HIV & STI Field Guide for Men who have sex with other Men

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HIV & STI FIELD GUIDE FOR MEN WHO HAVE SEX WITH MEN

HIV – human immunodefficiency virus

Human immunodeficiency virus (HIV) is a virus that attacks the immune system, your body’s natural defense against disease. Both the virus and the infection it causes are called HIV. If you have HIV and do not receive treatment, the infection can lead to acquired immunodeficiency syndrome (AIDS). However, being infected with HIV does not mean that you have AIDS. If you receive treatment for HIV, the damage to your immune system can be slowed down or stopped, thus significantly decreasing your risk of developing AIDS. With treatment, many people with HIV live long and active lives.

How is HIV spread?

  • HIV is passed through blood, semen, or breast milk. In order to get infected, blood or semen from who is HIV positive has to enter the bloodstream of someone without HIV.
  • Most new HIV infections occur during unprotected anal sex, through small tears inside the anus or on the penis.
  • HIV can also be spread while sharing needles during injection drug or steroid use or by sharing equipment when getting a tattoo or a body piercing.
  • HIV doesn’t survive for very long outside the body and isn’t spread by casual contact (such as by kissing, shaking hands, or hugging someone).

What are the symptoms of HIV?

  • Many guys who have been infected with HIV report flu-like symptoms including nausea, vomiting, night sweats, swollen glands, fever, and skin rashes. These may occur about 10 to 14 days after being infected, lasting for one or two weeks. This is known as seroconversion illness.  
  • Not all guys experience seroconversion illness; further, since this illness resembles the flu, it is sometimes misdiagnosed.
  • During the first few months following infection, the HIV virus is rapidly reproducing, making the newly infected individual much more likely to pass on the virus. This phase of the virus is called acute HIV infection.
  • After the first few months of HIV infection, viral load naturally decreases. When the viral load is lower, the infected person may not feel ill, although he still has HIV and can pass on the virus to other guys.
  • Many guys take HIV medications to slow down the virus. If medication is taken properly, it is possible to attain an “undetectable” viral load. This means that the amount of HIV in the blood and semen is very low, making it less likely to pass the virus to others.

How do you test for HIV?

There are three main tests used to detect HIV. Currently, only two are available in Saskatchewan, the Rapid (Point of Care) HIV test and the Standard HIV test.

How do I protect myself?

  • Regular use of condoms will greatly reduce the chances of getting HIV and other STIs. Having other STIs or being with a guy who has other STIs increases the chances of picking up HIV.
  • HIV is often passed along by guys who don’t know they are infected. Thus, limiting the number of different guys you have sex with will also reduce your risk. If you have sex with multiple partners, get tested regularly.
  • Don’t share needles when using drugs.
  • If you are getting a tattoo or a piercing, make sure that the business you are going to follows health and safety standards regarding HIV.
  • If you think you’ve been exposed to HIV, get tested as soon as possible.

Hepatitis A

Hepatitis A is a virus that causes liver inflammation. After a brief illness, most people get better on their own.

How is hepatitis A spread?

  • Hepatitis A is passed through the feces of an infected person.
  • The most common way to contract hep A from eating food or drinking water that has been contaminated with the feces of an infected person.
  • One can get hep A from licking the anus (or rimming) of a guy who has been infected.

What are the symptoms of hepatitis A?

  • Symptoms usually develop within two to eight weeks following infection. Sometimes the symptoms are very mild and many people don’t realize that they have the virus. Such symptoms may include a general flu-like feeling with a loss of appetite, fever, nausea, and vomiting. Dark-coloured urine, clay-coloured feces, yellow skin and/or eyes, and tenderness on your right side below your ribs are also symptoms.
  • Symptoms might last from two weeks to several months, but you will recover. After recovering from hepatitis A, you will be immune to reinfection but you can still get infected with other hepatitis viruses like hepatitis B or C.

How do you test for hepatitis A?

Be honest with a health care professional about your sexual history and your symptoms. You may be asked to have a blood test to confirm the presence of hepatitis A antibodies.

How do I protect myself?

  • There is an effective vaccine that will prevent infection; it is free for gay men. You could share a shower or suggest one to your partner before you lick his anus.
  • Avoid drinking water that could be contaminated with fecal matter, especially when you are travelling in countries in the developing world. Avoid eating fruits or vegetables that have been washed in contaminated water.

Hepatitis B

Hepatitis B is a virus that causes liver inflammation. Most people infected with hepatitis B will get a mild case and will completely recover. This is called an acute or short-term infection. For a small number of guys, their bodies do not clear the virus on their own and they go on to develop chronic or long-term hepatitis B.

How is hepatitis B spread?

Hepatitis B is spread through direct contact with saliva, blood, semen, or other body fluids from an infected guy. It is passed during sex or by sharing drug equipment like needles, cocaine straws, and crack pipes.

What are the symptoms of hepatitis B?

  • Whether you have acute or chronic hepatitis B, you may or may not have symptoms.
  • Symptoms of acute hepatitis B usually develop within four to six weeks of infection. Sometimes the symptoms are so mild you might not realize you have the virus. You may notice a general flu-like feeling with loss of appetite, fever, nausea, and vomiting. You might also notice dark-coloured urine, clay-coloured feces, yellow skin and/or eyes, and tenderness on your right side below your ribs.
  • Symptoms of a chronic hepatitis B infection can be similar to those of an acute hepatitis B: they tend to be mild to moderate in intensity and typically they come and go.

How do you test for hepatitis B?

Be honest with a health care professional about your sexual history and you drug use. You may be asked to give a blood sample to confirm the presence of hepatitis B antibodies.

How do I protect myself?

  • There is an effective vaccine that will prevent infection; it’s free for gay guys.
  • Regular use of condoms will reduce your chances of getting hepatitis B and other STIs.
  • You can reduce your chances of coming into contact with hepatitis B by reducing your number of sexual partners and by not sharing drug equipment.

Hepatitis B and HIV

  • Because HIV weakens the immune system, HIV-positive people who are also infected with hepatitis B are more likely to progress to chronic hepatitis B. If you have both HIV and hepatitis B, consult with your doctor about your options.

Hepatitis C

Hepatitis C is a virus that causes liver inflammation. There are acute and chronic stages of the disease. A small number of guy’s bodies are able to clear the virus on their own during the acute or early stage of infection. However, this is not the case for most people and, as a result, they develop chronic hepatitis C.

How is hepatitis C spread?

  • Hepatitis C is passed when blood from an infected person gets into the bloodstream of an uninfected person. Microscopic traces of blood can carry the virus and the virus can survive in dried blood outside the body for several days to weeks.
  • The most common way to get hepatitis C is by sharing needles during injection drug use. Sharing cocaine straws and other drug equipment that may have blood on it is another way to get hepatitis C.
  • Hepatitis C can be passed during certain types of sex between guys. This usually occurs when an infected partner inserts a penis, sex toy, or hand into the anus of another guy. This often happens during group sex, where more than one bottom is sharing the same top or sex toy. Both rough sex and prolonged sex increase the chances that blood will be passed between guys. Sharing lube and poppers during group sex may also be ways to pass hepatitis C.
  • Hepatitis C is not passed in semen or feces.
  • Less commonly, hepatitis C can be passed when people share razors, nail clippers, or other personal care items that may have blood on them.

What are the symptoms of hepatitis C?

  • Hepatitis C may not produce symptoms for several years. Many people are surprised to find out they have been infected.
  • The acute or early stage is the first six months after infection. During this time, you may experience a general flu-like feeling with a loss of appetite, fatigue, and fever. You might also notice dark-coloured urine, yellow skin and/or eyes, and tenderness on your right side below your ribs. Many people do not experience any symptoms at all. A small number of guys’ bodies will clear the infection on their own during this stage.
  • Chronic or long-term infection occurs in the majority of people; their bodies aren’t able to clear the infection on their own during the acute stage. Symptoms typically do not occur for several years. Gradually, however, the disease progresses to the point where the liver cannot function properly. Fatigue and poor appetite are common problems at this stage.

How do you test for hepatitis C?

Be honest with a health care professional about your sexual history and your history of drug use. You may be asked to give a blood sample to test for hepatitis C antibodies.

How do I protect myself?

  • Try to eliminate your exposure to the virus.
  • Don’t share anything that may have blood on it.
  • Don’t share drug equipment, especially needles, cocaine straws, or pipes.
  • During sex, don’t put anything into your anus that might have someone else’s blood on it. Sharing lube or poppers should also be avoided.
  • Use condoms during anal sex, and use plenty of lube to reduce tearing in your anus. Have anal sex for less time, and with less force. For fisting, use gloves on a clean arm and don’t share lube. Change condoms or gloves each time you move between partners. Be sure to wash up between partners as well.
  • You can reduce your chances of coming into contact with hepatitis C by reducing your number of sexual partners. If you have numerous partners, get tested regularly.

Hepatitis C and HIV

  • HIV-positive folks are especially vulnerable to getting Hepatitis C during sex. Compared to HIV-negative people, HIV-positive individuals’ bodies are less likely to clear Hepatitis C on their own. They are also less likely to respond to antiviral drugs.

Human Papilloma Virus (HPV or Genital Warts)

Human papilloma virus (HPV) is the most common sexually transmitted infection (STI). There are various strains or types of HPV that may show up on your penis or anus as genital warts.

What are the symptoms of HPV?

  • Almost everyone will be exposed to HPV during his lifetime, but most will never know it because they don’t develop visible warts or other symptoms.
  • Some “low-risk” strains of HPV may cause genital warts that appear weeks or months after exposure. Small warts look like small bumps or pimples; bigger ones can look like cauliflower. The warts are usually painless but sometimes they itch or burn; occasionally they may bleed. The warts are bothersome but are usually benign.
  • A small number of “high-risk” HPV strains are not associated with warts but in rare cases they may cause anal (or cervical cancer in women).

How is HPV spread?

HPV is extremely common and spreads very easily. HPV is usually spread through anal sex, but can also be transmitted through oral sex, rimming, or skin-on-skin contact.

How do you test for HPV?

  • Currently there is no easy test for HPV. Most doctors or nurses diagnose HPV by seeing or feeling warts on the genital or anal area.
  • A pap smear is used routinely to test for precancerous cells on a woman’s cervix. Sometimes a similar test is used inside the anus of men and women.

How do I protect myself?

  • Be honest with a health care professional about your sexual history and symptoms. Ask for a physical exam.
  • Your options might include a vaccine called Gardasil. It was approved by Health Canada in February of 2010 for boys and men age nine to 26 for the prevention of infection caused by HPV. It’s most effective if it’s given before men become sexually active. Currently, guys are being asked to pay for it at a cost of $150 to $300. Young girls are routinely immunized; there is a debate as to whether or not to do the same for boys.
  • Condoms will reduce exposure. Condoms do not guarantee protection because they don’t cover all of the skin surfaces from the penis and/or anus), but using them will reduce your overall exposure.
  • Limiting the number of different guys you have sex with will also reduce your exposure.

HPV and HIV

·         Nearly all HIV-positive guys have been exposed to HPV.

  • Visible warts may be harder to treat if you are HIV positive, especially if your CD4 cell count is low. You may also be at increased risk of getting precancerous cells just inside your anus (anal dysplasia). If you are concerned about this, talk to your doctor.

Chlamydia

Chlamydia is a sexually transmitted infection (STI) caused by bacteria. The bacteria infect the urethra, which is the tube that carries urine and semen through the penis. Chlamydia can also infect the anus or throat. Chlamydia is one of the most common STIs and is spread very easily. It can be picked up or passed on through anal or oral sex.

Symptoms of chlamydia

  • Symptoms appear one to two weeks following infection. Chlamydia produces a burning sensation during urination and sometimes a pus-like discharge from the penis. Some guys get a painful swelling of the testicles called epididymitis.
  • Guys who have bottomed with a chlamydia-infected partner often experience anal discomfort or discharge. In rare cases, chlamydia can appear in the throats of men who perform oral sex on guys infected with chlamydia.
  • Many guys who are infected with chlamydia don’t show any symptoms.

How do you test for chlamydia?

The doctor or nurse will ask you for a urine sample or they may swab the urethra (the opening of the penis).

How do I protect myself?

  • Regular use of condoms will reduce your chances of picking up or passing on chlamydia and other STIs.
  • Limiting the number of guys you have sex with will also reduce your risk. If you have lots of partners, get tested regularly.
  • Don’t have sex with a guy if he has chlamydia symptoms, or if he is being treated for chlamydia.

Chlamydia and HIV

  • Regular use of condoms will reduce the risk of picking up or passing on both chlamydia and HIV.
  • Having any STI or having sex with someone who has an STI will increase your risk of picking up HIV.
  • If you already have HIV, having chlamydia may increase your viral load increasing the chances that you’ll pass HIV on to others.

Gonorrhea

Gonorrhea is a sexually transmitted infection (STI) caused by bacteria. The bacteria infect the urethra, the tube that carries urine and semen through the penis. Gonorrhea can also infect the throat, anus, testicles, prostate, bladder and, in rare cases, the eyes.

How is gonorrhea spread?

Gonorrhea is spread quite easily. You can pick up or pass on gonorrhea through oral or anal sex.

What are the symptoms of gonorrhea?

  • Symptoms appear one to three weeks after infection. You may experience a burning sensation during urination, or there may be a pus-like discharge from your penis. Some guys experience a painful swelling of the testicles called epididymitis.
  • Guys who have bottomed with a gonorrhea-infected partner often experience anal discomfort or discharge. In rare cases, gonorrhea can appear in the throats of men who perform oral sex on guys infected with Gonorrhea.
  • Some guys don’t experience any symptoms at all but this doesn’t mean they’re not contagious. If you think you’ve been exposed to gonorrhea, get tested.

Testing for gonorrhea

Be honest with a health care professional about your sexual history and symptoms, and ask for a physical exam. You may be asked to give a sample of your urine or some fluid may be collected from your penis, anus, or throat.

How do I protect myself?

  • Regular use of condoms will reduce your chances of getting gonorrhea and other STIs.
  • Limiting the number of different guys you have sex with will also reduce your risk. If you have numerous partners, get tested regularly.
  • Don’t have sex with a guy if he has symptoms or if he is being treated for gonorrhea.

Gonorrhea and HIV

  • Having any STI or having sex with someone who has an STI will increase your risk of picking up HIV.
  • If you already have HIV, having gonorrhea may increase your viral load increasing the chances that you’ll pass HIV on to others.
  • Regular use of condoms will reduce the risk of picking up or passing on both gonorrhea and HIV.

Syphilis

Syphilis is a sexually transmitted infection (STI) caused by bacteria. The symptoms of syphilis can be similar to other diseases, which makes it difficult to diagnose.  Syphilis gets into the body through the mucous membranes, like your mouth and anus. Close physical contact—oral sex, anal sex, rimming and fisting—with a guy who has syphilis will put you at risk for infection.

What are the symptoms of syphilis?

Symptoms of syphilis come and go in four stages. You might notice them or you might think you are experiencing a different health issue.

Primary stage:

  • This stage usually starts within days or weeks after you’ve been infected. At this point, you may notice a painless open sore on the body part that has been in contact with the infection; probably on the penis, testicles, anus, or mouth.
  • The infection is passed to other guys through direct contact with the sore. The sore will heal after a few weeks, but even though it goes away, you still have syphilis.
  • Some guys do not notice any sores.

Secondary stage:

  • About four to ten weeks after infection, you might develop a rash on your chest, on the palms of your hands, or on the soles of your feet. General aches and pains or fever may also occur. The infection is passed to other guys through direct genital contact with the rash or mucous membranes (inside of mouth and anus).

Latent stage:

  • Often referred to as the hidden stage, the latent stage of syphilis occurs about a year after infection. While no symptoms may be present, you still have syphilis and you can still easily pass it on to other guys.

Latent (tertiary) stage:

  • Left untreated, the bacteria can cause serious health concerns including blindness, mental illness, problems with the heart and nervous system and even death.

How do you test for syphilis?

Be honest with a health care professional about your sexual history and symptoms; ask for a physical exam. If you have a sore, fluid may be collected from it. Whether or not you have a sore, a blood test will confirm the diagnosis.

How do I protect myself?

  • Syphilis is often passed along by guys who don’t have symptoms and who don’t know they are infected.
  • If you think you’ve been exposed to syphilis, get tested. If you have numerous partners, get tested regularly.
  • Limiting the number of different guys you have sex with will also reduce your risk.
  • Don’t have sex with a guy if he has symptoms or if he is being treated for syphilis.

Syphilis and HIV

  • Having any STI or having sex with someone who has an STI will increase your risk of picking up HIV.
  • If you already have HIV, having syphilis may increase your viral load, increasing the chances that you’ll pass HIV on to others.
  • HIV-positive guys are prone to picking up or passing on syphilis during unprotected anal sex with other HIV-positive guys.
  • Regular use of condoms will reduce the risk of picking up or passing on both syphilis and HIV.

Genital Herpes

Herpes is a viral infection caused by two strains of the herpes simplex virus: type 1 (HSV-1) or type 2 (HSV-2). Type 1 is usually associated with cold sores on or around the mouth. Genital herpes is usually caused by type 2.

How is genital herpes spread?

  • Herpes is an infection spread by kissing, oral sex, or anal sex with a partner who has a herpes infection.
  • Herpes is most transmissible during cold sore or blister flare-ups, but the virus can still be spread if these symptoms aren’t present.
  • Genital herpes can be transmitted by receiving oral sex from a guy with a cold sore. Genital herpes can also be transmitted by giving oral sex to a guy with genital herpes.
  • Symptoms vary from person to person. You might never have symptoms or the symptoms might be so mild that you don’t know you have the virus.
  • You might get itchy, painful blisters on your penis, testicles, or anus. The blisters will eventually rupture and turn into oozing, shallow sores that take anywhere from a few days to a few weeks to heal.
  • After the first outbreak of blisters, the virus moves into the nerve cells and becomes inactive. It springs to life every once in a while, and then travels down the same nerve causing another outbreak of sores. Being stressed, run-down, sick, or sunburned can trigger an outbreak. Eventually, the sores happen less often, heal faster, and don’t hurt as much.
  • If you’ve been exposed to genital herpes, it’ll take up to 14 days to experience your first outbreak. Sometimes symptoms won’t show up for months or even years, making it hard to figure out when the infection happened.
  • If you have an impaired immune system, genital herpes can be more severe.
  • Herpes infection can occur in other areas of your body, such as in your eyes and inside your anus. In rare cases, herpes can cause meningitis or encephalitis (brain inflammation).

What are the symptoms of genital herpes?

  • Symptoms vary from person to person. You might never have symptoms, or the symptoms might be so mild that you don’t know you have the virus.
  • You might get itchy, painful blisters on your penis, testicles or anus. The blisters will eventually rupture and turn into oozing, shallow sores that take anywhere from a few days to a few weeks to heal.
  • After the first outbreak of blisters, the virus moves into the nerve cells and becomes inactive. It springs to life every once in a while, and then travels down the same nerve causing another outbreak of sores. Being stressed, run-down, sick or sunburned can trigger an outbreak. Eventually, the sores happen less often, heal faster, and don’t hurt as much.
  • If you’ve been exposed to genital herpes, it’ll take up to 14 days to experience your first outbreak. Sometimes symptoms won’t show up for months or even years, making it hard to figure out when the infection happened.
  • If you have an impaired immune system, genital herpes can be more severe.
  • Herpes infection can occur in other areas of your body, such as in your eyes and inside your anus. In rare cases, herpes can cause meningitis or encephalitis (brain inflammation).

How do I test for genital herpes?

Be honest with your health care professional about your sexual history and symptoms, and ask for a physical exam. Without a sore, a test can be difficult. If you have a sore, a sample may be sent for testing. In some cases it may require a blood test.

How do I protect myself from genital herpes?

  • Condoms can reduce the spread of herpes. Prevention is never 100%; condoms protect only a portion of the penis or anus.
  • Don’t kiss, have anal sex, or have oral sex if you have symptoms or are being treated for herpes.
  • Don’t kiss, have anal sex, or have oral sex with anyone who has symptoms or who may have recently been exposed.
  • You can also reduce your chances of picking up or passing on herpes by limiting your number of sex partners.

Herpes and HIV

  • Having any STI or having sex with someone who has an STI will increase your risk of picking up HIV.
  • Herpes causes open sores. Open sores make it easier for HIV to be passed on. Even without open sores, areas where previous outbreaks have occurred may still be especially vulnerable to HIV transmission.
  • If you already have HIV, active herpes may increase your viral load, increasing the chances you’ll pass HIV on to others.
  • Regular use of condoms will reduce the risk of picking up or passing on herpes and HIV.

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