STD Information: Ask Dr. K
UNPROTECTED INTERCOURSE WITH
A NEW PARTNER
REALITY CONDOMS
TO USE CONDOMS OR NOT?
FERTILE TIME FOR WOMEN
MISSED BIRTH CONTROL PILLS
FLU-LIKE SYMPTOMS = STD?
VAGINAL FLUIDS DURING HAND JOB
TRICHOMONIASIS AND PREGNANCY
STD TESTS AND BODY PARTS
ALL ABOUT PEP
UNPROTECTED INTERCOURSE WITH
A NEW PARTNER
QUESTION
I recently have been having unprotected sex with a girl who is on birth
control. Three days after our first encounter, I have noticed a tingling
feeling on the tip of my penis. I have never felt this sensation before.
Is this something I should be worried about? My partner said she recently
has been tested and is clean. Any info would be greatly appreciated.
Thanks!
ANSWER
It is impossible to say for sure what's going on without getting checked
by an experienced clinician. He or she will ask you detailed questions
about your symptoms and then may check your penis or urine for any
signs of infection.
The symptoms you're describing could be related to urethritis -- an
inflammation or irritation of the urethra. Urethritis could be caused
by many things, including a sexually transmitted disease (STD) like chlamydia
(usually has no symptoms in women), or it may not due to an STD at all
(yeast, reaction to lube, even psychological). Getting checked is easy
and will help you get the information you need to stay healthy.
Most birth control methods are effective in preventing unwanted pregnancies,
but not STDs, including HIV. We recommend double-protection -- protection
against both pregnancy and STDs -- so using a condom and birth control
together. It is both partners' responsibility to reduce your risks.
REALITY CONDOMS
QUESTION
What's the story about gay men using the female condom? Does it stay
in a man? What about sensation for the top, etc. Where can I get the
Reality condom?
ANSWER
Many men have tried the Reality
or female condom and some prefer it to
traditional latex condoms. Try it, use lots of lube -- either oil-based
or water-based as it's made from polyurethane. It stays in the rectum
without the inner ring and some receptive men have reported they liked
it.
Most drug stores carry it. In San Francisco most Planned Parenthoods
have them, and we provide them for free at City
Clinic.
TO USE CONDOMS OR NOT?
QUESTION
I'm currently in a five-year relationship. We maintain our own homes,
however. For the past three years, we have been having sex without condoms.
On a recent trip to Provincetown, I noticed he was looking at other guys
and flirting a lot. It has me wondering if I should ask to start using
condoms again? I'm not feeling so safe anymore. How can you do that without
a fight?
ANSWER
You describe a difficult situation -- that is, what to do when a partner
may have not met your expectations. Obviously, the best thing to do
is discuss the situation, acknowledge that you are apart sometimes
and that you are concerned about your own health and his. It is common
for people not with each other regularly to find other sexual partners,
perhaps not for the emotional connection but for the physical connection.
That may be OK, as long as you both agree to the terms. It is not okay,
though, if it endangers your health. If you focus on the health aspects
and not the relationship issues, you may be successful when bringing
up the subject with him. It will be a tough discussion and you have
to decide if your love is worth it.
FERTILE TIME FOR WOMEN
QUESTION
When is the safest time to have sex -- when a girl is starting her period,
ending her period, or what?
ANSWER
If you use a condom or another form of contraception, you don't have
to worry about which time of the month you might be fertile (able to
get pregnant). But just so you know, the fertile period in a woman's
menstrual cycle usually lasts for three days, but can be up to 10 days
due to the life of sperm. The fertile time begins about 14 days before
a girl has her period. Trying to time your sexual activity without
using any other contraception is called the rhythm method and has a
high failure rate (10-20%). Condoms and birth control pills are much
more effective, and condoms also protect you against HIV and STD transmission.
MISSED BIRTH CONTROL PILLS
QUESTION
I missed two days of my BC pill and had unprotected sex with my boyfriend.
What are the chances of getting pregnant? Are there hormones left in
my system that will cover me for the days I missed? HELP!
ANSWER
Yes, it's true, having missed two pills and then having unprotected
intercourse puts you at risk for pregnancy. Please see your medical
provider ASAP to talk
about emergency contraception, sometimes known
as the morning-after pill. It is most effective within 72 hours of
unprotected intercourse.
FLU-LIKE SYMPTOMS = STD?
QUESTION
I just had sex with a new partner for the first time two days ago.
Last night, my throat started hurting and I felt a little feverish.
Today my throat is quite sore, and I feel flu-like symptoms. I have
often heard that for a lot of STDs, flu-like symptoms are the only
indication women get of infection. Should I be worried about STDs,
or is this too early to be the symptom of STD infection?
ANSWER
Symptoms of STDs can show up at any time from the day after contact
with an infected person up to 90 days afterwards, depending on which
STD we're talking about. In many cases, it can take much longer for
symptoms to appear because the first symptoms may be so mild that
you don't even realize they're evidence of an STD. In more than half
the cases of people who get STDs, there are no symptoms at all.
Symptoms that appear within 48 hours of sex could be from a bacterial
STD like gonorrhea. Within 3-5 days, herpes infections can present
themselves, while chlamydia usually takes about a week and syphilis
weeks to months. Also remember, depending on the time of year, many
non-specific symptoms -- fever, fatigue, headaches and sore throat
-- are most often due to common colds. But if you are still worried,
go to your doctor or a local STD clinic to get the full work-up of
tests so you will know for sure and can have peace of mind.
VAGINAL FLUIDS DURING HAND JOB
QUESTION
I am petrified over a possible exposure to an STD. I stupidly went
to a massage parlor and got a hand job from a woman who used lotion
from a bottle. I don't know if she touched herself during the act,
as at some point, I took over masturbating. She gave me a second
hand job later. I'm worried she may have had her own vaginal fluids
on her hand at this point. Am I at risk?
ANSWER
You can stop worrying -- what you described poses very little risk.
Just so you know, kissing, masturbation, mutual masturbation, and
frottage (dry humping) are considered safer sex activities with
very little to no risk of HIV transmission. Rarely, STDs like the
virus that causes warts can be transmitted from genitals-to-hands-to-genitals,
but most STDs and HIV are not transmitted this way. For more information
on what sexual activities can put you at risk for which STDs, click
here.
TRICHOMONIASIS AND PREGNANCY
QUESTION
I recently had an STD test and discovered that I have or have had
trichomoniasis. I would like to know if it is possible to get pregnant
later on if your partner was not infected? If I were to become pregnant,
would my child be affected because of my previous run in with this
infection?
ANSWER
Trichomoniasis (trich) infection is caused by a common parasite that
is sexually transmitted between men and women. trich infection
should not affect your ability to get pregnant. Other STDS like
gonorrhea and chlamydia, though, can reduce your ability to get
pregnant. This is why yearly testing for these infections is so
important. If you tell your provider that you are sexually active,
he or she should be testing for these infections during your annual
gynecological exam.
Untreated trich infection while you are pregnant can have serious
consequences. It may increase the risk of premature rupture of membranes,
preterm delivery, early labor, and low birth weight. Treatment of
trich during pregnancy is part of routine prenatal care.
Infection with trich can also increase your risk of getting and
passing HIV, so it is good that you've been treated. Your recent
sex partners should also be notified and treated for trich and tested
for other STDs, even if they have had no symptoms. Over 80% of people
who have an STD don't know it because they have no symptoms.
STD TESTS AND BODY PARTS
QUESTION
I'm confused about which STD tests work on which body parts. For
instance, is it possible to get gonorrhea or HPV in the anus or
throat as well as the genital area? Does a test in the genital
area confirm its presence elsewhere, or do all areas need to be
tested separately?
ANSWER
The reason you're confused is because unless you are an infectious
disease doctor, this is confusing stuff! Some STDs can be found
in more than one body part, depending on what type of sex you
had with whom (male or female). To answer your question specifically,
you can get gonorrhea in any of the three places you list --
anus, throat, or genitals (penis or vagina). HPV and chlamydia,
on the other hand, strike the genitals and anus, but rarely the
throat.
For gonorrhea and chlamydia, it is actually necessary to test
each and every part of your body that could be infected. This could
mean a urine test (which picks up penile or vaginal infection)
or a specific vaginal, penile, throat or anal swab. The test for
syphilis, though, is a blood test for antibodies, which means that
one test can tell if you've been exposed in any of the affected
areas. Herpes is a different beast all together. If you are having
an outbreak, you can test the sore, but if not, a blood test is
required to detect antibodies to the virus. HPV is usually tested
for by proxy -- looking for abnormal cells rather than the virus
itself but recently tests that detect HPV itself are being used.
Warts are also caused by HPV and many doctors can diagnose HPV-related
warts just be looking at them.
Keep in mind that most STDs do not have any symptoms. So to sum
up, if you use it, test it. If you are unclear, ask. Click
here for more information on complete STD screenings.
ALL ABOUT PEP
QUESTION
I was getting a blow job from a guy and afterward I noticed I had
brown blood on my penis and blotches of saliva mixed with brown
blood on my white underwear. Fortunately I had no cuts or abrasions
on my penis. Here are my questions: 1) Assuming the person giving
me the blow job was in fact HIV+ (I know not), what is the likelihood
of me being infected? 2) Also, if there was enough blood, couldn't
it overcome the barrier that saliva usually offers?
A local infectious disease doctor started me on the P.E.P. combo
of Combivir and Viracept about 20 hours after exposure. He said
I need to take it for 6 months. Wow! I'm a wreck -- upset that
I was so careless. Any advice would be greatly appreciated.
ANSWER
Current recommendations for PEP are 28 days, although it is not
uncommon for doctors to use guidelines, but not follow them exactly
in all situations.
That said, oral sex carries a very, very low risk of HIV transmission.
At City Clinic we do not offer PEP to people exposed to HIV through
oral sex regardless of the circumstances. One recent study has
shown the risk to be as low as zero, but there are case reports
out there of men who have gotten HIV from participating in oral
sex only. Best to speak to your doctor, or get a recommendation
to another local provider if you want another opinion for how to
move forward.
Being exposed to HIV, even possibly, is a very anxiety-provoking
experience. For some people, the anxiety leading up to the 3-month
HIV test and its results is debilitating. They suffer from irritability,
sleeplessness, fatigue, depression, personality changes, headaches,
and more. If you are experiencing any of these symptoms, speak
to a counselor who can help you work through them.
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