Dr. James Manos (MD)
August 7, 2018
Safer Sex Tips!
Image (free to use): Phillip & Marlene. Created by Phil Scoville on June 25, 2005. Uploaded by the user Joshuajohanson. Source: Wikipedia. Link: https://en.wikipedia.org/wiki/File:Phil_and_Marlene.jpg
Image (free to use): Phillip & Marlene. Created by Phil Scoville on June 25, 2005. Uploaded by the user Joshuajohanson. Source: Wikipedia. Link: https://en.wikipedia.org/wiki/File:Phil_and_Marlene.jpg
Sexually Transmitted Infections (STIs))
STIs (sexually transmitted infections)
The main STIs (sexually transmitted infections) (also known as STDs: sexually transmitted diseases) include HIV (the virus that causes AIDS), herpes simplex virus (HSV) type 1 (typical for labial herpes), and herpes simplex virus (HSV) type 2 (common for genital herpes), syphilis (causes the chancre), chlamydia, gonorrhea, HPV (Human Papilloma Virus; it causes the condyloma acuminate characterized by multiple lesions of genital warts; types 1 and 16 are connected with vaginal cancer, while oral sex may cause sore throat), Trichomonas vaginalis (causing vaginitis), Molluscum contagiosum (a virus causing skin warts), Hepatitis (including hepatitis B and not uncommonly hepatitis C), etc. STIs may also cause NGU (non -gonococcal urethritis) or NSU (non-specific urethritis (= inflammation of the urethra with the most common symptom being painful or difficult urination)), UTIs (urinary tract infections), lymphogranuloma Venereum (infections of lymphatics and groin lymph nodes caused by the bacterium Chlamydia trachomatis), chancroid (characterized by painful sores on the genitalia caused by the bacterium Haemophilus ducreyi), etc.
The kissing diseases
Many pathogens (bacteria, viruses, and fungi) can be transmitted through sexual practices, including penetrative and non-penetrative sex. Many microbes, including HSV (herpes simplex virus) and EBV (Epstein–Barr virus, a virus of the herpes family that causes infectious mononucleosis), may be transmitted even with a kiss! Infectious mononucleosis, also known as glandular fever, is characterized by fever, sore throat, enlarged lymph nodes in the neck, and often spleen enlargement. It is caused by EBV and may also be caused by Cytomegalovirus (CMV). It is common in adolescents and is colloquially called "the kissing disease!" That, like many other infections, may be caused by sharing toothbrushes! HSV is an STI, but infectious mononucleosis is not.
How can STIs (sexually transmitted infections) be transmitted?
With almost all kinds of sexual practice, including penetrative form (sexual intercourse), oral sex, anal and vaginal licking, etc. The chance of being transmitted with mutual masturbation is very low unless a skin lesion such as an ulcer exists. The most important way for HIV is through sexual intercourse; however, oral sex may also transmit HIV. Other sexual practices, such as anal and vaginal licking, can also transmit HIV, especially if there is a mouth lesion such as an ulcer. The other STIs (sexually transmitted infections) can be carried with almost all sexual practices.
Can STIs cause cancer?
Yes. For example, the HPV virus (Human Papilloma Virus) is common. Apart from genital warts, it may lead to severe problems such as penis cancer in men and cervical, vulva, and vaginal cancer in women, and other cancers such as anal and throat cancer (related to oral sex) and even lung cancer. A vaccine has been developed to prevent cervical cancer. However, it covers only the most important strains.
Is wearing a condom essential to prevent STIs?
A condom will not only protect from STIs (sexually transmitted infections) but also from unwanted pregnancy in case of sex between a male and a female. In every form of sex, a male partner should always wear a condom to practice safe sex. The size should be appropriate (i.e., not too small or large); if the individual is unfamiliar with its use, he may try to masturbate wearing the condom. He can also use a water-based lubricant, which is more important for the male-to-male sex.
The two following videos show how to wear and use a condom:
The ''female condom''
Although not so popular, a female can wear it to protect from STIs.
Is withdrawing before ejaculation efficient in preventing STIs or unwanted pregnancy?
Withdrawing before ejaculation, also known as ''coitus interruptus,'' is not safe, as not only STIs (sexually transmitted infections) can be easily spread, but also a female partner may still become pregnant, as sperm is also contained in the penis fluids even before ejaculation. Consequently, it is unsafe to prevent STIs or unwanted pregnancies.
Is a condom essential to prevent STIs from oral sex?
Yes, but people rarely use it when practicing oral sex. However, it is recommended as a safe practice even for oral sex. It is inconclusive if HIV can be transmitted through oral sex, but some suspicious cases related to this practice were reported. Oral sex may transmit other STIs (sexually transmitted infections) such as HPV, syphilis, gonorrhea, etc. If someone engages in oral sex and has an oral ulcer or another mouth lesion, even trivial, an STI may be transmitted. Orally transmitted STIs may even appear as an oral lesion or pharyngitis (a sore throat), e.g., caused by gonorrhea, HPV, or syphilis. An oral injury may also transmit an STI when practicing anal or vaginal licking.
Does a condom offer 100% protection?
No, as it may tear! For the same reason, it may not offer 100% protection against unwanted pregnancy.
Do spermicides help prevent STIs?
Some say that they may decrease the chance of STIs (sexually transmitted infections) transmission, including HIV. However, this is not proven scientifically. Spermicides contain nonoxynol-9 and are available in many forms, such as jelly (gel), films, and foams. They should never be used without a barrier method, such as a condom. Frequent use (twice daily or more frequently) of nonoxynol – 9 containing spermicide is not advised if an STI, including HIV, exposure is likely because, in this case, there is increased vulvovaginal epithelial disruption and increased risk of HIV acquisition.
A meta-analysis that reviewed whether spermicides reduce the risk for HIV and the rest of the STIs found no statistically significant reduction in the risk of HIV and STIs and concluded that the confidence intervals indicate that any protection is likely to be very small. There is also some evidence of harm through genital lesions. Thus, N-9 is not recommended for HIV and STI prevention (***).
When should the condom be removed? Just before or just after ejaculation?
The condom should be removed when the male who wears it ejaculates. Otherwise, if the penis, after ejaculation, remains inside the vagina or rectum, it will become flaccid, and sperm may flow. This practice increases the risk of transmitting an STI (sexually transmitted infection). The condom should be discarded in the dustbin and not in the toilet.
Is a double condom safer?
Although some recommend it as a safe practice, especially for anal sex, it is not recommended as it is exposed to a higher strain that may tear the condoms during sex!
Are all lubricants for vaginal or anal intercourse safe?
The lipid-based lubricants, including petroleum-based such as baseline and other oily ingredients, may tear the condom! Consequently, all experts recommend only water-based lubricants that are compatible with condoms. Not even olive oil or baby oil should be used. Saliva is inappropriate as a lubricant despite its extensive use in porn movies! Saliva may transmit STIs (sexually transmitted infections).
Are there safer condoms?
Some condom companies have launched special safer condoms (e.g., Durex Extra Safe (TM)) that are thicker for safer sex. These should be preferred to the less thick condoms advertised for offering more pleasure, but at the expense of safety as they may tear easier compared to thicker condoms.
Is douching (irritation with water of the vagina or the rectum) safe?
Douche is a device that introduces a stream of water into the vaginal (by a female) or rectal (by a gay man) region. Douching isn’t a safe practice, as the pressure of the water and the scratching from the device itself may cause small lesions in the anal or rectal region, such as wounds that may be minor and unnoticed. These lesions may be a route where STIs (sexually transmitted infections) can be transmitted.
Is anal or vaginal licking a safe practice?
No, as it can transmit an STI in case the partner who licks has an oral (mouth) lesion, such as an ulcer or even a minor, which may be unnoticed.
Should people who don’t have a permanent relationship be examined regularly?
Yes, they should. There are specialized clinics (public clinics, STD clinics, etc.) where someone can be regularly examined for STIs (sexually transmitted infections), including a test for HIV, throat swabs, etc.
Is there a way of preventing HIV transmission in case of high–risk exposure?
High-risk exposure includes unprotected sex and/or sex with an unreliable person and/or sex under conditions of influence (illicit drugs, alcohol, sedative medication, confusion), etc. After events with an elevated risk of exposure to HIV, such as unprotected anal or vaginal sex, needle stick injuries, or sharing needles, the exposed individual should immediately visit an STI (sexually transmitted infection) clinic for post-exposure prophylaxis/ prevention (PEP). This includes administering antiretroviral drugs that will reduce the risk of HIV seroconversion.
The CDC (Center for Disease Control) of the USA recommends PEP for HIV-negative persons recently exposed to HIV for any reason. To be most effective, PEP should begin within an hour of exposure. After 72 hours of exposure, PEP is much less efficient or may not be effective at all. Prophylactic therapy for HIV typically lasts four weeks.
Can hepatitis be prevented after exposure?
Can hepatitis be prevented after exposure?
Yes, it can. Hepatitis A can be prevented with an immunoglobulin and hepatitis vaccine. Hepatitis B can be prevented with hepatitis B immunoglobulin (HBIG) and the hepatitis vaccine. For hepatitis C, currently, there is not any post-exposure protection.
Are gays a high–risk group for catching an STI (sexually transmitted infection), including HIV?
In the past, gays (homosexuals is an outdated term) were considered a high–risk group relating to transmission of HIV and other STIs. They still are, despite the campaign for safe sex since AIDS emerged in the 1980s’.
The USA Centers for Disease Control (CDC) warns that HIV rates, already at epidemic proportions, continue to climb steadily among men who have sex with men (MSM). While gay men make up only a small percentage of the male population (about 4%), MSM disproportionately accounts for over three-quarters of all new HIV infections and two-thirds (63 percent) of all new infections in 2010 (29,800). MSM are also at substantial risk of developing other venereal diseases such as syphilis, genital herpes, condylomas & HPV skin manifestations (a carcinogenic virus), gonococcal disease (including pharyngitis from oral sex), etc.
In any case, the partner who is penetrated, the ''receptive,'' is at a higher risk of contaminating an STI than the ''insertive'' partner. The same occurs in sex between a straight or bisexual man and a woman. Moreover, anal sex is riskier for contamination of HIV than vaginal intercourse. That is complicated by the fact that today, gay couples are in a higher than the past percentage versatile (or ''switch''), i.e., alternate sexual positions rather than being exclusive ''top'' (insertive) or ''bottom'' (receptive).
Are there high-risk groups, such as homosexuals, on getting an STI (sexually transmitted infection), or should we instead focus on a high–risk behavior?
Although homosexuals are a high-risk group for getting an STI (sexually transmitted infection) and especially HIV, today, the trend is to instead focus on high-risk behavior, such as unprotected sex (sex without using a condom) or unsafe sex (such as withdrawing before ejaculation, also known as ''coitus interruptus) that may be encountered in straight partners as well!
Thanks for reading!
Reference:
(Retrieved: 12 September 2015)
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