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Safer Sex and Sexually Transmitted Disease - STD Prevention for Men who have Sex with Men - MSM

Safer sex and STD prevention are important practices for anyone who is sexually active. Safer sex means learning and practicing behaviors that decrease the chance of contracting or transmitting a disease. Safer sex is negotiated and planned honestly between partners. Those who know and discuss their limitations and expectations are likely to have better, safer sexual experiences. Prevention is possible only if one understands STDs and how they are spread.

An STD is any short-term or long-term disease that is transmitted via sexual contact. Many STDs are not life threatening but cause painful, annoying, impairing, chronic conditions that require frequent, lifelong medical treatment. Men who have sex with men (MSM) are at a greater risk than lesbian women for certain STDs that are more likely to be transmitted in semen and blood.

Human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS), is the most serious STD because it is life threatening. In July 2003, the Centers for Disease Control and Prevention (CDC) reported that the incidence of HIV and AIDS in MSM had increased by almost 18% since the lowest point in 1999.

In 2001, the Centers for Disease Control (CDC) reported an increase in syphilis cases in New York City, a recent outbreak of hepatitis A in West Hollywood, and a total 753,907 cases of AIDS in the United States. The greatest weapon against STDs is understanding how to avoid them.

STDs Associated with Specific Sexual Behaviors

Anal stimulation with fingers
STD risks include:

  • Hepatitis A, B, and C
  • HIV
  • Parasites (intestinal protozoa; e.g., Giardia lamblia, Entameba histolitica, Cryptosporidium parum; spread by fecal-oral transmission)
As long as the skin of the fingers and anus is intact (wound free), there is little risk associated with finger-to-anus stimulation. If the fingers are cut or the anus torn, this method of stimulation is not advised. The above STDs can be spread through blood, semen, and body fluid.

It may be safer to use one hand to stimulate a partner's anus while avoiding anal contact with the other hand. The hand used for anal stimulation should be kept away from the mouth and should be washed afterwards, to minimize the chance of spreading parasites.

Penis-to-anus penetration without a condom, with or without ejaculation
STD risks include:

  • Anogenital warts (human papillomavirus, HPV; causes anogenital warts associated with genital and reproductive cancers)
  • Chlamydia (Chlamydia trachomatis; genital bacterial infection causing discharge)
  • Genital herpes (herpes simplex virus, HSV; causes genital sores)
  • Gonorrhea(Neisseria gonorrhea; bacterial infection of genital mucosa causing discharge)
  • Hepatitis B and C
  • HIV
  • Syphilis (Treponema pallidum; bacterial infection causing lesions; may affect nervous system and heart)
Some STDs produce lesions or a discharge that is noticeable on the penis or anus and some do not. Asking a partner if he has a history of warts, sores, or discharge before sex is a good practice. Before anal intercourse, partners should examine one another's penis and anus for lesions, growths, or torn skin and each should ask about the other's health history. Although sex is safer with a condom, either partner should be comfortable abstaining from sex when there are signs of STDs.

Some people believe that it is safe to have anal sex without a condom if they are taking antibiotics for an STD. This is not true. The risk for transmission exists until the course or treatment is completed.

People with HIV should share their status with their partners and their partners should ask. HIV-positive people can contract new strains of HIV, which can worsen an existing condition and complicate treatment. If both partners are HIV-negative, there is no risk of contracting the disease.

Before anal intercourse, the anus should be relaxed by massaging it with a liberal amount of water-based lubricant (e.g., KY Jelly�) that does not contain nonoxonyl-9 (N9). This reduces the chance for tearing and bleeding and minimizes the risk for STDs. Anal sex, especially without lubricant, can cause rips and lesions and exacerbates hemorrhoids. Lubricants containing N9 are actually associated with an increased risk of HIV transmission.

Some medical centers offer postexposure prophylaxis (PEP), medication that reduces the chance of becoming HIV-positive if started within 72 hours after exposure to the virus.

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Penis-to-anus penetration with a condom
STD risks include:

  • Anogenital warts
  • Genital herpes
  • Syphilis
Wearing a condom significantly reduces the risk of exposure to HIV, gonorrhea, chlamydia, and hepatitis B and C but does not eliminate it because condoms can break. If a condom rips during anal intercourse, the penis should be withdrawn and the condom replaced. Condoms should be worn prior to penis-to-anus contact. Contrary to what some people believe, wearing two condoms to maximize protection actually increases the likelihood that one or both will rip. Petroleum jellies (e.g., Vaseline�, baby oil) are not suitable lubricants because they destroy latex. The lubricant should be water-based and the condoms should be a nationally recognized brand.

Receivers are advised to keep one hand on their partner's penis during initial penetration to ensure that the condom is on. One partner should grasp it during withdrawal to make sure that it does not slip off in the anal canal or rectum. Reading the instructions that come with nationally recognized brands of condoms is advised. Fingers, sex toys, or anything else that could tear the condom should be kept away from the anus and penis prior to and during anal intercourse.

STD risks include:

  • Crabs
  • Scabies
Crabs (pediculosis pubis: crab louse) are lice that predominantly infest the pubic region and can affect other hairy places on the body. They cause severe itching and must be treated with medicated shampoos. Physical removal of the eggs (nits) attached to the hair follicles must be done with a special comb to prevent subsequent infection when the eggs hatch. Scabies (sarcoptes scabiei) are arachnid mites that burrow under the skin and reproduce. They cause severe itching, pain, and slightly elongated red lines and spots on the skin. They are treatable with medication. Both parasites are transmitted through skin-to-skin contact or clothes, but crabs can be contracted through contact with infected sheets or toilet seats. If a partner is infected, cuddling with clothes on is the safest behavior.

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