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Scared and confused puppy
Sep 11, 2004

Dr.Frascino, I can't tell you how I'm getting so pessimistic towards sex. I am a gay man in my twenties. Been negative since starting HIV testing and I always been carefull using condom for anal sex which I do rarely. Now, after a long dry spell I meet this guy, have a great time but to my surprise after a few days I am diagnosed with gonnorhea...and one that was resistant to quinolone by the way. What is scaring me is thinking that this is nothing, my DOC tells me to get tested in a few weeks because I am 5 times more likely to get HIV from the gonorrhea infection if the guy is positive. What the F***!! What else can I do to avoid infection. Abstinence? sucking and kissing with a condom?priesthood?...What kills me too is by the time one finds out of std infection, it's too late to consider PEP, right? I am very depressed and scared! :( Please tell me something good 1.Is it true that I am at higher risk of getting HIV with the gonorrhea and what are the odds? 2.What's your take on preventing this, what's left? 3.Do you agree I should be tested in a couple of weeks?

Response from Dr. Frascino

Hi Scared and confused puppy,

OK, let's looks at your options first:

1. Abstinence/celibacy? Hmmmm, theoretically yes, that would work, but is it workable? Generally most of us find that not to be a viable option, as it can lead to a sense of deprivation, frustration, and, ultimately, acting out. (The Catholic Priest scandals are a good example.)

2. Sucking and kissing with a condom? Hmmmm . . . again, that would work, and indeed some folks do "plastic wrap all meat products for safety," so to speak, but others find a diet that consists only of nibbling on latex to be too restrictive and not worth the effort. Kissing with a condom? Gosh, I'm not sure that's such a good idea. You'd have to crazy glue it to your lips, and then when you spoke, it would inflate and get bigger and bigger until KABAM, it bursts and you fly around the room backwards as it deflates.

3. Priesthood??? Hmmmm . . . well, some dudes might find wearing a dress, not having to explain why you are not married, and living in an all-male dorm called a "rectory" appealing, but see response to #1 for the downside.

OK, so that leaves us with safer-sex methods. If you want all the details, check out the HIV InSite Knowledgeable Base Chapter on Safer Sex Methods (http://hivinsite.ucsf.edu/InSite?page=kb-07-02-02). Basically, the take-home messages for oral sex are:

1. There are different levels of risk, depending on the STD and the type of oral sex.

2. Having an STD can increase your chances of getting infected with HIV.

3. STDs that cause sores and blisters (syphilis, herpes, etc.) are easy to get from all types of oral sex getting or giving.

4. Gonorrhea, chlamydia, and NGU infections are possible from sucking and getting sucked.

5. It's easier to pass STDs when sores, blisters or discharge ("the drip") are present.

6. Available scientific data suggests that while some STDs are quite easy to contract from oral sex, like gonorrhea and herpes, others, like HIV, are not easy to get form any kind of oral sex.

7. Yes, there are some documented cases of getting HIV from sucking ("giving head"). Bleeding gums, gum disease, and sores in the mouth can make it easier to get infected with HIV through oral sex.

8. There have been no well documented cases of getting HIV from getting sucked.

Now, what about what your doc told you concerning gonorrhea and HIV transmission? I think there may be a misunderstanding here. Perhaps he was referring to your potential HIV exposure. There is some data indicating that dudes with one STD have an increased likelihood of having other STDs concurrently. But if we talk about actual STD transmission rather than exposure, the story is that having gonorrhea can increase your risk of getting HIV. This occurs because white blood cells at the site of a gonorrhea infection may make it easier for HIV to enter the body. But the reverse does not seem to be true: It does not appear that HIV infection affects transmission (or symptoms or treatment) of gonorrhea. So the bottom line is that a person who has active gonorrhea has an increased risk of acquiring HIV compared to someone who doesn't have gonorrhea.

Next, you ask about getting tested "in a couple weeks?" That, of course, is up to you. The important point here is to realize that a negative HIV test result would not be considered definitive until at least three months.

Finally, you ask that I tell you something good. Hmmmmm . . . OK . . . .

1. Your risk of acquiring HIV from oral sex remains very low.

2. Thank goodness you are not a priest. That would make explaining even having "the drip" very difficult.

3. Puppies are the most lovable creatues on the earth.

I hope your "pessimistic" view towards sex evolves into a more enlightened, informed, and positive (in the best sense of the word) view. Most of us, except for the entire Bush Administration, believe sex is not a luxury that you can easily do without!

Good luck.

Dr. Bob



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