manager or front desk staff. Everyone has the right to enjoy a safe time.

BE A SMART SEXUAL BEING:

  • Get vaccinated for Hepatitis A & B.
  • Get vaccinated for HPV if you're under 26. 
  • Give a fuck, get tested. Get tested for HIV, and STIs (sexually transmitted infections) every 2-3 months, or as recommended by your doctor. Some clubs even offer free testing on certain nights.
  • Educate yourself on common STIs.

*A note on douching:

Many sex clubs have douching rooms, and sell douching hoses for you to use in these rooms. I don't recommend douching (also known as using an enema) for several reasons. Check out my article Keep Your Frenemies Close and Your Enemas Closer.


Fuck safely and take care of yourself.

 

-Dr. Dick 

That Little Pill

Dear Dr. Dick,

I try to use condoms when I can, but I definitely slip 'n slide. I don't want to catch the bug - ya know, HIV. I've heard there's a little pill that can prevent it. Tell me mo' 'bout it... pretty please?!

 "Pretty 'n Pink"


Dear PnP,

It sounds like & quacks like - PrEP (Pre-exposure Prophylaxis).

Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV.

The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. Studies show that PrEP can reduce your chances of catching HIV, however, taking PrEP does not guarantee that you won't get HIV. 

The iPrEx study, which tested PrEP use in gay and bisexual men, found that participants were 44% less likely to get HIV than men who didn't take the pill. Furthermore, the guys who took PrEP everyday as prescribed (instead of missing or forgetting doses), reduced their risk of HIV infection by 90%. This year, the CDC released the results of the Bangkok Tenofovir Study--which tested PrEP in men and women who inject drugs. The study showed that participants who took PrEP every day had a 74% lower chance of getting HIV. However, some PrEP studies have found no benefit, probably because people didn't consistently take their medication.

It's important to keep in mind that PrEP alone won't stop you from getting infected with HIV. Some guys think that if they take PrEP, it's a ticket to ride bareback without the risk of HIV. PrEP should be one part of your safer sex and safer use practices.

 

Here are basic guidelines. GUYS WHO TAKE PrEP SHOULD:

  • Use condoms every time for anal and vaginal sex.
  • Talk to their partners about their HIV status and using protection.  
  • Get tested regularly for STIs, and get treated if an STI pops up.
  • Get tested every 2-3 months for HIV. 
  • Take their PrEP meds every day.

*If you take PrEP and use crystal, you should still use brand new needles and works every time. Don't share or reuse!


Talk to your doctor if you are interested in PrEP.

Before you can start PrEP, you'll need to test negative for HIV. Once you're on PrEP, your doctor will check-in with you regularly to talk about any side effects, your sexual safety practices, and make sure you are taking the medication as prescribed. You'll also get a blood test every 2-3 months to check for HIV and make sure the medication isn't damaging your kidneys or other organs. A common side effect of PrEP is upset stomach.

You shouldn't take someone else's PrEP drugs either. Only take it when it's prescribed for you by a doctor!

THINK IT OVER:

  • If you take PrEP, you have to take it every day for it to prevent HIV infection. You can't just take it the day before you plan to hook up with a hottie. Plain and simple, PrEP only works when you take it everyday. This can be hard for some guys, with all the other things going on throughout the day. Setting a phone alarm is one way to remember the medication.
  •  If you don't have insurance, PrEP can be super expensive. However, there are medication assistance programs like start.truvada.com.   

 

Read More:

Check out the PrEP Factsheet by Public Health Seattle King County here: PrEP Q&A: Using HIV Drugs to Prevent HIV Infection <http://www.kingcounty.gov/healthservices/health/communicable/hiv/publications/~/media/health/publichealth/documents/hiv/PrEPfacts.ashx>

Here's an editorial from OUT Magazine: Why Are We Not Talking About PrEP? <http://www.out.com/news-opinion/2013/07/24/michael-lucas-comes-out-hiv-negative-sexually-active-man-prep>

 

Yours truly,

Dr. Dick

 

 

 

Mouthing Off

 

Dear Dr. Dick,

 

I'm looking for a good, safe mouthwash to use--especially in orgy-situations where I tend to go down on several guys.

 

Thanks Doc!

 

-Mouthing-off

 

 

Dear MO,

 

It's great you want to keep your mouth squeaky clean. Mouthwash can help kill bacteria and germs, prevent gingivitis (irritation of the gums), and gum disease, and freshen breath. But, mouthwash WON'T stop you from getting or spreading a sexually transmitted infection (STI) if you use it before or after you go down on a hottie. 

 

If you're giving head, you're going to get friendly with sexual fluids like pre-cum and cum (if you're not using a condom), and of course anything else hanging out on the dick and balls (such as sores, bumps, or tiny breaks in the skin). You can get all the same STIs through oral sex that you can get through anal or vaginal sex, including herpes, syphilis, chlamydia, gonorrhea, human papilloma virus (HPV), and HIV.  

 

The amount of risk linked with getting or giving head isn't known and varies with different STIs.  You can get or give herpes from oral sex, and most cases of genital herpes in gay men are now caused by herpes simplex virus 1---the type of herpes that lots of people have on their mouths.  Syphilis is pretty easily spread through oral sex, and some studies suggest that about 15% of infections are transmitted via oral sex. Gonorrhea in the throat is also common, and an estimated 25% of all cases of gonorrhea in the penis probably come from oral sex.  Chlamydia can live in the throat as well, but is less common, perhaps because it's hard for the bacteria to live there.  HPV can infect the throat, though it rarely causes throat cancer.  Finally, you can get HIV by giving head, though the risk is much lower than having unprotected anal sex.

 

I don't want to be a Debbie Downer, but it takes more than mouthwash to prevent getting or spreading HIV and other STIs. There isn't a lot known with certainty about how to stay safe while giving head, but read on for a couple of commonsense safety tips:

 

?        Avoid getting cum in your mouth

o        Getting cum in your mouth makes it easier to get an STI, especially if you have dental problems, or tiny cuts in your mouth. Finish off with your hand instead, or use an oral sex condom. 

 

?        Don't brush or floss before giving head

o        This can cause tiny tears in the tissue of your gums and cheeks. Tears provide a nice opening for sexual infections to enter.

 

o        If you want fresh breath before or after giving head, rinse or gargle with mouthwash. *Remember, mouthwash will NOT prevent you from getting or spreading an STI.

 

?        Don't give head after going to the dentist

o        Your dentist might be hot, but his dental tools can cause tiny tears in your mouth and lips.

 

?        Use an oral sex condom

o        Oral sex condoms are non-lubricated and flavored. Add some water-based or silicone-based lube inside the condom to increase sensation for your partner. Put some flavored lube on the outside of the condom to make it a juicier experience for you.  

 

o        Deep throating can hurt the tissue of your throat, which can make you more likely to pick up an STI. Use an oral sex condom if you are deep throating.

 

?        Try a dam for rimming

o        Dams are made of latex or polyurethane (for our friends who have latex allergies), and placed over the anus or vagina to shield one another from fluids, sores, and skin-to-skin contact. You can also get Hepatitis A and intestinal parasites from rimming, because you might touch feces (poop) with your mouth. Like condoms, dams should be used once, and then thrown away.

 

?        Get tested for STIs

o        Make testing a regular part of your healthcare, and make sure that your doctor tests you for gonorrhea or chlamydia in the throat.  If you test positive for an STI, connect with a medical provider right away for treatment. Having an STI can make it easier to get another STI.

 

o        Click for a list of testing sites in King County: Testing in Seattle/King County

 

?        Talk to your partners

o        Talk to your partners about what, if any kinds of protection you want to use, and the last time you were tested. It may seem awkward at first, but you might be surprised how well-received the conversation is.

 

         Get vaccinated against HPV

o        HPV is an extremely common STI.  If you are age 26 or younger, get vaccinated.

 

 

Sexual bugs just want a warm and happy home to live in. Use care when having oral sex.

 

-Dr. Dick

 

 

 

Giving the finger...

 

Dear Dr. Dick,

 

What is the point of "finger condoms?" I can't even finger someone without having to use protection? What will they come up with next...

 

Sincerely,

 

Deeply Troubled

 

Dear Troubled,

 

I understand your disenchantment. It seems like everywhere you turn, there's a new device for covering up. Of course it's anyone's choice to use a finger condom, but it's good to know they're an option.

 

Would you want your doctor to give you a rectal exam without wearing gloves? Ok, forget the naughty nurse or doctor fantasy for a second. Finger condoms can help prevent you from getting bacteria or viruses that spread through contact with skin, or very small breaks in the skin.  These bugs include STIs like herpes, syphilis, and human papilloma virus (also known as HPV, the virus that can cause warts, anal cancer, and cervical cancer). 

 

If you put your fingers in someone's anus, finger condoms might also prevent you from touching bacteria that can cause diarrhea or hepatitis A. In addition, dirt under the fingernails can spread infection. You never know where someone's hand has been. *Although it is possible to get HIV or Hepatitis C through a sore on your finger touching a bloody area inside someone's anus or vagina, the risk is probably very small.

 

Finger condoms, (also called finger cots), look like mini condoms. They fit smoothly over a finger, and come in latex and non-latex varieties. They can also be used on small sex toys to prevent the spread of germs, bacteria, and sexual bugs. Add some sensual lube to increase pleasure (just make sure it's water or silicone-based).

 

To use, wash your hands, place the finger condom on the tip of your finger, and roll it down so that it touches the base of your finger. After use, carefully roll the condom up your finger to prevent touching the contaminated side, and throw away in the trash. 

 

Take care,

 

Dr. Dick

 

 

 

 

Crabs: A Dying Breed?

 

Dear Dr. Dick,

 

I heard that crabs aren't really a problem anymore because everybody shaves their pubes. Is that true?  

 

-Joey S.

 

 

Dear Joey,

 

If only it were that easy to "groom away" an STI. Crabs, also called pubic lice, are still alive and kickin', and affect roughly 3 million people in the US each year. There have been some rumors circulating this year about crabs "going extinct," but they aren't based on research, and can't be confirmed. While crabs can be a nuisance, they are easy to treat and get rid of with a prescription from your medical provider.  

 

Crabs are tiny insects that attach themselves to hair in the pubic area. They are commonly spread through sexual contact, and in rare cases, through bedding, towels, clothes, and fabric-covered furniture. Sometimes crabs will take up residence on other coarse body hair--like on beards, legs, and armpits.

 

Crabs can cause a crazy itch in the pubic area. Some people can also spot them with the naked eye. Crabs are pale gray to tan in color, and their eggs are white and found in small clumps near the hair root. If you have a magnifying glass, you can spot six legs, with the front two legs resembling crab pincher claws.

 

Crabs can be easily diagnosed by your medical provider. You'll get a prescription for a cream or shampoo that'll kill the bugs--and you should feel relief from symptoms within a short period of time. Your partner(s) will need to get treated as well, and you'll want to abstain from sex until treatment is complete.

 

You'll also need to wash bedding, clothes, and towels in hot water, and dry on high heat. Items that can't be machine-washed can be sealed in a plastic bag for 2 weeks.

 

A brazilian wax or smooth shave won't solve the problem. However, there are a couple things you can do to lower your chance of getting crabs:

 

v      Insertive ("female") condoms and dams will cover up more pubic hair than "male condoms," or just going bare.

 

v      Having fewer sex partners can lower your chances of "getting bitten."

 

v      Getting tested regularly for sexually transmitted infections will help catch sexual bugs early, and connect you with care to keep you healthier.

 

*If you do have crabs, you should also get tested for other STIs. Click here for testing clinics in Seattle/King County: HIV and STD Testing

 

 

Listen to your body. If you start feeling an itch--get it checked out! You'll be glad you did.

 

Regards,

 

Dr. Dick

Dr. Dick on Blow Jobs: Before you lick, check the dick

Hey Doc!

 

I give great head and lots of it! But I hate condoms. One day I hear blow jobs are safe. The next day I hear they aren't. So what's the bottom line on giving head? Can you please settle this issue once and for all?

 

Gratefully,

 

I. Lovedick

 

Well, every guy needs a hobby now doesn't he? And you're right, the issue of safety and blow jobs can be downright confusing. So let's try to make it simple.

 

The one who gives the blow job gets more of the risk. Your lucky recipient has less to worry about (HIV and some STIs can be transmitted to the receiver; it's not as common, but it is possible.) Today we'll just talk about giving blow jobs, not getting them.

 

Yes, there is clear risk for STIs. Gonorrhea, chlamydia, syphilis, and herpes can be shared when giving head. You can become infected if your mouth touches any sores, rashes, bumps, fluids, etc. So a thorough penis inspection is always smart before you begin. And play with any foreskins to check them out also. You can easily disguise it as teasing or foreplay. But inspecting a penis isn't guaranteed to make you safe! You can pick up an STI even if you don't see any symptoms! So be careful- there can be more than meets the eye!

 

Hepatitis is also a risk. But you can eliminate or reduce this risk by getting vaccinated for hep A and B. Even though it's not very common, it is possible to get hepatitis C through sex.

 

There have been reported cases of HIV transmission through oral sex. However, the number of cases is small compared to the whopping number of blow jobs that happen every day!

 

The experts agree on two points:

 

        You are less likely to get HIV from oral sex than anal sex,

 

and

 

        HIV risk is virtually zero if you use a condom when you give head

 

Your risks for any STI or HIV increase if:

        You have open sores or cuts in your mouth. These are the express lanes for infection! And since crystal is famous for causing gum problems and loose teeth, your mouth could be in serious trouble!

        You have just brushed or flossed. Scratches or tiny cuts in your gums can easily invite infection.

        You take cum in your mouth. Therefore, a lot of guys agree on this before the action begins. And many men prefer to "let it fly" anyway so it could be a win-win for you both!

 

 So here's my free advice to lovers of dick everywhere:

 

        Have an honest conversation about your STI statuses.  For example, you might say "I was negative for chlamydia, gonorrhea, etc...when I got tested last month."  

        Check your own mouth. Don't brush or floss before or just after giving head. Crystal users - take EXTRA steps to avoid gum disease and tooth decay!

        Check your partner's dick, especially under any foreskins. If you see anything unusual, play it safer. Use a condom or pass on giving head.

        Don't take cum in your mouth.

        When in doubt, use a condom. The flavored ones (and lubes) can be deliciously tasty. So why not give them a try?!

        Get vaccinated against hepatitis A and B

 

Well, fellatio fans, I hope this clears up the confusion.

 

Until next time

 

Dr. Dick

 

Edited and reposted 4/29/13

Info from Dr. Dick about Chlamydia

Dear readers,

We got a lot of calls last month from guys worried about chlamydia. We sent your questions to the good doctor for his sage advice. Here's what he had to say:
 

What is chlamydia?

Chlamydia (clah MID ee uh) is a bacteria that can be passed through oral, anal, or vaginal sex.  It grows really well in the cock, the butt hole and the pussy; and also infects the cervix (in female-bodied folks), and the throat.

Chlamydia often has NO SYMPTOMS. You can have chlamydia for a long time and not have a clue. Chlamydia is easy to cure with antibiotics, and the sooner it gets treated, the better. Serious health problems can develop if you don't get treated (more info under the symptoms section). The only way to know if you're infected with the bacteria is to have a culture or urine test done by a medical provider.  

Can I get chlamydia from giving or getting a blowjob?

Yes. A lot of people think that getting or giving head is totally safe. The risk of getting chlamydia through oral sex is lower, but it's still a risk! Use condoms to provide a barrier against contact with your partner's genitals and fluids. Use some tasty, flavored lube to make things more interesting. There are also flavored condoms specially made for oral sex.

If you're partner has chlamydia and you're giving them head without using a barrier like a condom, you can get infected even if they don't cum. The bacteria likes to live in warm, wet places like the urethra (where you pee from), and it's easier to come into contact with it if you don't use a barrier. 

 

If I get symptoms, what should I look for?

?        itching inside the penis

?        discharge from the penis

?        pain or burning when you pee

?        pain or swelling in the testicle(s)

If your butt gets infected with chlamydia, you may or may not have symptoms---but if you do, they might be itching or pain.  

If you get infected with chlamydia and don't get treatment, the infection can spread in the body. In men, this can mean epididymitis, which is inflammation of the epididymis (part of your testicle). This condition leads to testicular pain and swelling.


what if I'm HIV positive?

If you're HIV-positive, it's easier for you to get or spread chlamydia or other STIs. That's why testing is so important---because if you test positive for chlamydia, you can get treated and cured right away.

 

REMEMBER THESE TIPS:

?        Get regular STI check-ups

?        Talk about your HIV and STI status with partners. Then, you can frame a conversation around sexual safety.

?        Talk about what you and your partner(s) will do to keep each other safer--do you plan to use condoms or dams? Get tested together every couple of months?   

?        Use condoms, gloves, insertive condoms, and dams

 

For more info on where to get tested in King County, visit: King County Testing Sites
For more info on chlamydia and other STIs, visit: Chlamydia Facts or CDC Chlamydia Facts

 

Yours truly,

Dr. Dick


Updated and Reposted 3/29/13


Don't Be Silly, Wrap Your Willie

Dear Dr. Dick,


I'm HIV-poz and I only sleep with poz guys. Why should I use protection?

-Ben Dover

 

Dear Ben,

That's a very good question, and I'm glad you asked it. You might be thinking that you already have the most serious STI (sexually transmitted infection) so why worry about protection? This seems to make sense except, when you are HIV positive, other STIs can still cause serious problems for you.

 

If you become infected with a viral STI like genital herpes, you can be sure that it'll put some major stress on your immune system. Viral STIs can be managed with medications, but cannot be cured; in essence, a viral STI stays in your body forever. If you are HIV positive, a virus like herpes can become harder to treat and the symptom outbreaks can be longer and more painful. The bottom line is that if you're having sex, you could become infected with another STI that is incurable.

 

Here's a bit more info about genital herpes:

 

Genital herpes is spread by direct skin-to-skin contact, (such as you and your partner's genitals rubbing together), most often during anal or vaginal sex. You can also spread herpes through oral sex (f.e., your partner has genital herpes and you give them head). Genital herpes is most contagious when the sores are open and haven't healed yet. Keep in mind that herpes can be spread even when you don't have any herpes sores. Just because you don't see any sores or bumps on your partner's dick, it doesn't mean they don't have an STI.

 

The first symptom of herpes is a cluster of sores that appear on the penis, vagina, cervix, anus, or butt. Rarely, sores appear on other areas of the body. They start as small pimples or blisters, and soon become open, painful sores.

 

Other common symptoms of herpes include:

?        Pain around the genitals, butt, or legs

?        Flu-like symptoms (fever, chills, headache or body aches)

?        Swollen lymph nodes in the groin

?        Itching or burning when you pee

?        A hard time having a bowel movement or peeing

 

Bacterial STIs like chlamydia, gonorrhea, or syphilis can cause very serious infections in your penis, mouth, or butt that can be harder to treat if you are HIV-positive. Bacterial STIs can be cured, but the longer you wait for treatment, the more likely are you are to end up with permanent damage or complications.

 

If you are HIV positive and your partner is not, (or the other way around), STIs can make it easier for you or your partner to get infected with HIV. STIs can create breaks in the skin, which make "portals of entry" for HIV (HIV will have an easier time getting into your body). Additionally, inflammation from STIs causes more of the STI-infected cells to be hanging out in your genital secretions. These cells then serve as "targets" for HIV infection. Furthermore, HIV-positive individuals who are infected with other STIs, are more likely to shed HIV in their genital secretions (semen, pre-cum, or vaginal secretions). There are also multiple strains of HIV, and you could get infected by a different strain if you don't use protection. 

 

The bottom line--protection is key! Unless you are in a committed, monogamous relationship where you and your partner only have sex with each other, and are sure of each other's statuses, condoms and other barriers are important.

 

With that said, whether or not you decide to use condoms, GET TESTED. Regular testing can catch sexual bugs early, so that you and your partner(s) can get proper treatment. Test for STIs and Hep C every 2-3 months, or based on your medical provider's recommendation.

 

Remember that we can care for our sexual health in many ways, by asking questions, talking to friends, protecting ourselves and our partners, and getting STI checkups.

 

Take care,

 

Dr. Dick

 

 

For more info about STIs, visit: STI Info_Public Health Seattle King County

 

For info about FREE testing for HIV, STIs, and Hep C, visit: Where to get tested in Seattle/King County or join NEON and Gay City for TGIF, Fridays from 3-5 p.m. at Seattle Counseling Service. Get free, confidential testing for HIV, STIs, and Hep C, eats, films and workshops, and more!

 

Updated and Reposted 3/7/13

 

Uncovered in the U District

Dear Dr. Dick,

 

I'm a bi guy who has a couple of intimate partners (both men and women). At this time of year when it's freezing out, it's basically a 24/7 orgy. We all tested negative two months ago, and we're good about getting tested regularly. I feel like I don't have to worry too much about getting HIV. The only thing is, I really don't like condoms. They don't feel good and I have a hard time getting off when I use them. My partners are OK with me not using them.  Two of us use crystal, but we smoke only (we don't inject or booty-bump).

 

How worried should I be about getting HIV? Dr. Dick, I'm not about to start covering myself up. Is there anything I can do to play it safer?

 

Sincerely,

 

Uncovered in the U District

 

 

Dear Uncovered,

 

I'm glad you brought this up! While condoms can make sex a whole lot safer--it's important to acknowledge that some people just don't like them or use them. For many guys, sex without condoms just feels better---but it can come with a price (pardon the pun). If you're NOT in a monogamous relationship (where you and your partner only sleep with each other, and are sure you are both HIV/STI free) --- barebacking is risky.

 

Here's Why:

 

1) The lining of the anus and vagina are delicate. Micro tears can happen easily (especially with rougher, prolonged crystal sex), which leaves you and your partners vulnerable to HIV and other sexual bugs.

 

2) It's always a possibility that your partners have other partners. Even though you trust them, you should never assume you're 100% safe when it comes to sex.  Whether its oral, anal, or vaginal sex, all sex carries some risk.

 

3) Even though you and your partners test often, people are most infectious in the weeks right after they get infected with HIV. If one of your partners gets infected and doesn't yet know it, they could infect you.

 

With that said, if you're sure that you're never going to use a condom---consider the following tips for safer sex:

 

 

1) SKIP DOUCHING:

Douching (using an enema) damages the skin in and around your hole--making it easier to spread or get an STI. If you absolutely MUST douche before sex, use warm water only. Check out my recent article on enemas for more info.

                                                          

2) SMOKE SAFER:

Talk about sex before you smoke. Do you have the supplies you need? (water-based or silicone-based lube etc.). Crystal can make you forget everything when you're caught in a moment of passion.  

 

Try to use your own pipe only. Passing the pipe around can expose you to diseases and infections that can weaken your immune system.

 

3) TEST:

Test every 2-3 months

?        If you test positive for an STI--connect with a medical provider ASAP. You and your partners must all get treated. Otherwise, the bacteria/bug will continue to be spread back and forth. Your immune system will also be more compromised---which will make barebacking riskier.

 

4) EXPLORE YOUR OPTIONS:

Have you thought about trying an insertive condom? Insertive condoms are used in the anus or vagina, and offer protection against HIV, pregnancy, and STIs. You can put one in yourself, or ask your partner to do it. This is a great option for guys who have a difficult time staying hard with condoms on. Have fun with them by making them a part of foreplay.

 

For more info, see my recent article Too Big to Fit in Here.

 

5) REDUCE:

Have fewer partners. Fewer partners = less chance of getting or spreading a sexual bug.

.

6) PrEP & PEP:

PrEP

HIV-negative guys who are at high risk for getting HIV can take PrEP (Pre-Exposure Prophylaxis). PrEP involves taking a pill once a day, every day, to help prevent getting HIV. Guys who take PrEP should also use condoms, & get tested often for HIV and other STDs.

Talk to your medical provider if you are interested in PrEP.

 

PEP

(Post-Exposure Prophylaxis) can also lower your risk of getting HIV. PEP is the use of an HIV drug after a possible exposure to HIV. If you feel you might have been exposed to HIV, visit your medical provider ASAP. PEP needs to be started within a couple days of being exposed to HIV. 

 

7) COMMUNICATE:

It sounds like you're doing a superb job of talking with your partners. Keep it up. Talk about your HIV and STI status with your current partners--and if/when you get a new partner. You might say "I tested negative for HIV 2 months ago." If you don't talk with your partners, you don't have the chance to find out their status or sexual history.

 

8) LUBE:

Some guys use lube because they feel like it decreases friction and trauma to the skin. Friction can tear the lining of the anus or vagina, which makes you or a partner more likely to get a sexual bug.   

 

We really have no idea whether lube increases the risk of HIV and other STIs, decreases the risk, or has no effect.  More research is needed in this area. Your risk of spreading or getting HIV and other STIs may depend more on the kind of lube you use. 

Not all lubes are safe! Some lubes hurt the lining of the rectum and may increase HIV replication (the virus making copies of itself).  Here's a bit more info:

 

         If you are using condoms, don't use oil-based lube--which breaks down condoms. Crisco, Vaseline, and chapstick (lip balms) are oil-based and are NOT good options--even if you're desperate!!

 

         Stay away from lubricants that contain nonoxynol-9. Nonoxynol-9 is a spermicide that can irritate the delicate lining of the rectum and vagina, increasing the risk of HIV and other STIs.

 

         Some evidence suggests that lubricants containing an ingredient called polyquaternium-15 may boost HIV replication. Some of the lubricants that contain polyquaternium-15 are: Astroglide Liquid, Astroglide Warming Liquid, Astroglide Glycerin and Paraben-Free Liquid, and Astroglide Silken Secret.

 

         Some evidence suggests that certain lubricants can damage the cells in the lining of the rectum. These lubricants include: Astroglide, Elbow Grease, Gynol II, KY Jelly, Relpens, and Boy Butter.

 

 

         Some evidence points to the following lubricants as safer choices: Good Clean Love, PRE, FC 2 lubricant, and Wet Platinum.

 

9) CONSIDER THIS:

Have you thought about how important it is to you to stay HIV-negative? What would you do if you tested positive? It's worth thinking about....

 

 

Here's to safer humping.

 

 

Dr. Dick

 

 

*For more info on PrEP and PEP visit

 

PrEP

Go to: http://www.kingcounty.gov/healthservices/health/communicable/hiv.aspx

& click on PrEP Q&A: Using HIV Drugs to Prevent HIV Infection.

 

PEP

Go to: http://www.kingcounty.gov/healthservices/health/communicable/hiv/links/pep.aspx

 

& http://www.cdc.gov/hiv/topics/treatment/post-exposure-prophylaxis.htm

What's a freak to do?

 

Dear Dr. Dick,

 

Halloween is my favorite holiday, but I always end up with too much candy in the bowl. Any advice for how to keep my tricking in-check?

 

Yours truly,

 

Joe McFreaky

 

 

Dear Mr. McFreaky,

 

You'd be surprised how many people write me at this time of year, concerned about too much tricking on Halloween. Below is a sure-fire list of ways to get your freak on while reducing fright on Halloween night.

 

       Keep costumes to yourself. To avoid coochie critters and other fright-night cooties, keep your pants on and don't share!

 

       Keep condoms and lube handy. Planning to get some booty? Go trick-or-treating at Seattle Counseling Service on Friday, October 26 from 3-5 p.m., for free condoms (many sensual varieties available) and lube.

 

       Use the condoms and lube. Use a new condom every time you have sex. Remember, condoms may wear out before you do. Check them often during sex, when you change position, or withdraw. Worried you'll forget to use one? You can put an insertive condom in up to eight hours before sex. It could make a great addition to your costume!

 

*ALWAYS use LOTS of condom-safe lube (water-based) with condoms.

 

       Stay hydrated! Shaking your ghoul thing will make you sweat buckets. Drink plenty of water before the fun begins. It's also important to drink lots of water if injecting is on your list of plans for Halloween night.    

 

       Be smart about glitter. Apply it generously, but avoid your dick! Glitter has no place on your delicate flower (unless of course you dress up as a giant flower).

 

       Avoid biting. Wearing fangs? Avoid biting, and especially avoid drawing blood. You put yourself and your partner at risk for HIV and Hepatitis when playing Dracula.

 

       Don't mix crystal, boner-uppers, and poppers!  Your heart will shift into overdrive, causing changes in your heart rate and blood pressure. Read further.

 

       Be a smart sexual being. Get tested often. How about Tuesday? Sign-up for Health Night at Seattle Counseling Service to get free, confidential testing for STIs, Hepatitis, and HIV. Health Night happens every Tuesday from 4-6 p.m. Call 206.323.1768 to sign up. Snacks provided.

 

Planning on bare backing?

 

       Don't douche or use an enema before going out. You could damage the delicate skin around the anus, making it easier to get or spread HIV.

 

       Pull out before cumming. You'll lower your chances of getting or spreading HIV and other STIs.

 

       Avoid booty-bumping. Booty-bumping can damage your bowels and anus. It can increase your chance of getting HIV, and can also make anal sex painful. Ouch!

 

       Use LOTS of lube. Lube will reduce friction and lower your chance of tearing the skin around the anus.

 

I hope this helps reduce the trickery. Happy fright night!

 

Dr. Dick

 

Dear Dr. Dick, his profile says he's negative...

Dear Dr Dick,

Like so many other gay and bisexual men in Seattle I spend a great deal of time online looking for hookups. It seems that is where all the HOT guys hang out. When I hookup with guys from websites I practice safe sex. However, recently I met two guys online that I'm considering barebacking with. That's cool if all parties involved are HIV negative right? Both of the guys have posted the following statement in their online profiles: "HIV NEG as of November 2011."

So here's my question: is it safe to bareback with them?
Hooked on the Man Hunt

Dear Hooked on the Man Hunt,

Thank you for your question!

The short answer is, no, barebacking (intentional unprotected anal sex) is a very risky sexual practice. Barebacking can easily transmit HIV, along with several other sexually transmitted infections. These potential partners say they are HIV-negative but they were negative as of a year ago, so consider these facts:

In 2010, men who have sex with men accounted for 78% of all new HIV cases among males in the US, and 63% of all new infections in the US. Other studies have shown that recently HIV-infected guys are the most infectious, because they have very high levels of virus in their blood and semen in the first few months after being infected--before their bodies have brought the infection under some control.

Knowing your own and your partner's HIV status is an important part of maintaining one's overall health. However, just because one advertises their year-old HIV status in an online profile or in person does not necessarily mean it is accurate, and frankly you are probably taking a big chance.

Additionally, someone who is HIV negative can have another sexually transmitted infection (STI) present. Anal, oral (including rimming), and vaginal sex can spread infections such as syphilis, gonorrhea, chlamydia, and herpes. Using barriers for all types of sex can make getting-it-on a whole lot safer.

Be sure to talk more about this with your partners and even your doctor to settle on a decision that works best for all parties.

Best,

Dr. Dick

updated and reposted 1/13/14

Anal Fissure

Pride & My Ass

Dear Dr. Dick,

If this Pride season is anything like the last one - my ass is going to be very busy housing bursting buldges - literally! Last year, amidst all my safety tactics I still managed to get an anal fissure! While it has healed considerably since then, I am worried I might not be doing enough to have an exciting, safer and healthy pride season!

Thanks,
Robbie Rumpsworth!

Dear Robbie Rumpsworth,

I am glad to hear your anal fissure has healed considerably! For those readers who have not heard that term before, an anal fissure is a tear in the skin of anal canal. Most anal fissures are caused by severe stretching of the anal lining. Symptoms of an anal fissure include bright red bleeding from the anus, most noticeable on the toilet tissue or on the toilet.

Striking pain and/or consistent discomfort during anal sex should be a strong indication to inspect your ass hole. Or better yet, since someone has to be very flexible to really examine their own ass, go visit a doctor or knowledgeable health care provider and let them examine you carefully. If you plan on taking multiple dicks with lots of girth or even getting fisted -it is recommended that you do some anal prepping on your own. Get a butt plug or even use your own fingers and water-based lube to safely stretch your hole before the main event!

Given that a fissure is a tear in the anal skin, and that that provides ready access to your blood, you are at increased risk of acquiring infection by bacteria and/or virus' such as HIV, Syphilis, or Gonorrhea -if one of your partners is so infected, of course. And any partners who have direct access to your blood may more easily acquire a blood-borne infection, like HIV or hepatitis B or C, from you if you've already become infected.

Remember the old adage: Healthy pink parts contribute to a healthy sex life! So, stock up on water-based lube and condoms of all sizes, colors and feels for those bursting buldges! And, don't have too much fun, unless you're being very careful with yourself and with your partner(s).

Dr. Dick

***

Do I have a girl's disease?

Dear Dr. Dick,
I recently came out and have been enjoying a lot of gay sex! I've been told to get tested, and now I have this weird discharge on my penis & pain when peeing. My friends say it's chlamydia and that I need to run to the STD Clinic. But I thought chlamydia's only for girls?
--Young and Naive

Dear Y & N,
It's good you are enjoying gay sex. But it's best that you enjoy SAFE gay sex!

Your friends are definitely right that you need to get tested and you could have chlamydia; but you could also have something else, like gonorrhea. Let's start by clarifying that: CHLAMYDIA is NOT just a girl's problem, and I'll write a bit more about that. Call your nearest STD Clinic and set up an appointment ASAP.

What is chlamydia?
Chlamydia is a sexually transmitted disease (STD) caused by a bacteria called Chlamydia trachomatis. It can spread from person to person during sexual intercourse when a person's mucous membranes come into contact with an infected person. It can be transmitted without complete insertion of a penis into the anus. It is less likely, although possible, to be transmitted to the throat during oral sex.

Should you worry about chlamydia?
If left untreated, infections can lead to prostatitis (inflammation of the prostate gland), urethral scarring, infertility, or epididymitis (inflammation of the epididymis, a structure on each testis). Chlamydia makes it easier for an HIV negative person to acquire HIV if your partner is carrying the virus, and rectal chlamydia may increase chances of getting HIV ten to twenty-fold. If you already have HIV and have chlamydia, you could be 8-10 times more likely to shed HIV in your semen and increase your risk of infecting others with HIV.

What does chlamydia look like?
Symptoms of chlamydia usually appear from 1-3 weeks after infection, but then usually go away, even if left untreated. Many people infected with chlamydia never have any symptoms at all. Men may experience discharge from the head of the penis or the anus; pain or itching at the head of the penis; and/or pain with urination. 50% of infected men have no symptoms. Sometimes chlamydia is like gonorrhea (GC), another bacterial infection, which also causes discharge from the penis and pain or burning on urination. These infections can be distinguished by culturing the discharge. GC also makes it easier to acquire and transmit HIV.

Now what?
Get tested right away. If you are infected, chlamydia is cured with antibiotics. Your partner(s) should be tested as well. Continue to get tested every 3 months for HIV & STD. Start this regimen and use condoms with all partners. There are plenty of options to choose from.

For more information, call the HIV/STD Hotline at 206-205-7837 or Toll-free: 800-678-1595
--Dr. Dick

WTF? Is it herpes on my back?

Dear Dr. Dick,
I've got some kinda rash thing on my back way above my asshole. It looks like when I got herpes, but it's on my back. What the fuck?
--WTF

Dear WTF,
It's hard to tell from that little bit of information what the rash might be, but herpes (whether it's Herpes Simplex or Herpes Zoster) usually starts with a tingling or burning or even aching in the area involved.

Then almost simultaneously small blisters (fluid-filled) form that are hypersensitive, that usually break, leaving ulcers that may weep a few days then scab over.

It's possible that herpes simplex could occur there, but unusual. Herpes simplex usually involves a mucosal surface (like the penis, testicles--balls, or around the anus or mouth).

Herpes zoster is more likely up on the back, and is a re-occurrence of chicken pox--which is the same virus only localized, and is usually in a band-like distribution. Zoster is often more painful and more prolonged.

But there are a myriad of other rashes which might be what's going on...so be advised to see a dermatologist or a good doctor for starters!

And DON'T SCRATCH!

--Dr. Dick

DO COLDSORES TURN INTO GENITAL HERPES?

Dear Dr. Dick,
Every winter, I find myself irritated with a cold sore. And every winter, when it gets cold, I find myself cuddling up with someone...and getting really warm, and eventually hot under the sheets. If I have a cold sore, will it turn to genital herpes? I want to be safe and not give an STD to my partners.
--Cold & Cuddly Cub

Dear CCC,
That's really great to hear that you are concerned with your partners as much as you are with your sexual health! It's definitely a good way to enjoy the holidays.

Let's start with the basics and make sure we are on the same page with cold sores.

Cold sores (aka fever blisters) are small red blisters that usually appear on the lips and outer edges of the mouth. They often weep a clear liquid and form scabs after a few days.

Cold sores are usually caused by the herpes-1 virus (not
the herpes-2 virus, which causes genital herpes, an STD). Herpes-1 virus can lay dormant in the body and becomes active later when something triggers it.

There is no cure for cold sores, but there are remedies you can use that will reduce the severity and frequency of them. Cold sores may appear after colds, fevers, exposure to the sun, stress, during or for no apparent reason. Generally it is felt that anything that compromises the immune system may trigger the cold sores, such as infection, cancer or any illness.

If you have a cold sore already, pop the sore so it will drain and be able to dry out and heal faster.

Before-Care

  • Prevention of cold sores is advisable. Herpes simplex is highly contagious!
  • Avoid kissing someone with cold sores or having sex with someone who has genital
  • herpes. Exposure to sun triggers sores. Use a sunscreen of at least 15 SPF on your lips and other susceptible areas.
  • If stress triggers them, practice relaxation techniques.
  • Don't use the same towels, razors or utensils as someone with cold sores.
After-Remedies
  • Vitamin C: Take 200-500 mg. of vitamin C three times a day. This greatly reduces the duration of the sores.
  • Vitamin E: Applied topically, will provide pain relief.
  • Yogurt: Eating plain yogurt (with acidophilus) is a good preventive measure. Yogurt seems to stimulate the immune system.

Both herpes-1 and herpes-2 can cause cold sores and genital herpes, but cold sores are usually caused by HSV-1 and genital herpes usually by HSV-2.

However, it does compromise anyone with a cold sore for exposure to genital herpes, especially with oral sex or any type of skin contact. Condoms and dental dams maybe used, but can not guarantee protection.

If you believe you have been exposed to HSV-2 (Herpes-2), get tested! Call 205.STD (7837) or the Link Study, a research herpes trial at the UW (206) 251-5821.
--Dr. Dick

BUMPS ON MY BUTT?

Dear Dr. Dick,
I've been in a semi-monogamous relationship. My boyfriend and I have been playing with a third guy for the past year. It's been a different guy several times. We try to play safe, wear condoms, but sometimes we slip. We get tested every 6 months for HIV & STD's. But I've noticed these bumps on my butt. I think they're just skin tags. My boyfriend says they're nothing and to not worry and be so paranoid. Well, I am worried and paranoid! What am I to do?
--Nervous As Hell

Dear NAH,
It sounds like there are few things going on with you, your boyfriend and your sexual life. I'm not a therapist, but COMMUNICATION IS KEY. Always keep an open communication with your partners. So everyone knows what's going on, sexually and otherwise, especially with PLAYING SAFE.

In a better world, it would be nice to have a consistent third sex partner, who is both HIV/STD Negative and has SAFE SEX with you and your partner.

  • So, ALWAYS USE PROTECTION: Oral Sex, Vaginal Sex & Anal Sex.
  • If there's unprotected anal sex, you and your partner(s) should get tested more frequently. Every 3 months would be best.
  • Try to go to the same place, especially if they are COOL with your sexual history & lifestyle.

Now to the BUMPS on your BUTT. It's not possible to tell just from what you describe. They could be skin tags, fissures or just plain unusual folds. BUT (pun intended), they could also be anal warts. The BEST way is to see a doctor, a provider at the local STD clinic or a specialist like a proctologist, who can BEST ASSess your symptoms. At the very least, get tested for STDs.

Warts, caused by Human Papilloma Virus (HPV) can sometimes creep behind you without warning and could be what you're noticing! Sometimes, you may have been infected a while, but symptoms might not show up until weeks or even months afterwards. And warts are easily transmissible through genital contact, especially without condom protection.

Other than feeling these around your butt, generally warts are painless. Guys (& girls) often ignore symptoms without annoying pain or overt physical signs.

Typical signs are wart-like growths in the butthole, and sometimes inside the anus. They appear white at the tips or flesh colored, raised or flat. If in bundles, they appear cauliflower-like. They may bleed with irritation with bowel movement or just wiping yourself. Don't wait for bleeding! As soon as physical signs show, SEE a DOCTOR! Only a doctor can diagnose you, and of course it's hard to see your own butt.

Treatment can be as easy as cryo-laser (freezing with laser), surgically removing the warts or using anti-viral ointment treatment. There is no treatment to remove the virus in your system. Once you're infected, you're infected for life. But symptoms can be managed. So, try always to condoms consistently and correctly, communicate clearly, and play safe.

To manage your worry & paranoia, see a doctor!
--Dr. Dick

Genital Herpes and HIV

Dear Dr. Dick,
What's the deal with genital herpes and HIV? I had a herpes outbreak. Does this mean I'll get HIV next?
-Confused & Curious Chris

Dear CCC,
Not necessarily. Although studies show that if you have genital herpes, you could be 2X more likely to catch HIV (Especially when you have herpes sores). BUT, it doesn't have to be. And if you are HIV positive and have genital herpes you are more likely to pass on HIV to your partners.

First of all, WHAT is GENITAL HERPES?
Genital herpes is a very common sexually transmitted disease (STD) practically always caused by HSV-2 (herpes simplex virus-2). Although 25% of adults in the US have genital herpes, the rates are HIGHER among gay men. And 80% don't know they have it. But oral herpes (HSV-1), which commonly just causes cold sores on the lips or mouth can also be on the genitals. Blisters and sores on the penis, vagina, anus, buttocks and elsewhere are common signs. Itching, burning, pain and discomfort are likely to happen.

HOW does it get passed around?
Herpes 2 can easily be passed through skin-to-skin contact. So, you don't need to have sex to get this! But it is most often passed through unprotected oral (blowjob), vaginal and anal sex.

NOW WHAT?
Don't panic!
Get tested for sexually transmitted diseases regularly and make sure you are getting the blood test for herpes. Every 3-6 months is very good, especially if you are sexually active. Know your status! You can find out at NEON's Rest Stop, where anonymous and confidential testing is always available and FREE! Every Wednesday at 6pm to 8pm.

  • If you test positive, a good place to explore treatment options is the STD Clinic @ 731.3590 for treatment options OR the Link Study @ 520.3800 where you can get expert advice and great benefits like FREE herpes treatment for a year and get paid for it!
  • Minimize spreading it to your sexual partners, by properly and consistently using CONDOMS for oral, vaginal and anal sex, if abstinence is not a realistic option.
  • Try to avoid sex when sores and blisters are obvious and visible. HIV is more easily transmitted when sores are present!
  • It's not the end of the world, don't delay getting checked regularly. It's good to know.

Simply,
Dr. Dick

Factoids:
1. Genital herpes is treatable, but not curable (just like HIV).
2. Herpes makes HIV so much easier to catch and to spread.
3. With or without symptoms, people can pass viruses around.

1 out of 4 has genital herpes.

Whoa, Nelly! Gonorrhea has gone haywire!

Dear Dr. Dick:
What's up with all this talk about gonorrhea lately? I hear there's a lot of it going around. Is that true? What does it look like and how do I know if I have it?
Nervous Nelly

In 2001 there were 166 cases among Seattle gay/bi men. In 2002 there were 289! That's an increase of 74% in one year! Yikes!

So what's going on here? Well, lots of anal sex without condoms mostly. It doesn't take a rocket scientist or a brilliant handsome doctor like myself to figure that one out. Some guys are fucking like bunnies and not wrapping their carrots! And it only takes one bad carrot to turn the whole bunch bad!

It's easy to have gonorrhea and not know it. If gonorrhea is up your butt (which is very common in guys who butt fuck without condoms) it may be painless. Or the discharge may be hard to notice. It it's in your throat, you may have redness or pain when you swallow. So you might think you just have a sore throat or strep. And about 10% of guys never even develop symptoms- anywhere! See how easy it can be to spread gonorrhea?

What is gonorrhea? It's a bacteria that can infect your mouth, throat, urethra (pee tube) and butt. Symptoms appear 2-10 days after infection:

  • Burning when you pee
  • Green/yellow discharge from your dick or ass. Pre-cum looks clear. Gonorrhea doesn't.
  • Blood or mucus in your feces
  • Painful bowel movements or rectal pain

Having gonorrhea also makes it easier to get and give HIV. So for these reasons, every gay/bi man who has unprotected sex should get a STD test every 3-6 months. Make it a regular part of your health routine.

Gonorrhea is easy to treat. A simple swab or urine test, a single dose of antibiotics and you're done. You can go to your regular doctor or to the STD clinic. Once you've been treated, you should stay away from sex for at least a week and tell your recent sex partners to get checked too. So, fuck bunnies, please use those condoms! And if you haven't been to the STD clinic in a while-- best to hop on down and get checked out.

Until next time, Dick

What you can't see: Dr. Dick on symptomless STDs

Dear Dr. Dick,
Before sex I always check out a guy's dick for any sores, bumps, or rashes. If I don't see anything weird, I assume he's OK. But in your last article, you said you can still get an STD from a guy even if he doesn't have any symptoms. How does this happen? Do I need a magnifying glass to tell if a guy is really safe?
Signed, Sherlock

Dear Sherlock,
While I applaud your commitment to safer sex play, holding a magnifying glass up to a guy's penis might be misinterpreted, if you know what I mean. But the answer is yes, it is possible to get an STD -and infect others - even when you don't see any symptoms. This is true for HIV too.

STDs are caused by bacteria and viruses that get inside your body through sexual contact. Those lovely sores, bumps, oozes, and rashes you see are just outside signs of the infection inside your body. With many STDS, outside symptoms are often not present and can change over time. However, the bacteria or virus is still living on the surfaces of genital skin or mouth and throat tissue. Or in the fluids there too. This is their launch pad for infection!

Gonorrhea and herpes can be tricky like that. For example, many guys with gonorrhea never get the pus-like discharge. Herpes lesions can come and go, but most infection occurs before or after an outbreak. You might even have an STD right now and not even know it!

That's why all sexually active gay/bi men should get tested for STDs every 3-6 months! Routine STD check-ups are important if you're a bottom, have lots of sex partners, are HIV-positive, or if you've had an STD in the past. STDs don't go away on their own. Tests and treatments are easy and low-cost (often free) at Harborview's STD Clinic.

Until next time!!
Dick

Careful out there - a lot of symptoms hide in places you can't see! Like in the back of the mouth or throat and inside the anal cavity. There may be something lurking inside so put away that miner's hat and put on a condom!!

Dr. Dick on Syphillis: How can I avoid getting it again?

Holy syphilis Dick Doc,
Sure I like to have fun with the boys - but getting syphilis twice in one year is too much! Damnit, how come other guys can't figure out they've got syphilis? I noticed a sore just inside my tunnel-o-love, so I went straight to my doc. Believe me, it wasn't fun... I couldn't have sex for weeks. It's seems that every time I go to the baths or hook up with a guy off the Internet, I've got to get a dose of penicillin. Is there any way to make sure that I don't get it again? Twice bitten, thrice shy.

Dear Twice Bitten,
Two times in one year... I can see how you might be a bit upset. It may not make you feel any better but you're not the only one to be so unlucky. As you've discovered, syphilis has been making a come back among gay and bisexual men. In 1996, there were no cases of "locally acquired" syphilis in King County. But in 1997, this changed and for the last couple years, we've seen over 60 cases of syphilis each year. The majority of these cases have been among gay and bisexual men. Of these, 70% also have HIV. This worries me. Syphilis, like most other STDs, makes it easier for HIV to spread. Unlike syphilis, HIV can't be cured with a shot of penicillin.

Rates of syphilis among gay and bisexual men have been increasing in major cities of the United States, Canada, Europe, and even Australia. And since syphilis hasn't been around for a while, it's no surprise that many gay and bisexual men lack basic knowledge about this STD. To make matters worse, the symptoms of syphilis often go unnoticed or show up in places on your body that are difficult to see... unless you're a contortionist.

Most cases of syphilis in Seattle have been linked with places guys use when they want to find a partner for a quick hook up. So if you go to Seattle's baths, sex clubs, parks, or hook up over the Internet, you greatly increase your chances of meeting a guy who has syphilis. This appears to be what happened to you, Twice Bitten.

You can always talk with your sex partners before you have sex with them about STDs. You might still get an STD but at least you'll be more informed about the risk you are taking. Using condoms for anal sex - and oral sex - will reduce your risk as well. Avoiding bath house sex is another option.

I've pulled together a Little Quiz and some info that I hope may help inform others. And, if you think that you might have syphilis, please go to your doctor or an STD clinic for a sex check-up. If you have any questions, call the HIV/STD Information Hotline (206) 205 7837 or check out www.crystalneon.org or http://www.metrokc.gov/health/apu.

Wishing you good sex and good health,
Dr. Dick

How is syphilis spread?

  • Direct contact with a syphilis sore on the genitals, penis, vagina, anus, or in the rectum.
  • Direct contact with infected blood-- such as sharing used syringes.
  • Transmission can occur during vaginal, anal, or oral sex.
How is syphilis diagnosed?
  • Dark field microscopy can be used to examine material from infectious sores.
  • An accurate, safe and inexpensive blood test.
Is there a cure for syphilis?
  • Yes! A single high dose of injectable penicillin will cure most cases.
  • Taking leftover antibiotics won't cure syphilis.
Will syphilis recur?
  • Having had syphilis does not protect you from getting it again.
  • Follow-up syphilis testing is recommended.
How can I reduce my risk of getting syphilis?
  • Talk with partners about HIV and STDs before you have sex.
  • Using condoms for fucking and sucking.
  • Get tested for STDs every 3 to 6 months.

Nervous Nelly: Getting an STD screening

Dear Dr. Dick
I have some weird bumps on my dick that aren't going away, but I'm a little nervous about getting tested. I've heard all kinds of horror stories about what they do to you -- do they really stick a big Q-tip up your dick? Aren't these STD tests painful? What am I getting myself into?
Nervous Nelly

Dear Nervous,
Everyone has heard horror stories about STD testing -- of giant Q-tips that doctors and nurses wield with glee in their eyes. However, over my last 12 years as Dr. Dick, the STD Sexpert, huge strides have been made in patient comfort.

The most-asked question concerns the fearsome "swab."

First, it is not the size of a Q-tip!
It is actually very small (about the size of a kite string -- 1/16th of an inch), and only needs to be inserted about 1/8 of an inch into the urethra (pee hole). If you still have a phobia of anything that's not human going near your penis, then you can do another type of test that is done on a urine (piss) sample. You will need to ask for it though. It is a little more expensive to run, and so not offered as the standard form of penile STD screening.

While penile swabbing can be avoided, this is not true for the throat and butt.
While many people have symptoms like burning or discharge, many folks will not have symptoms or have very mild symptoms that they don't really notice (a herpes outbreak can some times feel like a pulled or ingrown hair). So, if you have oral sex and/or anal sex you should get your throat and butt swabbed.

Also, you should think about whether you want to get tested for HIV. Swabbing works for gonorrhea and chlamydia.

But the presence of herpes, syphilis, hepatitis A, B, and C, and HIV are all blood-based. However, only about 2 teaspoons of blood are needed.

If you are concerned about the clinician finding a vein, you can ask if they would be willing to let you help them. You can also go to a clinic that has a staff of more experienced clinicians like Spring Street Clinic on Capitol Hill. Also, your clinician should conduct a visual exam looking for rashes, sores, warts, or any other unusual symptoms that may lurk in hard to see places. A good clinician will be friendly and respectful, and respond to your needs.

You can just walk in between the hours of 7:30 am to 4:30pm, or call for an appointment at 731-3590.

Safely yours,
Dr.Dick

P.S. You should get vaccinated for Hepatitis A and B if you haven't had them. Why not make a day of it and get this done too!

Acted Rash-ly: STDs can increase your chances of "passing on" or "getting" HIV

Dear Dr. Dick,
I've been HIV positive for 8 years. My T-cells are in the toilet because I can't seem to tolerate the "miracle" drugs that everybody is celebrating. A couple months ago, I let another HIV positive guy ride me bareback. It was hot sex but I got a raging case of syphilis. I didn't even know it. I went to see my doctor after I got this rash on my hands and the bottom of my feet. He thought it was a reaction to one of my meds, so he switched me to something new, but the rash didn't go away. Finally, he tested me for syphilis and discovered I had it. And here's the kicker -- I was already in the second stage! I hate to think I could have passed this on to somebody else. My doc gave me a shot of antibiotics and now I'm OK. But the whole thing gave me quite a scare. Just a warning to others: Watch out! "The truth" ain't all that's "out there." Sign me...
Acted Rash-ly


Dear Acted Rash-ly,
Thanks for the letter. Your case is a good warning for a lot of us -- docs and patients.

For sexually active gay and bisexual men in Seattle, regular and thorough STD checkups are the order of the day. Syphilis cases are skyrocketing among local gay men. And sometimes docs miss the symptoms, especially if you have other health concerns. Syphilis was eliminated in King County in 1995 and 1996. But now it's back with a vengeance. And gay men are at highest risk, especially gay men who have HIV. Syphilis and other STDs appear to progress faster in men who have HIV. Also, STDs, including syphilis, make it easier to get and to spread HIV. As you found out there are many links between HIV and other STD infections. Here's some important info:

Having another STD increases your risk of getting or transmitting HIV.
Why? Because some STDs cause breaks in the skin or mucosal linings of the anus, mouth and vagina. STDs can infect the genitals and anus but they don't always show symptoms. Whether you see them or not, STD infections cause millions of white blood cells to gather around infected areas. These white blood cells are the body's first line of defense. They fight off invading bacteria and viruses. Sadly, white blood cells are also HIV's favorite target for infection. When HIV comes into contact with a syphilis sore or drippy discharge caused by chlamydia or gonorrhea, it's as if the body is rolling out a red carpet welcome. In short, we can say that pus (a visible collection of white blood cells) is a welcome wagon for HIV.


Here's an example. Say you don't have HIV, but you do have an active case of syphilis, chlamydia or gonorrhea. If you have unprotected sex with someone who is HIV positive, your chances of getting HIV can increase by as much as 400 percent. On the other hand, if you already have HIV and get another STD infection of top of it, the level of HIV virus in your semen or blood stream can go up to 10 times higher. This will make it much easier to infect your sex partners with HIV.


The higher the level of HIV in your body, the harder it is on your immune system. And if you have higher amounts of HIV in your genital tract, it is easier to give it to a sex partner. HIV positive people with seriously weak ened immune systems tend to have more frequent and serious STD-related symptoms. This is es ly true in late stages of HIV infection. For example, people with both HIV and herpes will often report more frequent and severe herpes out breaks.

Here are some tips that will keep you healthier:

  • Learn to know STD signs and symptoms. Pick up pamphlets from the STD Clinic or from NEON peer educators.
  • Reduce the number of new sexual partners and avoid sex with partners you do not know well. Many studies have shown that "anon" partners are especially risky.
  • Use condoms consistently and correctly with all new sex partners
  • If you are very sexually active, get a free check up at the Harberview STD Clinic. You can also get tested at Seattle Gay Clinic. Get a regular check up even if you don't have symptoms.
  • For women, douching (either vaginal or anal) may increase the risk of STDs. Douching is not an effective treatment for any STD infection.
Thanks for writing. Your letter is a good warning to all of us. Remember, most STDs are easy to treat. But they can have severe health consequences if they go unchecked.

Syph-less in Seattle: Many guys with syphilis don't know they have it.

Dear Dr. Dick
A friend of mine is getting treated for syphilis. He didn't know he had it until some guy started to go down on him at the baths. The guy jerked back and bolted for the door when he saw an oozy red-hot crater on my friend's dick. (He showed it to me and I don't see how he could have missed it. It was so red it looked like a stoplight). I say the idiot didn't feel it cause he was using too much speed. He says he didn't notice it because syph sores don't cause pain. Who's right? Also can you get syphilis in your mouth or butt? What's the deal?
PS. Who's the famous person that went crazy from syphilis? I can't remember. Do you know? I figure since my friend is already loony at least he'll have some company.
Syph-less in Seattle

Dear Syph-less,
Hope you didn't bet your shoes because you'd be dancing barefoot in Volunteer Park. He's right. His sore was painless because syphilis kills the nerve endings in the infected area. This is a true case of where no pain really means no gain.

Syphilis is caused by a corkscrew-shaped germ that drills its way into mucous mem brane tissue. This is the soft, thin skin on penises, in vaginas, butt-holes and in our mouths. Once you catch syphilis, it can take from 10 days to 3 months before you see the first sign. Some times, you won't see anything at all. If it is not treated syphilis can go on into three stages.

In the first stage a single, painless sore or ulcer grows wherever the bacteria first drilled into you. If you're a bottom this sore is going to grow in your butt. If you give head it will grow in your mouth. Since it doesn't hurt, you may not even know it's there. All you have to do to spread syphilis is bring the right type of mucous membrane into contact with this sore which teems with these bugs. No body fluids required - just tag, you're it. This sore can last for several weeks and then will just go away on its own. But the bugs are still in you.

After that you may not see anything else for a couple of weeks to a couple of months. Then, in the second stage, you may notice a rash on your face, chest, back, the palms of your hands or the bottoms of your feet. It can be very faint and it won't itch. You might also get fevers, what look like large warts in your genital area, white patches in your mouth or you may just feel tired all the time. If these symptoms show up some place that's moist (where the corkscrew germs can swim around), all you have to do to spread it is expose a partner's soft mucous membrane tissue. Sometimes the rash is so faint that people don't notice it or they think it's something else--like an allergy. All of these symptoms will go away by themselves within a month and a half. But again, the bugs are still there.

After this, you can enter the third stage. Syphilis can lie around in your body for years before it does anything else. If you carry it long enough, it can cause sores in your brain or eat away at other internal organs. Untreated, it can lead to insanity, a ruptured aorta (the main blood vessel from your heart) or death. (Remember Al Capone?) The other worry with syphilis is that all those open sores make it easier to catch HIV.


Now, here's the good news. Syphilis is easy to detect and very curable.
Recently there have been several cases of infectious syphilis among gay or bisexual men in King County. Most of these men report anonymous park or bathhouse sex.

So . . . if you or your partner have indulged, this is a very good time to visit your local STD clinic or doctor for a checkup. (Look for the free coupon in AmphetaZINE). If a partner or public health person tells you that you've been exposed to syphilis, see your doctor immediately. If the medicine is given before the first sore appears you won't get any symptoms at all.

As for famous people who have had syphilis, the list is long.

Here's a short sample: Henry VIII, Paul Gaugin, Friedrich Nietzsche, Ivan the Terrible, Ramses V, Peter the Great, Pope Leo X, Benito Mussolini, and the more than 400 Black Alabama sharecroppers who were not treated in the infamous Tuskegee experiment.
Dr. Dick

Itching to have sex again: How to get rid of crabs (pubic lice)

Dear Dr. Dick,
Help! I'm at my wit's end, and so I'm calling in a professional (that's you, doc). My problem is crabs. About six weeks ago I tricked with this really hot guy. He fucked me for 4 hours (using condoms and plenty of lube, you'll be happy to know), and left me his phone number so we could get together again.

Unfortunately, he also left me with a bad case of crab lice. Needless to say, I haven't used the phone number. But I didn't let it get me down. After all, crabs are easy to get rid of, right? "So no problem," I thought, "I'll just hop on down to the pharmacy and pick up some Rid."

Well, to make a long story short, I used the Rid 4 times, but those pesky crabs JUST KEEP COMING BACK! I've showered and scrubbed so many times, I'm afraid of rubbing my skin raw. It's driving me crazy! I can't have sex without passing them on. I can't seem to get rid of them. Not to mention the itching!! Please help me, doc. Do I have some sort of super mutant crabs, or am I doing something wrong? Sign me...
Itching to have sex again


Dear Itching,
Good news. Pediculis Pubis, also known as "crabs," haven't mutated into drug resistant super-crabs. It's more likely that you're missing a few of the little buggers, and all it takes is one fertile female, (and they are fertile practically from birth), and you are re-infected.


As you found out or knew, they prefer pubic hair, but as they multiply, they will spread to any hairy area. The upper legs, butt cheeks, and navel are favorite places. So make sure that you treat all hairy or fuzzy areas.

But killing the crabs on your body is only the first step. You also have to kill the ones that may have dropped off onto bedding, furniture, rugs and other surfaces. The beast can live up to 48 hours away from the host (that's you).

To take care of that, just regular washing of bedding in hot water and soap will suffice. On chairs, couches and mattresses, use a vacuum to go around all seams and buttons. It wouldn't hurt to spray a household cleaner (Formula 409, Pine Sol, etc.) before vacuuming. It will make you feel better and will smell good and clean.

If you've done all of this and you're still finding LIVE crabs, bring yourself and any intimate friends to your local STD clinic. We will help you get rid of the critters once and for all.

Have a Happy and itch-free Valentines Day...
Dr. Dick

Butt Licker: Health hazards from rimming (licking butt)

Hey Doc,

 

I'm a dedicated ass-licker who just got over a hellish case of hepatitis A. I suspect the hep germ came from my favorite pastime--not bad salad dressing. After two weeks of pure misery, I want to make sure this never happens to me again. I'm not going to quit rimming so what can I do? Also, could I get anal warts on my tongue? For that matter, anything else a devoted rimmer needs to know?

 

Butt-Licker

 

Dear Butt-Licker,

 

As you now know, no matter how lovely and mouth-watering the butt in question, it crawls with germs - thousands or millions of them. Most of these germs help balance the gut-to-butt environment. They keep it from dripping, stinking, or hurting. However, some germs, such as E-coli, salmonella, shigella, amoeba, giardia, and cryptosporidiosis (just to name a few), can make you very sick when they get into your body. As you found out, viruses such as hepatitis A are also spread through rimming. However, now that you've gotten that particular bug you should be protected against more hepatitis A in the future.

 

One of the best ways to protect yourself when rimming is to use a dam (also called a "dental dam"). You get full visuals and heat while he (or she?) gets the full feel of your big hot tongue. A dam is a thin, smooth, and flexible sheet of latex or polyurethane. You can get them flavored or unflavored, colored or clear. Some guys however just prefer to use good old household saran wrap (plastic wrap)--just make sure it's not the microwaveable or colored variety (these have tiny pores in them). A double layer adds extra protection... just to make sure you don't tear through it. Squirting a dab of water-based or silicone-based lube on the butt-side will help it stay in place. You can also "pin" it in place with some deep tongue penetration.

 

Genital warts (from butts, dicks or pussies) can be found in or around the mouth, on tongues, lips, gums, etc. But they are not common unless you have HIV infection. And even with HIV, they are pretty rare. In my 10 years of working with STD's, I have only seen "oral warts" in about five people. Each of these folks was also dealing with HIV. It appears that a weak immune system can allow genital warts to grow in places like the mouth. As always, people with HIV or other immune system problems need to be especially careful.

 

Dr. Dick

 

Info from Dr. Dick about Chlamydia

Dear readers,

We got a lot of calls last month from guys worried about chlamydia. We sent your questions to the good doctor for his sage advice. Here's what he had to say:
 

What is chlamydia?

Chlamydia (clah MID ee uh) is a bacteria that can be passed through oral, anal, or vaginal sex.  It grows really well in the cock, the butt hole and the pussy; and also infects the cervix (in female-bodied folks), and the throat.

Chlamydia often has NO SYMPTOMS. You can have chlamydia for a long time and not have a clue. Chlamydia is easy to cure with antibiotics, and the sooner it gets treated, the better. Serious health problems can develop if you don't get treated (more info under the symptoms section). The only way to know if you're infected with the bacteria is to have a culture or urine test done by a medical provider.  

Can I get chlamydia from giving or getting a blowjob?

Yes. A lot of people think that getting or giving head is totally safe. The risk of getting chlamydia through oral sex is lower, but it's still a risk! Use condoms to provide a barrier against contact with your partner's genitals and fluids. Use some tasty, flavored lube to make things more interesting. There are also flavored condoms specially made for oral sex.

If you're partner has chlamydia and you're giving them head without using a barrier like a condom, you can get infected even if they don't cum. The bacteria likes to live in warm, wet places like the urethra (where you pee from), and it's easier to come into contact with it if you don't use a barrier. 

 

If I get symptoms, what should I look for?

?        itching inside the penis

?        discharge from the penis

?        pain or burning when you pee

?        pain or swelling in the testicle(s)

If your butt gets infected with chlamydia, you may or may not have symptoms---but if you do, they might be itching or pain.  

If you get infected with chlamydia and don't get treatment, the infection can spread in the body. In men, this can mean epididymitis, which is inflammation of the epididymis (part of your testicle). This condition leads to testicular pain and swelling.


what if I'm HIV positive?

If you're HIV-positive, it's easier for you to get or spread chlamydia or other STIs. That's why testing is so important---because if you test positive for chlamydia, you can get treated and cured right away.

 

REMEMBER THESE TIPS:

?        Get regular STI check-ups

?        Talk about your HIV and STI status with partners. Then, you can frame a conversation around sexual safety.

?        Talk about what you and your partner(s) will do to keep each other safer--do you plan to use condoms or dams? Get tested together every couple of months?   

?        Use condoms, gloves, insertive condoms, and dams

 

For more info on where to get tested in King County, visit: King County Testing Sites
For more info on chlamydia and other STIs, visit: Chlamydia Facts or CDC Chlamydia Facts

 

Yours truly,

Dr. Dick


Edited and reposted 3/29/13


Desperate: Urethra discharge. Which sexually transmitted diseases could it be?

Dear Dr. Dick,
Help! I'm in trouble and I don't know what kind of trouble it is. I've been having some pain and bleeding in my ass. A couple of times I've even shit out some yellowish stuff that looks like pus! I'm usually a top but have been fucked a few times lately--but not hard enough to still be hurting! I'm scared to go to the doctor because it seems serious and I have enough stress in my life. What is it?? What can I do?? I want my old happy butt back!
Desperate

Dear Desperate:
OUCH!! Sorry about "old happy butt." I hope that your obvious sense of humor about this situation means that you aren't feeling as desperate as you claim.

So, what is it or what can you do? Well, from the symptoms you describe, I can't tell you exactly what's going on. However, I can suggest some possibilities.

The first thing that comes to mind is a new type of gonorrhea that is making the rounds in Seattle. Unfortunately, this new strain thrives in butts. So far it occurs mostly among gay and bisexual men who have recently had the good luck of getting butt-funked and the bad luck of getting an ass infection. Now, most gonorrhea does not like to live in rectal neighborhoods. (I used to live in a neighborhood described as an "armpit.") Anyway, this new form of gonorrhea not only likes buttholes, it thinks they're a great place to breed large families. The good news--this kind of gonorrhea is easily treated. It causes no long term problems if it is treated soon.

On the other hand, your butt misery might be caused by other viruses or bacteria. Germs like chlamydia (clah-MID-ee-ah), herpes (HER-peez) or syphillis (SIFF-lis). Or it might be some other kind of run-of-the-mill butt bacteria that grows out of control and causes rectal swelling known as proctitis (prock-TIE-tus). Herpes is the only one of these diseases that is not curable.

Yes, dear Desperate, I do understand about STRESS--especially stress about going to clinics and seeing doctors. When I feel something going on with my body, my first thought is, "Maybe the problem will take care of itself." But most of the time it's still there--nag, nag, nag. Then it gets worse--more pain. then it becomes more stressful. So for peace of mind, go have your less-than-happy butt checked out. Even if your symptoms seem to have gone away, your butt can still have some bad bacteria living there. Besides, if you think the problem is stressful now, think about the idea of adding panty-liners to your wardrobe. Butt infections are nothing to play around with.

I wouldn't be doing my job if I don't ask an obvious question: Where do condoms fit into your butt-play? Was your fuck buddy wearing one that broke? Was he wearing one at all? Remember, even if you are HIV+, it is not good to get new infections. If you are HIV-, a bad butt infection allows HIV even more chances to get into your bloodstream. If you're bored with the rubber selection, check out the great new flavored TRUSTEX (see page __) or the Reality Condom (the one that you stick up your butt--it's fabulous). These new condoms are available at the Capitol Hill and Stonewall needle exchanges and at NEON's Thursday night harm reduction meetings.

BEST PLACES TO GET CHECKED: The STD Clinic at Broadway and Madison (720-4333) or the STD Clinic at Harborview Hospital (731-3590). Take an AmphetaZINE coupon with you and get everything free. Another place to get excellent STD care is the Country Doctor Clinic on 19th and Republican (461-4503).

Marathon Man: Anal Warts (HPV), an unrecognized epidemic among gay and bisexual men

Dear Dr. Dick --
A man that I fuck (and get fucked by) for hours at a time just told me that he has genital warts in his butt. I didn't know you could get them there, and I'm not sure what the problem is if you do. What's up with warts?
Marathon Man

Dear Man,
This is such an important issue. I'm glad you asked about it. Again I was forced to go to the experts to get the best information on what are sometimes called "the other speed bumps."

Here are some of the main points:

You don't have to have anal sex to get anal warts, also known as HPV (Human PapillomaVirus).

The warts can be on your dick, butt, balls, upper thighs or on your lips and mouth.

HIV+ people are more likely to get pre-cancerous or cancerous skin changes or growths on their anus.

Once you are infected with warts you will have the virus in your system for the rest of your life. The warts, however, can and should be removed as soon as you see them.

The signs you should look for if you are afraid you have warts are:

  • Bleeding and itching from your anus.
  • Anything that is on your genitals that is new, like bumps or skin that looks "funny."
  • As one local youth put it, "It's like when you look down at your dick and it looks like you dropped some rice krispies on it and they got stuck."
  • Unfortunately, many people have warts and don't know it. Sometimes they are hard to see, especially if they are inside the body.

To best protect yourself from warts and the threat of cancer, the experts recommend:

  • All men who have signs of anal or genital warts or have had unprotected anal sex should get what is called an anoscopy. An anoscopy is when you have a device put up your butt to look for anything that may be unhealthy. The device used is called an anoscope. The best way to look at Uranus is with a telescope, but the best way to look at your anus is with an anoscope.
  • All HIV+ gay or bisexual men should get an anoscopy once a year or when they have symptoms.

REMEMBER: You won't always have warts that you can see, but you still can be infected and infectious. Condoms will protect you on the parts of the body that they cover, but that does not include everything. Doctors won't always volunteer to do the anoscope thing -- some Doctors are buttphobic. You must be a good consumer and ask for an anoscopy. And as the old story goes, the Doctor may feel more appreciated while doing the anoscopy if you have a bouquet of flowers and a nice note waiting up there for her/him. If you are HIV-, the best place to get treated is the Broadway Clinic at 720-4333. If you are HIV+ and have questions, please call the AIDS Prevention Project wart study at 205-6247.

Jerkoff: What every gay man should know about herpes

Dear Dr. Dick,
I get speed bumps from shooting meth. I was masturbating to videos the other night and I wondered, can the herpes from my dick get into my speed bumps?
Jerkoff

Dear Jerkoff,
Good question. Let me guess: you played with your dick, picked at your bumps, played with your dick, picked at your bumps.

You can relax. Yes, a person can infect other parts of their body besides their dick, BUT it is not likely if you have had herpes for a long time. The longer a person has herpes the harder it is to pass to other parts of their body. This was a big question for many years -- does herpes spread from one part of your body to another because you might have a cut, scrape or some other opening in your skin? Or, does it spread because some types of skin are easier to infect than others? Research tells us it is mainly the type of skin. For example, the skin around your crotch, mouth and eyes is easier to infect with herpes than the skin you have on your hands or arms. This is assuming that your immune system is strong. If your immune system is not strong the risk goes up.

Also, if you do have a herpes outbreak on your arm it is not likely to happen more than once. Genital and oral outbreaks are more likely to happen again. Remember that friction can cause an increase in herpes outbreaks, so use LOTS of lube when you jerk off.

How will crystal meth affect my herpes? Will I have more outbreaks?

Great question -- so great that even the very smart Dr. dick had no answer. I had to call two herpes experts. They also really liked this question. To my dismay, they told me that there are no specific studies about crystal meth and its effects on herpes. Bummer, but not too surprising. So, to address your question, we do the next best thing. In this case, like Dr. Doolittle, we "talk to the animals" -- mice and guinea pigs in par-ticular. There have been a couple of studies where mice and guinea pigs infected with herpes were given epinephrine (EPP-e-NEFF-rin). Epinephrine is the same thing as adrenaline (a-DREN-a-lin) -- the hormone that our bodies produce during our "fright, fight or flight" reactions to danger. Speed drugs make our bodies produce epinephrine, and also tend to make the user feel threatened. That's why, when you shoot crystal, your heart rate speeds up, your muscle strength increases, and your lungs open up for faster and deeper breathing.

The mice and guinea pigs had more herpes outbreaks because of getting the epinephrine. We do not know if this would be true with humans, but there are studies to show that the use of alcohol and pot increased herpes outbreaks in humans. The same studies showed that the number of outbreaks went down when the person stopped using the drugs. I don't know the details of the studies so I can't comment more on this right now.

So what's going on with your herpes outbreaks right now? Do you notice that they're worse when you're shooting crystal? (What about you other readers?) If your outbreaks are not too bad and you want to keep shooting crystal, then you will most likely do what we all do when an activity we like has some bad effects on our health. You weigh the good things against the bad things and then decide. Is the pain from the herpes outbreaks so bad that the pleasures you get from shooting crystal aren't worth it? Unless the outbreaks are really bad, you can treat them like the manageable nuisance that they are.

Willy J: Is there a type of gonorrhea that can't be cured?

Dear Dr. Dick,
What about that strain of gonorrhea that can't be cured? I've been hearing about it on the news. I'm HIV+ and this worries me a bit. What will it do to me? Can I get it in my butt or mouth?
Willy J.

Dear Willy,
Relax. The news was wrong. With the right medication, this strain of gonorrhea is easy to cure. The problem is, the best medication is not the one that a lot of clinics use. The news also failed to mention that there have been only 11 cases of this kind of gonorrhea in Seattle. If you have had gonorrhea in the last year and you are worried, go to the Harborview STD Clinic and get checked out.

(Take a yellow NEON Coupon from this issue of AmphetaZINE for a free check-up and treatment.)

By the way: Recently, the STD Clinic has seen more and more cases of gonorrhea in the throats and butts of gay and bisexual men. There are probably more guys out there who are infected but they might not know it. The symptoms (for instance, it burns when you pee or there's oozing, dripping yellow stuff coming out of your butt or dick) don't show up in about 20% of the guys who get gonorrhea.

On the other hand, some guys might see the symptoms but avoid going to the clinic because they're too embarrassed. Don't be.
What about HIV and gonorrhea? Here's the deal. Gonorrhea causes tissue damage in the rectum, throat, and inside the penis. (It also damages the vagina but most AmphetaZINE readers don't have one.)

When the tissue is damaged, white blood cells (also known as pus) rush to fight off the infection. So...

  • For HIV negative guys, having gonorrhea makes it easier for HIV to enter your system once you get exposed. Why? Because HIV likes to infect white blood cells. Having gonorrhea is like rolling out the welcome mat as far as HIV is concerned.
  • For HIV+ guys, a case of gonorrhea can really wear down your system. If you see symptoms or suspect you've been exposed, go to the clinic and get checked out.

My advice: Don't sweat the petty things -- just pet the sweaty things (safely).