I always bareback (have unprotected anal sex) with my partner. We are monogamous, both HIV negative and got checked for STIs about 6 months ago. Since my boyfriend loves to ejaculate inside me, I am wondering whether there is any health risk from the cement left in my rectum?

No, there is no particular risk of semen (cement) left in your rectum. Most of it will spill out of its own accord with your next bowel movement, if not before. The trick in your situation is to be very sure both partners are truly monogamous. This means that neither you nor your partner are enjoying a quickie here or there on the side. It's a good idea to keep communication open so you can both continue to be assured of your sexual health.

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.

My girlfriend suggested that we have anal sex without a condom. It would be our first time. I thought you were always supposed to use one because of the risk of infection. If you and your partner don't have any STIs or HIV, is it safe to not use a condom for anal sex? All of the information I've found out there assumes you don't know your partner's status in regards to STIs and HIV.

You're right -- in order for you to be exposed to HIV or STIs, your sex partner(s) has to be infected. So, if you're in a relationship and you've both tested negative for STIs recently, and neither of you are having sex with anyone else, you're not at risk for getting or giving an STI.  A person can have an STI and spread it to others without knowing it. You can't tell whether or not a person has an STI just by looking at them which is why its important to get tested for STIs, even if you're feeling ok.

I’m a woman and I only ever have sex with other women. I never inject drugs. What is my HIV risk?

HIV transmission between two cis women (that is women who were female at birth and who identify as female) is very rare. There is one documented case of HIV being transmitted this way [https://www.cdc.gov/mmwr/preview/mmwrhTml/mm6310a1.htm]. In this case, one partner was HIV+ and not on medications. The couple engaged in oral sex, vulva-to-vulva contact, and sharing of sex toys. They had sex during menstruation and sometimes had “rough sex” where blood was present.

If I have herpes, can I still have children?

Absolutely. Many people with herpes have healthy pregnancies and healthy deliveries. If you have herpes and you want to get pregnant with your partner, you can protect your partner by taking medication that will suppress your herpes while you are trying to get pregnant. If you have herpes and you are pregnant or want to become pregnant and not pass anything on to your baby, talk to your doctor, nurse practitioner or midwife about how to protect your baby.

Are there any vaccines I should get that could protect me from STIs?

Yes! There are several vaccines that can protect you from getting other STIs. All sexually active adults should be vaccinated against hepatitis B. All men and women < 26 yo should receive the vaccine against HPV (and anyone aged 26-45 should also consider it). The HPV vaccine can prevent genital warts, cervical cancer in women and anal cancer in men and women.

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.

Can you get HIV from giving a rim job?

No. While it may be theoretically possible to get HIV from a rim job (i.e. oral-anal sex or eating ass), most health experts believe this is safe sex in terms of HIV transmission.  There have been no cases reported of HIV transmission through oral-anal sex. Oral-anal sex can, however, transmit shigella, amoeba, giardia, hepatitis A and maybe even syphilis and gonorrhea. There are vaccinations available to prevent you from being infected with hepatitis A and B. Regular STI check-ups are also recommended as a good way to stay healthy.
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