Safe sex and other things

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So I'm up at 6 AM with no chance of going to sleep. I thought I'd talk to y'all about sex. I'm not going to bother linking sources because I really don't feel like taking the time to load the pages (my computer's very upset with me right now) just so I can show you that I know what I'm talking about. If you doubt what I'm saying, look it up yourself. If you can't find the information, ask for it. I will provide it. It really shouldn't be too hard, though.

There are a lot of misconceptions when it comes to safe sex, so why don't I dive right in?

Yes, there's no such thing as safe sex. If you want to take that stance, though, there's also no such thing as a safe escalator ride. Or a safe trip to the grocery store. It's all about acceptable risk. In order to best protect yourself, though, you need to know the risks.

First of all, condoms don't protect against all STDs. HPV and herpes are both very common (~1 in 15 and ~1 in 6 people in the US have them, respectively) and passed from skin to skin contact, which means that condoms don't actually provide much protection against them. Syphilis is less common, but is also passed from skin to skin contact.

Secondly, HPV is usually harmless (90% of cases are cured on their own), but calculating from the figures of new infections, percent of cases that clear on their own, how long it takes those cases to clear, and the current number of infected people, I would say that about 1 in 30 people have a HPV infection that will not clear on its own. Furthermore, it can't be tested for. This is why there are people holding HPV as a major practical reason to abstain from sex, since that is really the only way to reduce the risk down to an acceptable amount for them. Whether or not a 1 in 30 chance (not taking into account age, number of sexual partners, etc) of your partner carrying a strain that can't be cleared by your body's immune system is acceptable or not is up to you. Don't let anyone try to tell you what is or is not acceptable for you.

Now, let's talk about herpes. The truth is that most people with herpes never develop visible sores, and even those that do can still pass it along in between outbreaks. It's always transmissible, and condoms are only ~30% effective at preventing its spread. The only way to effectively prevent yourself from contracting herpes is to get tested. Seriously. Get tested. Get your partner tested (and no, this isn't common sense. In America, only about 40% of sexually active women get regularly tested for STDs, and few people demand to see test results before sleeping with someon). This is further complicated by the fact that not all doctors will run herpes tests on people asking for STD testing. Ask to get tested for herpes, and make sure your partner does, too.

Ah, syphilis. Syphilis is a bacterial infection, and can be cleared up with a (rather uncomfortable, I'm told) shot of penicillin (more if it's been in your system for a while), as near as I can figure, 100% of the time. To those allergic or not wanting the shot, there is Azithromycin, which will clear up most strains (though one strain has become resistant to it). So syphilis is no problem, right? Well, two problems with that line of thinking: First, you have to know you have syphilis to be treated for it. People in this day and age still develop complications from syphilis, and antibiotics can't fix the damage done. So, again, get tested. In this case, it's less of an issue of preventing the spread of a STD and more of an issue of being able to prevent damage to your body.

Now, in this post, I've talked about getting tested. It is the best way for sexually active people to prevent getting a STD. Yes, it is (much) better than a condom, as I believe I've demonstrated, though there is still VERY good reason for people using more effective birth control (condoms are 80-90% effective in actual use, depending on the people using them and who you ask) and getting tested to want to use a condom, as I will explain. STDs have a period in between getting infected and being able to test positive for that infection. HIV takes the longest at 6 months. This is why condoms are so important to preventing its spread. Other STDs take time, too (including herpes, so keep that particular risk in mind). By the way: Those with latex allergies and issues can use polyurethane or lamb skin condoms, though they aren't as effective as latex condoms, and lambskin condoms aren't effective at all at preventing the spread of STDs.

I would hope that I wouldn't have to point this out, but I will, just in case: All forms of sex (intercourse, outercourse, oral, anal, and even mutual masturbation) can spread STDs, so be careful with those as well. Outercourse also carries a (smaller) risk of pregnancy than intercourse (anal sex can also carry this risk if the semen leaks out and into the vaginal opening).

My advice is this: If you are sexually active. get tested and use a condom in conjunction with a more effective form of birth control. A condom by itself increases your risk to... well, quite a bit more than with testing. But take care on a number of things: 1. Do not start to get a false sense of security from testing. Wear a condom. 2. Make sure that your partner gets tested before you have sex with them (rather than a 4 month old test, for example), and make sure that you see the results yourself. If they don't care enough to get tested, they aren't worth your time.

One more thing that I'd like to talk about that, it seems, is never talked about goes outside of the physical risks of sex, and into the psychological risks. There are a lot of people out there that regret not waiting. Before you start having sex, really stop and think about whether or not you want to. Not only that, but a bad first experience can taint your experiences (sexual and emotional) down the road. For some people, the best choice really is to wait until marriage (Edit: Not that the only choices are sex now or wait until marriage... it's more like a range for non-asexuals), and plenty of people do it (including for non-religious reasons). It's not nearly as weird as Hollywood would make you think (roughly a third of college seniors are virgins, most for non-religious reasons, and about a third that aren't regret that they didn't wait). For other people, though, the best choice is NOT to wait (in that same study, about half of college seniors did not wait and did not regret it), and there's nothing wrong with that, either. This also applies to people that have already had sex. If you've never really thought about it, then now's the time to do so. And never, ever, EVER let someone pressure you into sex. It's not an obligation.

Hopefully, you didn't need to know any of this. If you did, I'm glad I could help. Good luck in all your relationships, whether they end up in bed or not.

Oh, one last thing! You wouldn't fly in a plane with a pilot that was figuring it out on his own, would you? The same logic should be applied to sex. When talking about safe sex, people often leave out the importance of enjoying sex. Educate yourself and make sure your partner is educated on how to make sex more enjoyable for the both of you. This is especially important for those that plan on having only one sexual partner in their lives, as the lack of experience and ability is a major cause of regret to those that wait.

Where you're talking about that it's okay to wait, it's okay not to wait, either way is fine, and don't let someone push you into something. I kind of describe this as being attune to the energy. If it's positive energy, a person might want to give oneself permission to go forward. If it's more mixed energy, a person want to take his or her time and go to the side. Then, like a lot of things, a series of medium steps and see how it feels after every step.

With health issues, I feel I'm pretty good at focusing on the 80 or 90% and not getting distracted by the rare birds.

So, with herpes, as I understand it, the whole game is abstaining from sexual contact during an outbreak. herpes is a goofy, dopey little virus that at times can make a real nuissance of itself. Like a lot of viruses, it can be hard to treat (although some people have had success with acyclovir to prevent future recurrences). The virus hides in nerve ganglia and at various times, sometimes brought on by various forms of stress, comes down the nerves, replicates and causes small blisters. And I've read that herpes type 1 and herpes type 2 are largely the same, differences of interest mainly to virologists, but as far as clinical symptoms, are largely the same. There is the prodronal (sp?) sometimes described as a pins and needles feeling, when the outbreak is first coming on, and a person is advised to avoid contact during this, but without becoming paranoid. Okay, so, I'm sure there are some cases of it being spread without an outbreak (the human body is tricky in a 101 different ways), but as I've read the lion's share of cases by far are spread during the period when a person has blisters, including new blisters or not-quite-healed blisters. But focusing on avoid contact during an outbreak, a person is focusing on the main game and focusing on what he or she can change. I mean, herpes is largely the same virus that causes cold sores and fever blisters. I tend to think we probably take cold sore underserious and genital blisters overserious, and we miss that all important middle game. (And the other really big thing you don't want to do is to kiss a baby when you have a cold sore.) In fact, one book on herpes recommended as a possible way of broaching the subject to a potential sex partner, 'You know about cold sores, right? And maybe sometimes you might even get one. And important thing is to not kiss someone when you have a cold sore.' So, it's avoidance during outbreak, as 90% or more of the game, I think. And next generation drugs, maybe better than acyclovir, more power to them.

Now, with HPV, another dopey little virus, which is the one that causes genital warts. In some cases it also causes cervical cancer. Ouch! Yes, so it's potentially serious. Which is why I understand most doctors now recommend that pre-adolescent girls get vaccinated, so that when they do become sexual active (or if someone wants to or chooses to be asexual that is perfectly okay, too) they at least won't have this to worry about. But really, I kind of think anyone single or not in a marriage relationship with a lifetime partner might benefit from the vaccine. Because your next partner may not be your last. And I don't want to either get something nor pass something on.

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I'm planning to write a little bit here about influenza and pneumonia, because it's a much less emotionally charged topic and because it's something I know about, so I think I can better explain what I mean about playing a sound middle game, being neither paranoid nor stupidly reckless.

Please Note: I AM NOT A DOCTOR. have thought about medical journalism, feel I rather have a knack for researching and looking things up, and am all-round a pretty alright guy

1. I'll address the second part first: The vaccine is only good for a few years (7, I think), and only protects against some strains of HPV. Cervical cancer is the big one people talk about, but it can also cause other cancers.

2. http://www.cdc.gov/std/herpes/stdfact-herpes.htm

Of note:

3. STDs are never fun. Even if it's not fatal. Herpes and HPV can cause a number of problems. The major problem (as I see it), is this: STDs (including and especially herpes) can be a major barrier to relationships. Not only that, but transmission to a child, while rare, can occur and be potentially fatal. Look at it this way: You mentioned influenza. Even though the risk of fatality for most adults is either zero or near-zero, you wouldn't expose yourself to it.

4. Even if they find an anti-viral that works on herpes, the same problems with its spread exists with syphilis (though, admittedly, it's not as dangerous untreated). You have to know you have it to get treatment, and in order to know that you have it, you have to get tested.

5. A lot of people's judgement gets clouded when it comes to STDs because of beliefs and/or urges. People who just want to go out and get laid tend to underestimate the risk and complications of STDs, and people who believe strongly in abstaining tend to overestimate the risk. I'm germophobic, and a bit romantic, so maybe I overestimate the risk of sex without getting tested. I also feel that illnesses stress the body in unnecessary ways (your body's immune system can get a workout without you getting sick), but I think that, overall, I have a much less biased view than most out there.

I can go along with that. Trying to find the middle path.

Now, I've got to tell you, yes, you've used a good reference, yes, it's CDC. Still, I think they're hedging their bets, I think they giving advice that is "safe" from the perspective of the advice giver, so someone is not going to come back and blame them. Rather than advice that is genuinely useful and informative to the person receiving the advice. Honest to gosh, things I've read, 90% of it is avoiding contact when blisters are forming, are present, or are not quite healed. I would be interested in studies of couples, where one partner has it and one partner doesn't at beginning of relationship, if they practice prevention, how likely is it that partner without it will end up getting it? And I really don't know. Don't know if there are such studies.

Now, as you say, babies are more susceptible to herpes. And as always, you want a doctor you can halfway talk with (and many doctors can't talk worth sh*t, to be frank about it), so halfway talk with is perhaps the most a person can hope for. And if a woman has an outbreak of genital herpes, she should not have a vaginal delivery. At a certain point, perhaps she and her doctor should begin considering a Caesarean so it's not a big surprise and a last minute thing. And also, it may seem like a very small point, but important, if a person has a cold sore or fever blister, the person should not kiss a baby.

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Okay, as advertised, about influenza and pneumonia (which it occasionally causes).

1)if a person has flu, and starts having trouble breathing, get some damn help. Please. All the exhaustive news coverage on H1N1 and, almost in zen simplicity, it comes down to this.

2) In addition, there is a pattern that if a child (or presumably an adult) seems to be recovering but then relapses with high fever, that relapse might be bacterial pneumonia. Again, get some damn help. Like a doctor calling in a prescription within a couple of hours. Or, this one, I think warrants a trip to the emergency room. But you're going to still be waiting there. The advantage of having a pre-existing good working relationship with your doctor, if that he or she can call in the prescription, you can start the medication for yourself or your child in the same time it would take you to wait in the emergency room.

3) Flu (again, occasionally) can lead to either direct viral pneumonia or secondary bacterial pneumonia. Often it's unclear which one, and in these cases it's recommended that such patients be treated with both an antibacterial and an anti-viral (like Tamiflu). One study of hospital patients with flu symptoms and suspected pneumonia found almost all got antibiotics but only about three-quarters received an anti-viral. Again, valuable to be able to talk with your doctor.

4) Most common symptoms of flu are fever and dry cough. It is recommended for people in risk groups, if flu is in the area and you start getting symptoms, begin antivirals. Not everyone is going to follow this. So, second line of defense, again is: if trouble breathing --> get some help.

Following are two references regarding flu:

Dr Nikki Shindo, Medical Officer, Global Influenza Programme,
World Health Organization
12 November 2009
http://www.who.int/mediacentre/vpc_tran ... shindo.pdf

" . . . In a country where the virus is circulating, we have 3 updated recommendations.

“1. Firstly, people in at-risk groups need to be treated with antivirals as soon as possible when they have flu symptoms. This includes pregnant women, children under 2 years old, and people with “underlying conditions” such as respiratory problems.

“2. Secondly, people who are not from the at-risk group but who have persistent or rapidly worsening symptoms should also be treated with antivirals. These symptoms include difficulty breathing and a high fever that lasts beyond 3 days.

“3. Thirdly, people who have already developed pneumonia should be given both antivirals and antibiotics, . . . ”


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“Report Finds Swine Flu Has Killed 36 Children,” New York Times, Denise Grady, Sept. 3, 2009.
http://www.nytimes.com/2009/09/04/healt ... .html?_r=1

“ . . . In children without chronic health problems, it is a warning sign if they seem to recover from the flu but then relapse with a high fever, Dr. Frieden said. The relapse may be bacterial pneumonia, which must be treated with antibiotics. . . ”<--This is the kind of medical advice that I like. I mean, in poker terms, this is a playable hand!

Keep in mind that all the delivery advice and precautions in the world still does not remove the risk entirely (Edit: If you want, I can look up statistics).

http://www.annals.org/content/116/3/197.short

In 70% of cases, there were no symptoms.

(Actually, the reduced risk for men is something that's interesting: I'm wondering if it only has to do with the acidity of men's skin or if there are other factors involved)

I don't understand why you posted influenza information in a topic dealing specifically with sex. (I also don't like the fact that you linked a Swine Flu story. It worries me about where you normally go for sources)

I'll be honest, I didn't read your whole post... my computer battery is about dead and I don't have time

What I will say is: unless you are in a committed relationship and want children, ALWAYS PLAY IT SAFE! Wrap it up if you're a guy, take the pill if you're a girl, and make sure the guy always wraps it up. If you know you never want kids, just get a vascetomy.

Having unsafe sex isn't worth it whether it's because you'll get an STD or get someone pregnant/get pregnant. DON'T DO IT! EVER!

You can always double the protection, too: guy wears a condom, girl is on the pill.

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Which is a prime example of why, if you can't read the full post, you set it aside for later until you can, rather than reply.

I learn about several things as well...

1. Condom can break.

2. Fluid can still leaks from condom.

3. Your saliva is not protected.

4. Health Department or suitable place is your testing center for testing.

5. HIV testing can be done for free at a local community college if there are sponsor.

6. Same blood type may be safer than different blood types.

7. Most people probably don't know the STD's symptom by heart but visual inspection is more revealing than internal inspection.

Syplish - recognized having a dime color spot at different skin

Herpes - crusted from different area

That's all I can remember about spotting.

Symplish impaired brain function and can leads to brain damage.

Everybody don't have equal size and female are likely to bleed if broken or menestrual or something.

I think you are kind of screwed either way. There is no such thing as safe, only relatively safe. I dont really want to stay living in a cave because of all the diseases out there though.

And, there is Hepatitis.

Listen. I've definetly had my scares, but i'm no longer a hussy. I wear rubbers everytime i do anything with another person. I dont even have unprotected oral sex anymore and kissing is completely off limits oh no

That's how I got HPV- during sex with a condom. I had no idea I had it until a doctor's visit (no symptoms). I go years at a time never "remembering" that I have it, but it's still something I have to worry about telling someone I'm in a relationship with.


There's been a test for the 18 types which affect the cervix for well-over eight years now, and it also identifies low versus high risk strains. It's done automatically when women have a Pap smear.

Tests detect present pathologies, they don't prevent their transmission.

Very true, and how shocking! After the HPV scare, I went to a health clinic to have the supposed "full battery" of STD tests- it does not include herpes, nor do the routine ones run by my gynecologist.


Multi-drug resistance is quickly becoming a problem as with all bacterial infections (MRSA, anyone? Gram negatives, as well.) and those for whom penicillin does not effectively penetrate the nervous system must be given intraVENOUS antibiotics daily for ten days.




*IF* they have an already-established policy of only sleeping with people who are first diagnosed as STD-free (as you've already pointed out, most women do not)

*IF* they know to request a specific STD test (as we've discussed, Herpes is not included in most test batteries or ordered by most gynecologists, and to my knowledge there is no HPV test for men)

*IF* their partner does not have a disease which is still in a latent phase before becoming clinically-detectable by modern testing (HIV and other viruses, for instance)

and most importantly

*IF* it is 100% certain that both partners are sexually monogamous in every way (Herpes Simplex type 1 is NOT limited to the oral cavity- it can be spread all around the body).

As I said, testing detects pathologies. If they are clinically-detectable at the particular time.
It in no way prevents transmission.

It is quite clear that the most reliable and responsible mode of action is condoms IF you are going to choose either testing or condoms- a physical barrier between the mucosal membranes is the single safest way to protect oneself. But obviously the safest is both a barrier method, regular testing, and an additional method of birth control.


Most infected people have developed HIV antibodies detected by current clinical testing thresholds at 4-6 weeks following exposure, and 99% within 3 months.


Absolutely- in fact anal sex can carry a higher risk than vaginal to the recipient because tearing is more likely, even if not noticeable. Microscopic tears count.


Absolutely!

Let me tell you something: I'm annoyed.

I originally posted a rant about why I was annoyed. Basically, though, Bethie was the only one with the knowledge to correct the information I screwed up (either from out of date information or from it being 6 AM and me going on almost no sleep). I would hope, in a society where so many are sexually active, this thread wouldn't go five days without those corrections (I'm not saying that everyone should know everything [I certainly don't], but if people knew as much as they should, I would've been corrected within the first couple of days).

(By the way, with the IFs, those are the assumptions that I take. The advice I give on reducing the risk of STD transmission takes the first three into account... unfortunately, there's no certain way of saying that a relationship is monogamous, only a certain way of saying that it isn't)

Thank you, Bethie, for pointing out the information I screwed up (Edit: Or was unclear on). I may correct my post later to take your corrections into account.

Edit: By the way, I found some information on HIV testing (why they say 6 months):

Edit2: From the CDC itself (second question): http://www.cdc.gov/hiv/topics/testing/r ... /index.htm