What's in your butt?

Last month I was chatting with two guys at an Ottawa testing clinic and one of them told me how he recently persuaded a thirty year old gay buddy to go for his first STI and HIV tests. His friend had been sexually active since he was 16. That's fourteen years without a test.

Kind of astounding, to me anyway.

That got us talking about why some gay guys don't get tested regularly and, of course, there's all kinds of reasons. Like a fear of learning you're HIV+ because of how it might change your life (though the longer you're positive without receiving treatment, the more HIV will change your life). Like Canada being the #1 country in the world for sending HIV+ people to jail, leading some guys to think that if you don't know your status, you won't be charged (though in reality, actual transmission of HIV is not even necessary for criminalization in Canada - the charge is for exposure to the virus, regardless of outcome). Like laziness (and flat out, some guys really are just lazy when it comes to testing). Like going out of your way not to encounter the medical system because of a past homophobic experience with clinic staff or not wanting to spend 3 hours in the awkward clinic waiting room (which could certainly lead to a bit of laziness when it comes to getting off the couch...). And like not wanting q-tips poked into your body (though in Ottawa, the penis q-tip swab is no longer performed - a urine sample is sufficient - and the anal swab takes three seconds and is nothing compared to taking a cock up your ass...).

Those are all reasons why some guys might delay getting a test for HIV, but what about getting tested regularly for other sexually transmitted infections (STIs)? Its equally important for both HIV+ and HIV- men. Why?

• Having an existing STI makes HIV+ men more infectious and more likely to pass on the virus. It also makes HIV- men more vulnerable to infection.
• STIs are extremely easy to share. Most only require skin-to-skin contact, so many activities that are no risk for HIV become high risk for STIs. Kissing is one example. With bacterial infections like gonorrhea and chlamydia, contact isn't even necessary. Let's say I have gonorrhea in my dick. My accommodating fuck buddy is patiently waiting at my feet with his mouth open while I jerk off. As the cum shoots from my cock into his throat, it takes the gonorrhea with it and he now has oral gonorrhea. Yet we never touched.
  
• You can get STIs in or on your dick and balls, butt, mouth and throat or vagina. And STIs can be shared between any of these locations. If you're getting busy with any of these places, you need to get it checked - plus a blood test for syphilis.
• Many, many, many STIs will show no symptoms or symptoms so subtle you can mistake it for an ingrown hair or a zit or a yeast infection that seems to have cleared up on its own. Yet you still have the STI and you can still pass it on to others.
  

STIs are not a big deal - if you get tested regularly.

This is what an STI really looks like. Photos of STIs on the internet usually only show the most extreme cases that are intended to scare you and make you feel like sex is bad. They discourage people from getting tested and can make you think that, unless you have crazy puss oozing out of your cock, you don't have an STI... Not true!

As an outreach worker for gay men, I've been sharing this info with guys for years. In particular I find many gay guys don't realize the connection between having an STI (which you might never see or notice) and the increased likelihood of HIV transmission during sex.

And up until now, there hasn't been a ton of evidence on this connection in a gay context. You see, a lot of HIV studies still focus on good, old penis-in-vagina sex. Which makes sense and is useful on a global scale, since HIV affects more heterosexuals worldwide than it affects us homos. But this overlooks two important things:

1. In industrialised regions like North America, Europe and Australia, the HIV epidemic is still very much a homo disease. Not entirely, of course, but in Ontario, for example, over 50% of new HIV infections are still among gay men.
2. Heteros like to take it in the butt too.
   

Which is why it's exciting to learn the results of a recent study conducted by Australian researchers and reported on in the Journal of Acquired Immune Deficiency Syndromes. The researchers examined a range of common bacterial and viral STIs as risk factors for HIV transmission. What they found is that the two STIs most strongly associated with HIV transmission in gay and bisexual men are anal warts and anal gonorrhea:

• Men who had anal gonorrhea were seven times more likely to acquire HIV.
• Men with anal warts were over three times more likely to acquire HIV.
• Herpes infections did not emerge as significant factors in HIV transmission.
• Infections of gonorrhoea and chlamydia in the penis were not associated with acquiring HIV. But remember! If my buddy has gonorrhea in his cock and humps my butt for a while without a condom, I'll likely then have gonorrhea in my ass. Which means HIV transmission is seven times more likely the next time he sticks it in, right?
  

So gonorrhea in your penis isn't a big factor for HIV transmission, but gonorrhea in your butt is. And it's a real shame that it isn't the other way around because when you have gonorrhea in your dick, you will get symptoms a majority of the time. But when it comes to gonorrhea in the butt, you only get symptoms about 10% of the time. Indeed, the researchers note that in most cases, the anal gonorrhea diagnosed was asymptomatic. They suggest that it is plausible that long-standing infections, which can cause rectal inflammation, may be associated with HIV infection.

Checking out butts is important

Let me give you an example from my own sex adventures: this spring, my gorgeous boyfriend started getting discharge from his dick and an unpleasant, burning feeling while peeing followed not long after. Pretty clear sign that something was up. So the two of us went to the clinic and both got tested and took the antibiotics for gonorrhea and chlamydia right away because the doctor was pretty sure the results for one or the other would be positive. Seven days later the infection was all cleared up and dealt with. Easy peasy. And, of course, when our test results came back, he was positive for gonorrhea in his dick and I was positive for gonorrhea in my ass. I never had any symptoms, though: no discharge, no burning, no pain. And in all likelihood, it was me who gave it to him.

Imagine if I had shared gonorrhea with a random partner I wasn't in contact with or who didn't feel comfortable calling me up to tell me his dick was on fire and his underwear was stained yellowy-white? A guy could go a very long time with an infection in his butt and have no idea. He'd be increasing his risk for HIV.

When it comes to warts, the researchers suggest two possible ways they may facilitate HIV transmission. Firstly, the warts themselves likely weaken the integrity of the delicate tissues inside the ass. Secondly, treatment for warts often produces ulceration and inflammation over a period of weeks or months, and it may be the treatment itself that increases the risk of infection. This second point needs more research, however. If true, it would suggest that consistent use of condoms and lube in the weeks and months following treatment for anal warts is especially important. A period of avoiding anal play immediately following treatment would also make HIV transmission less likely.

I know this can all sound kind of heavy and scary, but it really doesn't need to be. I enjoy an active sex life and STIs don't stress me out. I've found a clinic that's attuned to gay guys' sexual habits and their health needs. Based on my sex life and comfort level, I go every 3 or 4 months and get tested by this nice doctor who asks me how work's going and how my boyfriend's doing lately as he's inspecting my balls for sores. Whether you live in a bigger city where they have gay-specific clinics or you're in a small town where you need to tell a few white lies to prevent the doctor asking too many questions about your personal life, gay men need to find a workable way to get tested for STIs regularly.

Seriously, guys, don't wait fourteen years...


[via AIDSmap]