We recommend that sexually active gay men and other men who have sex with men be tested for HIV and STDs (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. You can ask your provider what your syphilis infection status is; whether you have gonorrhea or chlamydia in your butt, throat or penis; and talk with your provider about ways to reduce your risk for getting STDs and HIV. If you're not on PrEP, you could talk with your provider about whether PrEP makes sense for you.
There are a number of vaccines that can protect you against STDs - ask your provider if you need vaccines against Hepatitis A, Hepatitis B, HPV or meningococcus. You should also ask about anal cancer screening and your risks; and what warts look like and how they are treated. Your provider should be thinking about all aspects of your health including use of tobacco, alcohol and recreational drugs; and what you do for exercise and your diet.
It is definitely possible that you have genital herpes and that your partner does not. Only your partner knows for sure if he is telling the truth, but here are some scenarios in which he could be correct about not having herpes when you do. One possibility is that you have had herpes for a long time and were just recently diagnosed. Many people with genital herpes are unaware that they are infected and find out when they get a positive blood test for herpes, or when they develop symptoms of an outbreak. It can be very hard to accurately determine when you contracted a herpes infection. The only way to prove that your current outbreak is new is to have a swab test of the genital lesions turn out positive right now, and a blood test for the same type of herpes be negative right now. If a second blood test a few months later turns out positive it would confirm that this is a new infection, since blood tests take a few months after a first herpes outbreak to turn positive. If your herpes blood test is positive at the time of your first outbreak, this tells us that you have had that type of herpes for at least a couple of months, but we cannot be any more specific about when you first got the infection. It is also possible that your partner does have herpes and had a false negative test. Herpes blood tests can be negative even though someone is actually infected. This is most common in the first few weeks after infection, before the body has produced antibodies to the virus – the blood test is looking for these antibodies, so the blood test can be negative during the first few weeks after someone has been infected with herpes. Additionally, herpes does not transmit 100% of the time. It’s possible to have a long-term partner who has herpes and to never get the infection.
If your partner does not have herpes, there are some things for you both to know to move forward. If you have herpes, it is not a guarantee that you will give the infection to your partner. One study showed that transmission between couples is about 10% per year, and about 70% of these transmissions happened when the infected partner had no symptoms (https://annals.org/aim/article-abstract/705283/risk-factors-sexual-transmission-genital-herpes?volume=116&issue=3&page=197).
Condom use can reduce (but not eliminate) the risk of transmission. One study showed that using condoms most of the time reduces transmission from an infected man to an uninfected woman (https://jamanetwork.com/journals/jama/fullarticle/193953) – though this study only looked at monogamous heterosexual couples. Another study analyzed multiple other studies and found that people who use condoms every time they have sex have a much lower risk of contracting HSV from an infected partner (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860381/).
Daily medication (using either acyclovir or valacyclovir) can reduce the risk of you spreading the infection to a partner. One study of people with genital HSV-2 who took a daily antiviral medication showed that people taking medication were both less likely to shed virus, and less likely to transmit the virus to their partners (https://www.nejm.org/doi/10.1056/NEJMoa035144?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov). In addition, people who both took daily medication and used condoms for intercourse had no cases of herpes transmission in this study.
With herpes, as with any STD, a diagnosis shouldn't be about the blame game. What it should be about is good communication between you and your partner(s), education about the disease and the best way to stay healthy, and limiting transmission to others in the future. Herpes is incredibly common, but very manageable.
Though it can be difficult, it is recommended to discuss a herpes diagnosis with a potential sex partner. Doing so can set the relationship off on the right foot and allow both of you to be involved in a conversation about prevention strategies. For a great resource for talking with partners about a herpes diagnosis, check out: http://www.ashasexualhealth.org/stdsstis/herpes/a/.
For more information about herpes go to herpes STD basics.
Giving head (i.e. performing oral sex, giving a blow job) can put you at risk for chlamydia, gonorrhea, herpes, syphilis and possibly HPV. Getting HIV from giving head is extremely rare.
It can take several days or up to several months to show symptoms of STDs. STDs in the back of the throat often have no symptoms and some clear on their own. A throat swab for gonorrhea and chlamydia and blood test for syphilis can tell if you have an infection. Because most STDs have no symptoms, the only way to know for sure is to get tested. Sexually active gay men should get screened for STDs and HIV every 3 months If you're concerned about your HIV risk, talk to your provider about whether PrEP (pre-exposure prophylaxis) makes sense for you.
Although many have been studied, at this time no medications have been approved by the FDA for treating methamphetamine addiction. There is ongoing research into the pharmacologic treatment of methamphetamine addiction, and so there is hope that a medication that helps with meth use will be found. In a small study looking at a medication called mirtazapine, men who have sex with men actively using meth who were in the counseling plus mirtazapine group had fewer positive urine tests for meth than those in the counseling-only arm.
We know that oral sex does carry risk for STD transmission. The risks vary depending on which infection we are discussing.
Some STDs are transmitted through skin-to-skin contact, including oral-genital and oral-anal contact. For example, herpes and syphilis are spread by contact with infectious sores or lesions, so oral sex could definitely spread these infections regardless of ejaculation. HPV can also be spread from genitals to mouth, or from mouth to mouth (http://cebp.aacrjournals.org/content/23/12/2959). Ejaculation during oral sex makes no difference with any of these infections.
Many people believe that gonorrhea and chlamydia can only be transmitted if ejaculation happens, but this is not true. The infections live in the epithelium (skin cells) of mucous membranes, like the cells lining the urethra (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC523569/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886739/). The bacteria are present on these cells, and can be transferred to the throat without ejaculate (cum) or even pre-ejaculate (pre-cum) being present. Interestingly, one study (https://sti.bmj.com/content/93/2/88) showed that gargling with Listerine reduced the amount of gonorrhea bacteria in the throat, but this study didn’t follow up to find out if this means fewer cases of gonorrhea were transmitted from throat to genitals.
Oral sex with or without swallowing semen both carry a very low risk of HIV infection – so low that we cannot calculate an accurate number (https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html). We do not have any studies that look specifically at the difference in risk without ejaculation.If you are concerned about the low risk of HIV transmission via oral sex, you could communicate this to partners and then not swallow any semen that is present. From a harm reduction perspective, this may be less risky, but we just don’t have any scientific proof to say for sure if swallowing makes a difference.