One of my sex partners just found out that he has syphilis. The last time we had sex was about 3 weeks ago. I was tested for syphilis at my PrEP follow-up visit last week and was negative. My doctor says I still should get the shot. Is that true? Why do I need it if I'm negative?

The syphilis test can take up to 12 weeks to turn positive after someone is infected. Syphilis is really easy to transmit. It’s very possible that you got syphilis from him when you had sex 3 weeks ago. By getting the shot, you will get rid of any incubating syphilis. This will prevent you from developing symptoms and also prevent you from transmitting syphilis to any of your other sex partners. It’s great that your partner told you and that you're both getting checked out and taking care of your health.

I am a gay man and just got diagnosed with anal warts. They were treated with liquid nitrogen and went away. Is it possible that they will recur? Is there anything I can do to prevent a recurrence? Is it possible for me to spread HPV to my partner even if all the warts are gone?

Anal warts, which are caused by HPV, can be removed by a doctor or with treatments applied at home. Depending on which treatment is used, there is a 10-30% chance of the warts coming back. Some people have only one outbreak of warts, others have recurrences over time.

I've been with my boyfriend for about 3 months. I've always had normal pap smears, but I just had a check-up and found that that my pap smear was abnormal, and the HPV test came back positive. Did I get it from my new boyfriend? Is there a way he can get tested to find out if he has it?

While most HPV infections clear on their own, some HPV infections can live in the body for a long time, and often do not cause any symptoms. It is very possible for someone to have HPV for years (10, 20, even more) and never know it, and so you may have gotten HPV from a past sexual partner. HPV is extremely common, and most people who have been with two or more sexual partners in a lifetime have been exposed to the virus. Currently there are no HPV tests for men, and so there is no way to know if your boyfriend has it.

A guy who I hooked up with about a month ago just texted me and told me that he just found out he has Hepatitis C. I'm on PrEP and I topped and bottomed with him without a condom. We snorted some meth together before we hooked up but there were no needles involved. He said I should get tested for Hep C. Should I be worried? I thought Hep C was something that people who inject drugs get?

The majority of hepatitis C infections result from people sharing needles or other equipment used to inject drugs. However, some people do become infected with hep C through anal sex. This risk increases for people who have an STI and are exposed to hep C. Sharing equipment used to snort drugs can also pose a risk for hep C. For people on PrEP we recommend testing for hepatitis C once a year. It sounds like you are potentially at risk for hepatitis C and that you should get tested. If you do have Hep C, there are great treatments that can cure Hepatitis C in 8-12 weeks.

My BF and I recently got back together after a breakup. We had unprotected sex and oral sex. A few days after we had sex, I began to have STI symptoms, including lots of discharge from my penis. I went to an STI clinic and was told on the spot I was infected with gonorrhea and was treated with a shot and a pill. I confronted my BF and he confessed to kissing someone else. I don't want to sound naïve, but I believe him or at least I want to for the sake of our relationship. My question for you is: Could he have gotten gonorrhea in his throat from kissing someone, and then a few days later, passed it on to me when he gave me a blow job?

Although there are some data that its possible to get gonorrhea in the throat from deep kissing, this is not the easiest or most common way to get gonorrhea in the throat. Usually people get gonorrhea in the throat from giving a blow job (i.e. performing oral sex on a penis) to a person who has gonorrhea in their penis.  You could have gotten gonorrhea in your penis either by getting a blow job from him (if he had gonorrhea in his throat) OR from topping him without a condom (if he had gonorrhea in his butt).

I just bottomed with a guy who came inside me. He says he is HIV negative and has no STIs. I can't be sure of how honest he is being, and now I am panicking. What should I do?

It would be a good idea to see a medical provider and get a complete HIV and STI checkup. If its been < 72 hours since the sexual encounter, you should seek care right away as PEP can prevent HIV if started soon after a possible exposure to HIV. If its been more than 72 hours, its still a good idea to talk to a medical provider. You can get tested for HIV and STIs, and talk to your provider about whether PrEP is right for you.

How long after being exposed to syphilis can you be accurately tested? Also, how long after being exposed will symptoms start? What symptoms should I look for?

The symptoms of syphilis can appear as soon as two weeks after you are infected, but it can take up to 12 weeks. The syphilis blood test can turn positive two weeks after you are infected, but it can take longer. Sometimes the syphilis blood test does not turn positive until 12 weeks after you are infected. That is one reason why we recommend you get treated for syphilis if their partner was positive, even if your test result is negative.

I have a blister/sore/pimple/bump on my penis/scrotum/genital area. What is it and what should I do?

Scrotums and penises, as you've likely noticed on your own, have many tiny bumps and textures that are absolutely normal. Non-STI lesions on the penis include the common condition of folliculitis, which is a bacterial infection of a hair follicle, usually caused by friction or irritation. Lesions on the genitals can be a sign of a sexually transmitted infection. Painful, tiny clusters of small blisters may indicate genital herpes. Other ulcers or sores on the penis, whether painful or painless, could be a symptom of syphilis.

What are routine questions regarding gay men's health that I should be asking my physician during a regular examination?

We recommend that sexually active gay men and other men who have sex with men be tested for HIV and STIs (gonorrhea, chlamydia, and syphilis) every three months. Testing for syphilis usually involves a quick physical exam and a blood test. Testing for gonorrhea and chlamydia involves a urine sample if you perform insertive oral sex or anal sex (i.e. if you “top”), a swab of your throat if you perform oral sex on other guys, and a rectal swab if you practice receptive anal sex (i.e. if you “bottom”).  If you are not getting tested every three months ask your provider if you can be.

If I've been treated for an STI once, can I get it again?

Having been treated once for a bacterial STI like gonorrhea, syphilis or chlamydia does NOT protect you from future infections. Treatment with antibiotics helps get rid of STIs but it doesn't keep you from getting them again. Every day at SF City Clinic, we see patients with a new STI that they have had before. Each germ is a little different and your immune system does not always protect you. Condoms are the most effective way to protect yourself against STIs.
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