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Should I be concerned about mpox?

San Francisco Department of Public Health is working with state and federal agencies to monitor for mpox, and to help control the spread of the virus.

If you need to get checked for STIs, is there an age limit? Do your parents have to know?
In California, anyone age 12 years or older can get a medical check-up that is completely private and their parents do not need to know. However, if you use insurance, your parents may see the insurance bill. Planned Parenthood and most public clinics provide services to young patients and can bill you privately or provide care for free to protect your privacy.
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. It is difficult to tell exactly which sex act transmitted HIV. So the risk of two cis women transmitting HIV is very low but not zero. The most important intervention you could take would be if you have a female partner who is known to have HIV, she should be on treatment.
Why do some guys have crooked penises? Is there a cure or a way to straighten a penis?
It is normal for some men to have a shape to their penis. The way the muscles, fascia and skin develop from birth to puberty shape the final result. No two penises are exactly the same, and that is part of the miracle of human diversity. Some partners report greater pleasure with different shaped and sized penises. I am sure that there is some surgeon out there who could convince someone with a very differently shaped penis to undergo cosmetic reconstructive surgery, but medically the treatment would be unnecessary and potentially very harmful.
Whenever my boyfriend and I have unprotected sex, I develop a bladder infection and need to go on antibiotics. Is there anything I can do to prevent this?
Many women get urinary tract infections (i.e. UTI or bladder infection) from any physical contact with their genitals -- penile intercourse, oral intercourse, digital intercourse, sex toy use, masturbation, etc. To prevent this, some women drink lots of fluids before sex, and empty their bladders both before and after sexual activity (the acidity of the urine can help to kill some bacteria). Your partner washing before sex, especially under the hood of his penis if he's uncircumcised, couldn't hurt either to reduce the frequency of your infections. 
What type of lube is best for anal sex?
While water-based lubricants (for example, astroglide) are the most commonly recommended type of lubrication, many people like silicone-based lubricants (for example, Wet). Silicone-based lube lasts longer, is still effective in water and you need less of it. In addition, there are some data that silicone-based lubricants are less irritating to the rectal mucosa (i.e. the butt), and that people who use silicone-based lube are less likely to get rectal STIs than those who use water-based lube. Oil-based lubricants (e.g. petroleum jelly) are not safe to use with latex condoms, as they cause the condom to break. If you are having sex with a condom and want to use an oil-based lubricant, you should use a polyurethrane condom.
What is the risk of HIV from fisting, fingering, mutual masturbation, oral-anal sex, cum in the eye, cum on a cut, sharing a glass, sweat, etc…?
There is zero risk of getting HIV from mutual masturbation, oral-anal sex (aka rimming, eating ass, etc), sharing a glass, sweat, or other types of casual contact. Likewise, there is zero risk of HIV from getting cum on a cut, unless it is a fresh, open cut where HIV could gain entry. Fingering also has no risk unless there is an open cut or wound on the skin, although fingernails could damage the rectum or vagina and make it more susceptible to infection through subsequent sexual activities like intercourse/fucking. You can talk to your provider or call the City Clinic PEP line if you have questions about whether you need PEP. Fisting (inserting part or all of the hand in the rectum or vagina) in and of itself is not considered high risk for transmission of HIV. However there is a much higher risk of damaging rectal or vaginal tissue, which would be much more vulnerable to infection through any intercourse/fucking that happens after fisting. Washing up before and after ass play like fisting, and using latex gloves, and/or making sure there are no open cuts or wounds is a good idea to prevent transmission of infections.
What is a pelvic exam? What is a pap smear and what's the difference between them?
A pelvic exam is a check-up of the vulva, vagina, and cervix (opening of the uterus, inside the vagina). It may or may not include a pap smear, which is a test looking for abnormal cells on the cervix that are usually caused by an infection of human papillomavirus (HPV). For more information, please visit our pelvic exam and pap smear info page.
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. 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 STIs 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 STIs - 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.

I went to a bachelor party and went down on a stripper.  Can I get an STI from performing oral sex on a woman?
It is extremely unlikely that you would get a sexually transmitted infection from putting your mouth on a vulva (external genitals of someone that does not have a penis). By the way, this sexual activity is called ‘cunnilingus’. We do not believe that gonorrhea or chlamydia are transmitted that way and you cannot get HIV from performing oral sex on a vulva. It is theoretically possible to get syphilis from performing oral sex on a vulva but that is very rare. If you wish to protect yourself, you can use a barrier (a ‘dental dam’, a thin square of latex) between your mouth and your partner’s vulva.
I was recently diagnosed with non-gonococcal urethritis and I'm unclear about what causes it. Help!
Urethritis means inflammation of the urethra (the tube that carries urine from the bladder through the penis out of the body).  Symptoms of urethritis include discharge from the penis and pain or discomfort with urination.  The most common sexually transmitted infections to cause urethritis in men are gonorrhea and chlamydia.  When a man has symptoms of urethritis but has negative tests for gonorrhea and chlamydia, it is called NGU (non-gonoccocal urethritis) or NSU (non-specific urethritis).  NGU can be caused by infections such as chlaymdia, mycoplasma genitalium, herpes, adenovirus or trichomoniasis. You can get NGU from insertive anal, vaginal or oral sex (that is, putting your penis in someone else's butt, vagina, or mouth). It can be caused by an infection, and is sometimes non-infectious (that is, not caused by an organism like a bacteria, virus or parasite). 
I was recently diagnosed with non-gonococcal urethritis (NGU). I took some antibiotics and my symptoms went away, but they came back about 2 weeks later. What should I do?
Most people who get repeat infections get them from untreated partners so it's really important to make sure your partners are also treated. That said, NGU can be challenging because sometimes the medical provider is unable to determine exactly what bug (i.e bacteria, virus or parasite) is causing it.  If you have not yet been tested for mycoplasma genitalium, you could ask your provider if they could order this test for you. When NGU recurs soon after treatment or never gets better, it's sometimes necessary to try a different type of antibiotic.  You could ask your provider to check the latest CDC treatment guidelines, or seek consultation from an expert in sexual health.
I was recently diagnosed with genital herpes. My partner says he got tested and that he was negative. Is he lying to me?

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 STI, 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.

I was diagnosed with HIV about a year ago. I started on meds right away and have been undetectable for the last 9 months. If I top someone without a condom, what are the chances of me transmitting HIV?
If you take HIV medications correctly and maintain an undetectable viral load (meaning, the amount of HIV in your blood is so low that it can’t be detected with tests) for at least six months there is no risk of sexually transmitting the virus to an HIV-negative partner. This concept is called U=U (Undetectable = Untransmittable). It is important that you continue to take the medications correctly, every day. Also being undetectable means that you can't transmit HIV, but you could still get get or pass on another STI (like gonorrhea, chlamydia or syphilis). Condoms are the best protection from getting most other STIs.
I was diagnosed with genital herpes a few years ago, but haven't had an outbreak in over 8 months. I just got into a new relationship, should I tell my partner?

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: https://www.ashasexualhealth.org/herpes-and-relationships/.

For more information about herpes go to herpes STI basics.

I was at a bathhouse a few days ago and gave blow jobs to a bunch of different guys. I did not have any anal sex. If I picked something up, how long will it take until I show symptoms? What STIs should I be worried about?

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 STIs. STIs 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 STIs have no symptoms, the only way to know for sure is to get tested.  Sexually active gay men should get screened for STIs 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. 

I used to take valacyclovir to prevent herpes outbreaks but my new insurance doesn't cover it; I have to switch to acyclovir. Is there a difference?
Acyclovir (Zovirax) and valacyclovir (Valtrex) are very similar medications that differ mainly in how often one has to take the medication. They are both antiviral medications that are proven safe and effective in preventing herpes outbreaks. Both medications also help prevent spreading herpes to other people.
I'm a top. I was wondering if I can get HIV from barebacking. I know it's risky for the bottom who is receiving cum, but what about the top who is giving it?
Yes, you can get HIV from topping (putting your penis in someone else's butt) without a condom. While the risk of getting HIV from topping is about 10 times less than from bottoming, there is still a significant risk. The risk of getting HIV from topping is higher if you are uncircumcised (uncut). If you are not using condoms 100% of the time, PrEP is a great way to protect yourself from HIV. In addition, if you're living with HIV, taking medications for treatment and keeping your HIV viral load undetectable will prevent you from transmitting HIV.
The last time I had unsafe sex was 8 months ago, I just had an HIV test and it was negative. Do I have to worry?
There is a period of time (commonly referred to as a “window period”) between infection and a positive HIV test, but with the type of HIV tests used today, this period is generally only about 3 weeks (and no more than 6 weeks). If you have not had any possible exposures in the last 8 months (i.e you either used a condom, were protected by PrEP, or your partner was undetectable), than you can be extremely confident that you are HIV negative. We recommend that sexually active gay men and other men who have sex with men get tested for HIV and STIs every 3 months. If you're concerned about your risk for HIV, talk with your provider about whether PrEP is right for you.
I started using meth a few years ago. At first, I was only using it about once a month when I would go out to party and hook up. Now I use it daily and can't hook up without it. My friends have no idea how much I'm using. The nicotine patch was a lifesaver when I quit smoking cigarettes. Are there any medications I can take that might help me stop meth?

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.

Check out Tweaker.org for more information on methamphetamine and sex or call The Stonewall Project at 415.487.3100.