FAQs

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How often should I be tested for HIV?

The CDC recommends that all adults > 18 years old are tested for HIV at least once in their lifetime. Men who have sex with men, trans people who have sex with men and people who inject drugs should be tested more frequently. In San Francisco, we recommend that folks in these groups get tested for HIV every 3 months. People on PrEP should also get tested for HIV every 3 months.

We recommend that you talk with your healthcare provider about your sexual and drug use practices. This will help your provider determine what tests you need and how often you should be tested. Testing recommendations depend on your situation, for instance if you or your partner use drugs (like methamphetamine or cocaine), if you're experiencing homelessness, have a history of incarceration, have a history of an STI, do sex work, or if you think your partner may be having other partners.

How long does it take for HIV to show up in a blood test?

This really depends on what type of HIV test is done. Most labs now use what's called a ""4th generation"" HIV test. This type of HIV test detects antibodies against HIV - which your body produces in response to the virus, as well as HIV antigens which are part of the virus itself. It usually turns positive about 3 weeks after infection, and should definitely be positive by about 6 weeks after infection. If you are worried about an exposure to HIV that occurred more recently than 3 weeks ago, ask for an HIV viral load test (also called an HIV RNA test). This test will usually turn positive around 10 days after infection. Using currently available tests, it is difficult to detect an HIV infection that occurred within the last 10 days. [link to HIV testing page].

If you think you may have been exposed to HIV in the last 3 days, then you may be eligible to take PEP to prevent HIV infection.

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. The initial symptom is a painless sore at the site of infection - sometimes people don't see the sore, especially if it’s inside the vagina, rectum (butt), or throat.  A few weeks after the sore goes away, most people will develop a rash. The rash can be on the chest, back, arms, legs, hands, feet and/or genitals.
I am HIV-negative and just started dating a guy who is HIV positive. He says he's "undetectable" and that we don't need to use condoms. Is that true? What should I do?

An HIV-positive person who takes HIV medications correctly and achieves and maintains an undetectable viral load (meaning, the amount of HIV in their blood is so low that it can’t be detected with tests) for at least six months has no risk of sexually transmitting the virus to an HIV-negative partner. This is known as U=U (Undetectable = Untransmittable).

However, in any relationship, particularly a new relationship, it takes time to get to know and trust your partner. How long have you been dating this person? How well do you know them? Are you having sex with other people or do you have an agreement to be just with each other? PrEP is a great way to take your health into your own hands and protect yourself from HIV, regardless of your partner’s status.

If I have sex without a condom and get an STI, how long does it take for an STI test to turn positive?
The amount of time it takes your body to test positive for an STI depends on the type of STI. STIs like gonorrhea, chlamydia, and trichomoniasis can show up in a few days after exposure while infections like syphilis, herpes or HIV, depending on the test, can take at least 7 days and often longer. Gonorrhea, chlamydia and trichomoniasis are detected with a swab or urine test that measures the presence of the actual germ. Syphilis and herpes can be detected from the fluid in a sore when there is a sore present. There are also blood tests for syphilis and herpes. HIV can be detected with a blood or oral fluid test that measures the body’s immune reaction to the germ through the creation of antibodies. HIV can also be detected by testing for the HIV virus in the blood BEFORE you have even created antibodies.
I have read online that HPV can go away after 1-2 years, is this true?

Human papilloma virus (HPV) is a family of over 100 different types of viruses. They are very common and spread very easily, and over 70% of sexually active adults will show evidence of a past HPV infection. Most HPV infections are asymptomatic - that is, people are infected and do not know it.

To answer your question, many HPV infections do go away on their own. However, some HPV infections persist and stay in the body. Some strains can cause warts and others abnormal PAP smears. The strains referred to as "high-risk" can cause changes to cells that eventually can lead to cervical cancer, anal cancer and rarely, oropharyngeal cancer.

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.
I have Hepatitis B. I was diagnosed six weeks ago. Can I give Hep B to my partner by kissing? How about giving or receiving oral sex? We haven't had anal sex yet, but I assume a condom will protect both the top and the bottom?

Hepatitis B virus is found in blood, semen, and vaginal fluid. The virus can be passed from person to person when one of these fluids has contact with cuts or punctures in the skin or with the moist skin (mucosa) around the genitals or anus. Although hepatitis B virus can be found in saliva, it is not believed to be transmitted through kissing. Giving and receiving oral sex does put your partner at risk, particularly if you receive.

Condoms will protect both partners during anal sex. Remember to use lots of lube so the condom doesn't break. However, the best way for your partner to protect himself from hepatitis B is to get vaccinated right away. He should reach out to his medical provider, or to his local public health department, as soon as possible to figure out where he can get the vaccine. If you have anal or oral sex without a condom before he gets the vaccine, he should talk to his provider about PEP (post-exposure prevention) for hepatitis B right away.

Transmission of hepatitis B can also occur through sharing toothbrushes, razors, sex toys or injection drug equipment.

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. Rarely, scabies can present as bumps under the skin in the pubic region, and small blisters could also be caused by allergies or yeast. Only a clinician can make a diagnosis after a proper medical examination. If you're not sure what you've got, make an appointment today.
I had sex without a condom and I'm worried I might have HIV, what should I do?
The only sure way to know your status is to get an HIV test. You can buy an HIV home test kit at a pharmacy, go see your regular medical provider, or drop into a local HIV testing site: https://gettested.cdc.gov/ HIV antibody tests take 3-6 weeks to turn positive after someone gets infected with HIV. If the sex without a condom was less than 3-6 weeks ago, you can talk to your provider about getting an HIV RNA test instead of an HIV antibody test. The HIV RNA test becomes positive 10-14 days after someone gets infected with HIV. If the sex without a condom was within the last 3 days, you should talk to a provider right away to see if you should start PEP. Your risk of getting HIV depends on your gender and sexual practices. Some sexual practices are much lower risk for getting HIV than others. You can talk to your provider or call the City Clinic PEP line if you have questions about whether you need PEP.
I had sex for the first time recently and the condom got stuck in me and my boyfriend pulled it out. Is there any way I could get pregnant?
Yes, there is a chance of pregnancy any time a condom comes off or breaks during sex. If this happened within the last 5 days, you can come in to get emergency contraception (the morning after pill) [link to emergency contraception page]. Please come in as soon as possible so we can help you get this medicine. If you are not able to come to the clinic, one kind of emergency contraception (Plan B) is available without a prescription at most pharmacies. If this happened more than 5 days ago, then emergency contraception is no longer recommended but you can take a pregnancy test. To get an accurate result, you will want to take the test 10 to 14 days after sex. You can buy an over-the-counter test at a drugstore or visit City Clinic or another medical provider. Planned Parenthood is also a good source for confidential help. To find a Planned Parenthood center near you, visit http://www.plannedparenthood.org/findCenterProcess.asp
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.
I got a Depo shot 3 months ago but now I want to try to have a baby. How soon can I get pregnant?
It can take a long time after your last Depo shot for your fertility to return. The average amount of time it takes someone to get pregnant after stopping Depo is 9 to 10 months – this means about half of people who stop Depo will get pregnant within 10 months. By 18 months after the last shot, about 90% of people will get pregnant [https://managingcontraception.com/after-taking-only-two-depo-provera-shots-how-long-will-it-take-for-me-to-become-pregnant-30315/ and https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020246s036lbl.pdf ]. If someone wants to use Depo and knows she would like to be pregnant within a year or so, Depo may not be the best method (especially for people over age 35). If you are planning to conceive in the near future and have used Depo, we encourage you to talk to your provider about other methods of birth control, or when to stop using Depo.
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 gay man. I'm not on PrEP because I basically never have anal sex, and when I do, I always use condoms. When I hook up, its usually oral sex or mutual masturbation and I never let anyone cum in my mouth. Last night I was drunk and gave a blow job to a guy who came in my mouth. Should I take PEP?
PEP, or Post-Exposure Prophylaxis (prevention) is the use of combination anti-HIV medications after an exposure to HIV. Giving head is extemely low risk in terms of HIV transmission, and we do not generally recommend PEP for people who perform oral sex on someone else, unless in very specific situations - for instance the person giving head has bleeding gums, recent dental work or open sores in the mouth. Receiving oral sex (i.e. having someone blow you) is an even lower risk activity.
I am a gay man. Everyone I know is on PrEP. Its hard to find a hook-up because I'm not on PrEP. But I only have sex about 1-2 times a month, and don't want to take a pill everyday. I've heard that there may be another way to take PrEP. Is it safe?
PrEP is very safe and highly effective and is recommended for people at risk for acquiring HIV. Feel free to talk to staff at City Clinic or your health care provider about how to take PrEP. If you don't think you're high enough risk to take PrEP everyday, you can talk to your provider about just taking PrEP before and after you have sex. This is called 2-1-1 PrEP and is a good option for some men.  In 2-1-1 PrEP, you take 2 pills of Truvada 2-24 hours before sex and then if you have sex, you take another pill 24 hours and 48 hours after the double dose.   Talk to your provider to learn more about it and to make sure you understand how to use 2-1-1 PrEP correctly.
I am a gay man and just got diagnosed with anal warts, does this mean I'm at risk for anal cancer? Should I get an anal pap smear?

While anal warts themselves are unlikely to develop into anal cancer, people who have had anal warts are more likely to get anal cancer. This is because people who are infected with HPV subtypes that cause anal and genital warts are also more likely to be infected with HPV subtypes that cause anal cancer.

Infection with HPV is common, and in most cases the body can clear the infection on its own, but in some people the infection doesn't go away and becomes chronic. Chronic infection, especially with high-risk HPV types, can cause certain cancers over time, including anal cancer.

There are currently no national recommendations to screen for anal cancer. If you are living with HIV, then there is a higher risk of anal cancer and an anal pap smear could be considered. You should talk with your healthcare provider to determine whether an anal pap or other screening test might be useful for you.

There is also an excellent vaccine that protects against 9 of the most common strains of HPV -including 4 high-risk strains and 5 strains that can cause warts. Its recommended that all men and women <26 receive this vaccine.  Since you may not have been infected with all 9 strains, the vaccine could still provide some benefit to you.  If you have not already been vaccinated,  you should talk to your provider about getting vaccinated. 

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.

Genital warts are most likely to be transmitted to your sex partners when the warts are actually present but sometimes warts are too small to easily see. Very little is known about passing HPV to sex partners if the virus is present but no warts can be seen. It is possible that your partner has already been exposed to this strain of HPV but didn't get any warts.

There is no way to know for sure though because there are currently no HPV tests for men. There is an excellent vaccine that protects against 9 of the most common strains of HPV -including 4 high-risk strains and 5 strains that can cause warts. Its recommended that all men and women <26 receive this vaccine. If you or your boyfriend have not already been vaccinated, you should talk to your providers about getting vaccinated.

I am a gay man and am exclusively a top. Most of my partners are HIV-negative and on PrEP. I don't think I'm at high enough risk to be on PrEP - seems like overkill. What do you think?

What a great question! PrEP is just one of several HIV prevention tools; deciding to take PrEP is a personal choice. As you say, people who only top statistically have a lower chance of acquiring HIV- according to the CDC, 0.1% as the top compared to 1% as the bottom (receptive anal sex). Some things to consider in deciding if PrEP is right for you: -Is your sex partner truly HIV negative, are they taking PrEP correctly, do you want control over HIV prevention by taking PrEP, are you ok with the small risk associated with getting HIV as a top if not on PrEP and not using condoms?

Overall PrEP is very safe and highly effective and is recommended for people at risk for acquiring HIV. Feel free to talk to staff at City Clinic or your health care provider about how to take PrEP. If you don't think you're high enough risk to take PrEP everyday, you can talk to your provider about just taking PrEP before and after you have sex. This is called 2-1-1 PrEP and is a good option for some men. Talk to your provider to learn more about it and to make sure you understand how to use 2-1-1 PrEP correctly.

I'm a gay guy and have been together with my boyfriend for over a year. We don’t use condoms. Recently I've become worried that he's having sex with other people. It has me wondering if I should ask him to start using condoms again? How can I do that without a fight?
You describe a difficult situation - that is, what to do when agreements about condom use and sex may feel broken. The best thing to do is to discuss the situation and acknowledge that you are concerned about your own health, as well as your partner's health. If you focus on the health aspects and not the relationship issues, you may be successful when bringing up the subject with him. It will be a tough discussion and you have to decide if your love is worth it. With all that said, you both may want to consider getting on PrEP, and at the minimum making sure to have your provider do routine STI testing recommended for gay and bisexual men.