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A safer sex guide
for men who have
sex with men
Contents
4
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SEXUAL HEAL
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STI’s (Sexua
ORAL SEX SUCKING or
CONDOMS TH SERVICES
SEXUAL HEAL
Phone: 0191 233 1333
www.mesmacnortheast.com
[email protected]
www.facebook.com/MesmacNorthEast
www.twitter.com/TeamMesmac
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SEXUAL HEALTH
SEXUAL HEALTH
(For men who have sex with men)
Introduction
In this booklet we cover the sexual health concerns
of gay and bisexual men and men who have sex
with other men. MESMAC North East can offer
information and advice on your sexual health in
person, over the phone, through our website or
from this booklet. If you don’t find the information
you are looking for please contact us on the phone
number at the back of this booklet.
Information in this booklet includes:
• Sexual health
Sex and You!
A lot of people question their sexuality at some
point in their lives, for most it’s when we are
teenagers but for others it can be at anytime
during their lives. Sometimes people can be in
a straight relationship and something might not
feel right or something may even happen to make
them question their sexuality. For that reason
when talking about sex in this booklet we will cover
some sex with women as well as sex with men.
Having a healthy sex life involves knowing what
risks there are from STI’s to unplanned pregnancy
to even the type of sex you have.
Sex means different things to different people, to
some it’s not that important but, to others it can
be a compulsion.
• STI’s (Sexually Transmitted Infections)
• Safer sucking and oral sex
• Condom usage
• Sexual health services
4
5
Knowing what sex you enjoy and the best ways to
enjoy it are very important, not just for your body
but also for your mind. Sexual frustration can be
quite damaging so it’s important not to push it
aside or to try to ignore it. Talk about it either with
your partner, a trusted friend, your doctor,
a sexual health advisor or a MESMAC worker.
There are different ‘strategies’ people use when
thinking about safer sex, from always carrying a
condom to abstaining from sex altogether.
Whether single, with a partner, having multiple
sex partners or abstaining, it’s always a good idea
to have a safer sex plan. Think about it, talk to
partners and negotiate what is going to work best
for you.
6
The type of plan you might want
to think about:
• Contact info for the nearest sexual health
service.
• Where to get condoms and lubricant (lube).
• Where in a gay sauna the condoms and lube
are located.
• Your nearest family planning clinic.
• Where to go for sexual health advice.
Always be aware that the affects of drugs and
alcohol can seriously effect your judgment and
can make safer sex difficult to achieve.
7
Whatever your situation try to enjoy
a healthy sex life
A Loving Relationship
For most people, having a regular partner and love
in our life is important. Finding and maintaining
a healthy relationship however takes work and
commitment. If you are having difficulty with
relationships, whether you have a partner or can’t
seem to find the relationship you want, it’s worth
thinking about whether there are things you can
improve upon to find what you want.
• Are you going to places to meet people such as
groups, bars, clubs and saunas?
• Are you trying to mix with people as much as
possible? Talking is the best way of getting to
know someone!
• Do you have any off-putting habits or bad
personal hygiene?
• Are you making the most of your appearance?
Looking good through clothes and hairstyle
can boost your confidence when it comes to
attracting possible partners.
8
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9
HIV Positive Men
There can be a range of issues about your health
and the anxiety about it can affect you keeping
up a fulfilling sex life. There’s nothing wrong with
having lots of sex, or no sex at all. You don’t have
to give up things that give you pleasure and you
may decide to weigh up the pleasure and the risks
involved. How safe, secure and happy you feel
about the sex you’re having can have a big affect
on your general well being. Safer sex information
for HIV+ gay and bisexual men is available on our
website: www.mesmacnortheast.com
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Unfortunately, it’s almost certain that you’ll face
some prejudice and discrimination. Sometimes
it can come from unexpected and unwelcome
sources, and that includes other gay or bisexual
men who are HIV negative or who haven’t been
tested. There’s still a lot of ignorance, and people
can make some very strange, illogical and hurtful
assumptions about you.
HIV is a very personal subject. Having the
chance to discuss your concerns may increase
your own confidence so that you can make
your own informed decisions and take control.
MESMAC continually works towards challenging
the prejudice and discrimination against HIV+
people. It’s hardly surprising if you’re worried and
confused about being HIV+.
11
STI's
MESMAC can offer you help with this, and also
the opportunity to talk about concerns you may
have about things like disclosure of your status,
relationships, abuse, legal issues, illness, HIV
drug side affects, harassment, housing and
discrimination.
MESMAC can put you in touch with other support
groups and specialist HIV workers throughout the
North East. We provide HIV+ gay and bisexual
men with the opportunity to access the following
services:
• Individual support in a safe, friendly and
confidential setting.
• A social group for HIV+ men.
• The latest up-to-date information on a wide
range of issues, from housing to medical
treatments.
• Relevant and practical down-to-earth advice
on sexual health for positive men.
• A reference library with books, journals and
articles on HIV/AIDS from Britain, The USA
and other countries, as well as free sexual
health magazines.
• FREE condoms and lubricant.
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STI’s (Sexually Transmitted Infections)
There are many different STI’s, in this section
we cover the most common:
• Chlamydia
• LGV
• Genital Herpes
• NSU (Non-Specific
Urethritis)
• Genital Warts
• Scabies
• Gonorrhoea
• Hepatitis A/B/C
• Pubic Lice (or crabs)
• Syphilis
• HIV
Cock and Balls
Pubic Area
(Pubic Hair)
Shaft
Blood Vessels
Spermatic Cord
(Arteries and Nerves)
Epididymis
(Where the cum
travels from )
Penis
(Cock)
Scrotum
(Ball Sack)
Prepuse
Testicles
(Foreskin)
Glans
(Knob)
(Balls)
Where the sperm
(cum) is made
At times we will mention sex with women as
well as men for the bisexual men and men in
relationships with women who read this booklet.
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CHLAMYDIA
Chlamydia is a STI caused by small
bacteria that live inside human cells.
It is the most common STI in people
under 25. Left untreated, Chlamydia
can permanently damage the sexual organs
leading to infertility in women and in men. Symptoms
Chlamydia is called the ‘silent’ disease as around
50% of men and 70-80% of women do not
experience any noticeable symptoms.
Because of this lots of people do not know they
have got it. Symptoms in men may include pain
when pissing, a discharge from the cock or pain or
discomfort in the balls. In women there may be pain
when having sex, bleeding between periods or after
sex.
Treatment
Chlamydia can be easily diagnosed through a ‘pee in
a pot’ test or having a swab taken from inside the tip
of your knob, once diagnosed it can be treated with
antibiotics.
Under 25s can get a free, confidential chlamydia
test through the National Chlamydia Screening
Programme or check the local website:
www.checkyourbits.org
People over 25 can visit their GP or a local Sexual
Health Service to arrange a test.
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GENITAL HERPES
Genital herpes is an infection of the
genital skin (below the waist and
between the legs) that is caused by
the herpes simplex virus (HSV).
HSV lives in nerve endings and is the
same as cold sores on the face. HSV can be easily
passed from person to person by close, direct skin to
skin contact. Genital herpes is passed on by having
sex with some one who already has it.
Genital herpes is a long-term (chronic) condition.
Symptoms
At least 80% of people who carry the virus don’t
know that they’ve been infected because there are
often few or no symptoms to begin with. Other
people may develop symptoms very soon after
getting the infection. These usually start as an area
of small blisters that may be itchy and then burst
leaving the area sore and uncomfortable. Sometimes
it can be impossible to pee (more likely to occur
in women) resulting in the need for a hospital
admission.
Even if someone with genital herpes doesn’t have
any symptoms, it’s possible for them to pass the
condition on to a sexual partner as the virus is
present in the skin cells (that are shed) in the area
where the infection has been.
Treatment
When herpes is first diagnosed, medication can be
given to treat it along with painkillers if necessary.
15
Some people will only ever have one outbreak
although the virus will still remain in their body,
others may have further outbreaks. For others the
virus starts up again, causing a further outbreak of
herpes. The symptoms of genital herpes also tend
not to happen as often and not be as bad each time
someone has the condition.
If an outbreak happens more than 6 times in 12
months you or if you prefer the sexual health service
can talk to your GP about treating the virus with
medication, usually over 6 months, in an attempt to
reduce the amount of outbreaks.
GENITAL WARTS
Genital warts are the result of a
viral skin infection that is caused by
the human papilloma virus (HPV).
Genital warts are usually painless
and are not a serious threat to a person’s health.
However, they can look unpleasant and make you
feel unhappy or upset. Genital warts can be spread
during sex, and by sharing sex toys. You do not
need to have penetrative sex to pass the infection on
because HPV is spread by skin-to-skin contact.
Condoms do not provide complete protection
because it is possible for the skin around your
genital area (that is not covered by the condom) to
become infected. HPV is most likely to be passed on
to others when warts are present, although it is still
possible to pass the virus on before the warts have
developed and after they have disappeared.
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Symptoms
Genital warts are small fleshy growths, bumps or
skin changes that appear on or around the genital or
anal area.
It can take up to a year for symptoms to develop
after getting an infection, so if you are in a
relationship and you get genital warts, it does not
necessarily mean that your partner has been having
sex with other people! Warts may grow in clusters
and cause pain when you are having sex.
Treatment
Treatments for warts usually work well. Several
treatments are available, such as using medicated
creams and freezing the warts (cryotherapy).
However it is important to know that many
treatments can take up to three months before they
work properly.
GONORRHOEA
Gonorrhoea is a STI caused by
bacteria called Neisseria gonorrhoea
or gonococcus.
It used to be known as “the clap”.
Gonorrhoea is easily passed between people through
unprotected vaginal, oral or anal sex, and sharing
vibrators or other sex toys, that have not been
washed or covered with a new condom each time
they are used.
Anyone who has sex with another person can get
gonorrhoea, however it is more common with people
17
who change partners more often and people who do
not use a condom when having sex.
Symptoms
Typical symptoms are a yellow/green discharge from
the cock or vagina, pain when pissing and sometimes
a burning sensation and itching. Some people get no
symptoms at all when they have Gonorrhoea.
Treatment
Gonorrhoea can be easily diagnosed through a ‘pee
in a pot’ test or swab and is treated with antibiotics.
You are likely to be asked to come back for repeat
tests after your treatment to check that the infection
has gone.
If you don’t get treatment, it may lead to more
serious long-term health problems and infertility.
Successful treatment for gonorrhoea does not stop
you from catching it again in the future.
HEPATITIS A, B and C
You get Hepatitis when there is
inflammation (swelling ) of the liver,
often caused by a virus.
caught by putting something in your mouth that has
been contaminated with shit containing the virus,
so can commonly be transmitted through rimming
(licking the bum hole for pleasure) for example.
Hepatitis B
Caused by the Hepatitis B virus, it’s present in body
fluids such as blood, saliva, semen and vaginal fluid.
It can be passed from person to person through
unprotected sex or by sharing needles or drug
injecting equipment, for example.
Hepatitis B is not very common in the UK: about one
in 1,000 people are thought to have the virus, MSM
(Men who have Sex with Men) are more at risk of this
virus through unprotected sex.
Hepatitis C
Caused by the Hepatitis C virus, it’s present in the
blood and, to a much lesser extent, the saliva and
semen or vaginal fluid of an infected person. It is
particularly concentrated in the blood, so it is usually
caught through blood-to-blood contact. The most
common way you can become infected is by sharing
contaminated needles or drug taking equipment.
Symptoms
The three main types of hepatitis are described
here:
Hepatitis A
Caused by the Hepatitis A virus, it’s the most
common type of viral hepatitis.
It is more common in countries with poor cleanliness
and sanitation (sewage and rubbish). Hepatitis A is
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There are often no symptoms for Hepatitis A, B, or C,
which is why it is important to get checked regularly.
Symptoms, if you get any, can include feeling tired,
aches, nausea, being sick, pissing darker pee than
usual and being jaundiced (yellowish skin tone).
Blood tests are needed to confirm if you have an
infection, which type it is and whether the infection
19
has cleared itself or needs further investigation.
Treatment
Hep A: In certain parts of the UK sexual health
services will offer all MSM vaccination against
Hepatitis A, if there have been a lot of people
infected locally.
Hep B: A course of vaccinations, which can prevent
getting the virus, is recommended for all MSM and is
available from sexual health services.
Hep C: There is currently no vaccine to prevent
Hepatitis C.
If you show signs of Hepatitis you are most likely to
be referred to a Liver Unit at a hospital where more
tests will take place and you may be offered drugs
that fight the virus, these can clear the infection for
about half of those who are infected.
HIV
The Human Immunodeficiency Virus
(HIV) is a virus that attacks the
body’s immune system.
A healthy immune system provides a natural defence
against disease and infection.
HIV infects special cells, called CD4 cells, which are
found in the blood and are responsible for fighting
infection. After becoming infected, the CD4 cells are
destroyed by HIV. Although the body will attempt
to produce more CD4 cells, their numbers will
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eventually go down and the immune system will stop
working. This leaves a person who is infected with
HIV with a high risk of developing a serious infection
or disease, such as cancer because the immune
system is no longer able to prevent it happening.
How is HIV spread?
HIV is spread through the exchange of bodily fluids.
This most commonly happens during sex, including
oral, vaginal and anal sex. HIV can also be passed on
through sharing needles.
There is no cure for HIV and no vaccine to stop you
from becoming infected. However, since the 1990s,
treatments have been developed that help most
people with HIV to stay well and live relatively normal
lives. The sooner you know you have HIV the better
as treatment can keep you healthy.
What is AIDS?
Acquired Immune Deficiency Syndrome (AIDS)
describes the later stages of HIV, when the immune
system has stopped working and the person develops
a life-threatening condition, such as pneumonia
(infection of the lungs).
The term ‘AIDS’ was first used by doctors when
the exact nature of the HIV virus was not fully
understood. It is not used as much because it is too
general to describe the many different conditions
that can affect somebody with HIV. Specialists now
prefer to use the terms advanced or late-stage HIV
infection.
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Symptoms
The first stage of HIV is known as primary HIV
infection. In people who are infected with HIV, 60%
will develop associated symptoms, usually two to six
weeks after they are first infected with HIV.
Symptoms of primary HIV infection may include:
Fever, sore throat, tiredness, joint pain, muscle pain,
swollen glands (lymph nodes), or a blotchy rash on
the chest. These early symptoms are often very mild,
so it is easy to mistake them for something else, like
a cold or glandular fever. After this HIV will often not
cause any other symptoms for many years. This is
known as asymptomatic HIV infection. During this
time, the virus is still reproducing and damaging
your immune system.
Late-stage HIV infection
Left untreated, HIV will lower the number of CD4
cells in your body to a dangerously low level, and
your immune system will stop working. On average it
takes 10 years for the virus to damage the immune
system in this way. A damaged immune system
will result in you developing a serious infection.
Possible symptoms of a serious infection caused
by a damaged immune system include: feeling tired
all the time, night sweats, unexplained weight loss,
diarrhoea that won’t go away, blurred vision, white
spots on your tongue or mouth, dry cough, shortness
of breath, a fever of above 37C (100F) that lasts
a number of weeks, or swollen glands that last for
more than three months.
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AIDS-related illnesses, such as tuberculosis,
pneumonia and some cancers, may appear. Many of
these, though serious, can be treated to some extent
and some are likely to improve if you start treatment
and your CD4 cell levels increase.
Monitoring
If you are diagnosed with HIV, you will be offered an
appointment to a HIV or Sexual Health Service. You
will also be offered counselling. You will need to have
regular blood tests to check how the HIV is affecting
your body.
As part of the blood testing two main things are
checked:
Your CD4 count - which is the number of CD4 cells in
your blood.
Your viral load - which is the amount of HIV in your
blood.
These tests allow the staff at the HIV service to see
how far the disease has progressed, and whether you
might develop an infection.
Treatment
If the level of CD4 cells fall below a certain
level (currently 350) you will be advised to start
medication called HAART. This holds back the growth
process of the HIV and allows CD4 levels to increase.
Once HAART is started it should not be stopped
without discussing it with your doctor because
the disease can then come back quickly and the
medication may not work again.
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LGV
Outlook
There is no cure or vaccine for HIV and researchers
believe it will be many years before either is found.
However, special medicines that are used in what
is known as Highly Active Antiretroviral Therapy
(HAART) have been really successful in slowing down
HIV and helping people to live longer. Researchers
are confident that improvements in therapy will mean
that a person with HIV will live as long as somebody
who does not.
PEP – POST EXPOSURE
PROPHYLAXIS
PEP may stop someone from getting
HIV as long as the treatment is
started within 72 hours (3 days) of
having unsafe sex or condom failure. The sooner
it is started the better the chance of HIV being
prevented.
PEP means taking anti-HIV drugs for 4 weeks and
can have side effects. PEP is not a cure for HIV and
is not guaranteed to prevent HIV from taking hold
once the virus has entered the body. PEP is available
from Sexual Health Services and most Accident &
Emergency centres across the North East.
You might only get the first 5 days of medication
from A & E, so you would need to go to a sexual
health clinic to get the further medication needed.
Call MESMAC North East if you would like more
information.
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LGV stands for ‘lymphogranuloma
venereum’. It’s a serious STI caused
by a type of chlamydia bacteria. In
2004 the first cases were noticed
in gay and bisexual men and is now seen more in
MSM.
Symptoms
A few people have had LGV without noticing but most
get symptoms within a few weeks. Most gay and
bisexual men get infected with LGV inside their bum.
This can cause painful swelling (proctitis).
Going to the toilet might become difficult and
painful, and you may get an abscess or ulcer. Some
people feel ill, get a fever and might lose weight.
If you get LGV in your cock you might also get a
discharge or pain when you piss and the glands in
your groin can swell.
You don’t often get LGV in the mouth or throat.
There may be a small, painless sore where the
bacteria got into your bum or penis but most people
don’t get or notice a sore.
Untreated LGV can cause lasting damage for
example: the inside of your bum can be so seriously
damaged that you might need surgery and your
penis and scrotum can swell massively with blocked
fluid.
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The Unusual Suspects
Anyone can catch a sexually transmitted infection!
Syphilis
am
Chl
ydia
Herpes
HIV
Crabs
26
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Treatment
As long as it’s treated quickly LGV can be cured in
three weeks of starting antibiotics and leaves no
lasting damage. Because of the bleeding and skin
damage LGV causes it makes it easier to pick up or
pass on HIV, hepatitis C, syphilis and other STI’s, so
It’s likely you will be tested for these when attending
a sexual health service.
NON-SPECIFIC URETHRITIS (NSU)
Non-specific urethritis (NSU) is a
condition where the tube that pee
passes through becomes inflamed,
usually due to infection.
The term “non-specific urethritis” is used when
the cause is not yet known (Gonorrhoea is an STI
that can also cause urethritis and tends to be more
serious than NSU). NSU can have a number of
possible causes, but it is thought that chlamydia is
responsible for 75% of all cases.
Symptoms
Symptoms tend to range from mild to a stinging
sensation in the piss tube and this can usually pass
within a few months, this needs to be checked out.
Treatment
You should always have any unusual stinging
sensations checked out with your GP or sexual health
service because of possible causes, and treatment
will be required to prevent the spread of infection.
Antibiotics are usually used to treat cases of NSU.
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Untreated NSU can lead to swelling of the small
tubes in the balls (epididymitis).
PUBIC LICE
Pubic lice (phthirus pubis), also
known as ‘crabs’, are tiny bloodsucking insects.
They live in coarse human body hair,
most commonly pubic hair, and cause
itching and red spots. The lice can also be found in
the eyelashes or eyebrows, hair on the abdomen or
back, and facial hair, such as beards or moustaches
if left untreated. Adult pubic lice are about 2mm
long and are grey-brown in colour. They are caught
through close contact with someone who has them.
The most common way is during sex.
There is not enough evidence to say whether pubic
lice can be passed through items such as bedding
or towels, although some experts think that it might
be possible. Only humans get pubic lice, you can get
them at any age but they are seen most in young
adults.
Symptoms
Pubic lice can cause itching to the infested area and
lay egg sacks at the base of pubic hair which have a
silver or shiny appearance.
Treatment
Pubic lice can usually be successfully treated with
insecticide medicines available over-the-counter
in most chemists, or from a GP or sexual health
service. You should tell any current sexual partners
29
and any partners from the past three months as
they may need to be treated. If pubic lice are caught
through sex, it is best that tests for STI’s also be
done.
SCABIES
Scabies is a skin condition caused by
tiny insects called Sarcoptes scabiei,
which burrow into the skin.
It can be spread through prolonged
skin-to-skin contact (such as sleeping) with someone
who is infected and sexual contact with someone.
Scabies can also be passed on through sharing
clothing, towels and bedding with someone who is
infected. However, this is less likely than getting the
infection through skin-to-skin contact. They feed
using their mouthparts and front legs to dig into the
outer layer of the skin. They eat tissue and fluids as
they burrow.
As they feed within the skin layer, they burrow at a
rate of about 0.5mm a day. The females lay two to
three eggs a day inside the burrow. After three to
four days, the baby insects (larvae) hatch from the
eggs and travel to the surface of the skin where they
lie in shallow pockets before becoming adult insects.
Scabies like warm places on the skin, such as skin
folds, between the fingers, under fingernails or
around the buttock or breast creases. They can also
hide under watchstraps or bracelets, and in the skin
on the finger under rings. Crusted scabies is when
there are insects that have had lots of babies that
30
have spread; this can affect older people and those
with a lowered immune system (the body’s natural
defence against illness and infection).
Symptoms
Scabies is not usually a serious condition, but the
itching can be unpleasant and leave you feeling low
or depressed. Visible signs can be small ‘silver’
threads that you may see that run across the skin.
It can take up to eight weeks before you have any
symptoms.
Treatment
Itching that is caused by scabies can usually be
effectively treated using specialist skin creams, some
of these need to be re-applied over 24 hours and
may need to be put on the body again a few days
later. The itching can persist for several days after
treatment. Scabies can lead to another skin infection
if the skin becomes irritated and inflamed through
excessive itching and scratching. If this happens you
need to see a GP or visit a sexual health clinic.
SYPHILIS
Syphilis is a bacterial infection that
is usually passed on through sex.
Three stages of disease
Syphilis may not always be seen in its three stages,
not everyone will have symptoms and if syphilis is up
the bum changes may not be noticed.
Stage 1 (primary syphilis). Symptoms of syphilis
31
can be painful and highly infectious, they can range
from one to lots of look-alike sores on the genitals or
sometimes on the mouth/tongue/cheek/gums.
If somebody else comes into close contact with the
sore, for example during sex such as oral sex or anal
sex, they can also become infected. The sore lasts
two to six weeks before disappearing.
Stage 2 (secondary syphilis). Secondary symptoms,
such as a rash on the palms of the hands/
soles of the feet, then develop. These symptoms
may disappear within a few weeks, after which
you experience a hidden (latent) phase with no
symptoms, which can last for years. Due to being
in the body untreated for years, syphilis can then
progress to its third, most dangerous stage.
Stage 3 (tertiary syphilis). At this stage, it can cause
serious damage to the body.
two years after becoming infected), syphilis
cannot be passed onto others but you can still get
symptoms.
Treatment
If found early, syphilis can be easily treated with
antibiotics, usually penicillin injections. If it is not
treated, syphilis can progress to a more dangerous
form of the disease and cause serious conditions
such as stroke, paralysis, blindness or even death.
Some STI's have no symptoms - it is
important to have regular check ups.
Symptoms
The first and second stages are when you can most
easily pass it to infect other people. Symptoms can
include: swelling in your lymph glands (small organs
found throughout the body, such as in the neck, groin
or armpit), a non-itchy skin rash appearing anywhere
on the body, but commonly on the palms of the
hands or soles of the feet, tiredness and headaches.
Less common symptoms include: fever, weight
loss, patchy hair loss and joint pains.
In the middle (latent) phase (and usually around
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33
SUCKING or ORAL SEX
Many of us aren’t sure about the risks
involved in oral sex. In this section we try
and explain some of the risks involved
and the STI’s that you can catch through
sucking.
HIV and Oral Sex
The bottom line is:
• Sucking is not totally safe from HIV infection.
• The latest evidence suggests that there is a
small risk, because there are a number of
cases each year where infection could only
have occurred through oral sex.
• Compared to sucking, unprotected penetrative
sex with men or women is definitely still the
most risky kind of sex.
Can HIV enter my blood through
the mouth or throat?
The linings of the mouth and throat are very
thick, and they don’t absorb much, even if they’re
damaged. They also contain few cells that are
vulnerable to HIV infection. Fluids stay in contact
with these linings for a very short time because
you swallow frequently. This suggests it’s unlikely
that infected blood or cum could be absorbed
through the mouth or throat.
However there may be an increased risk if your
gums are damaged, if you have cuts or sores in
your mouth, or if you’ve got an inflamed throat
caused by a cold, flu, or a sexually transmitted
infection (STI) like gonorrhoea.
So should I let someone cum in my mouth?
The decision is yours! The risk of HIV infection
can be reduced if you avoid getting cum in your
mouth.
Why?
HIV is found in cum and pre cum, and the risk of
HIV infection through sucking may be significantly
increased when the amount of HIV in the cum of
a man who is HIV positive is especially high. It’s
thought this happens at two particular times:
• During the period just after he’s become
infected with HIV
34
35
• If he starts to develop HIV related illnesses
(which could be years later)
Most people who’ve just been infected probably
aren’t aware of the fact, so they won’t realise
there may be risk of passing on HIV through their
cum.
If he does cum in my mouth,
should I swallow?
Swallowing cum takes it away from any damaged
tissue in the mouth and acids in the stomach
probably kill HIV.
However, if you do swallow cum it will also make
contact with any inflamed tissue in your throat.
If you decide to spit, the cum is in contact with
gums and ulcers longer.
There is no evidence to suggest either way is
safest. The best way of reducing the risk of
infection is by avoiding getting cum in your mouth.
Does saliva kill HIV?
Not exactly, but evidence suggests it contains an
enzyme which makes it harder for HIV to infect
vulnerable white blood cells.
Saliva itself can’t pass on HIV.
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Can pre-cum pass on HIV?
Pre-cum (the clear, slippery liquid
which appears before ejaculation) can
certainly contain HIV, though some
experts think it doesn’t contain enough
HIV to be infectious (and some men
don’t produce very much of it). This
suggests that, although pre-cum might
pass on HIV, it is particularly unlikely.
Can I get HIV from being sucked?
This is highly unlikely.
What about the risk of other STI’s?
Other STI’s though generally less
serious than HIV are often more easily
picked up through sucking. They
include Gonorrhoea, NSU (NonSpecific Urethritis), Chlamydia,
Syphilis, Hepatitis B and Herpes.
Condoms when used correctly are
the only way to protect yourself from
these STI’s.
See the STI’s section for more
information on these and other
infections.
37
If you think you may have picked up an infection,
or just want a routine check up, visit your local
sexual health service for a free & confidential
examination, see the Sexual Health Service section
for more information.
Making sucking safer
Only you can choose how safe you want to be,
and only you can decide what precautions you’re
willing to take.
Here are some suggestions:
• You may decide that the risks of oral sex are
low enough for you to continue your regular
behaviour.
• You may prefer not to have oral sex because
you do not wish to take even a low risk of HIV
transmission.
• Stop sucking him before he cums. Some men
will tell you when they’re about to cum, others
will groan louder, others will take their dick out
of your mouth anyway. Some will shoot their
load without warning, so be careful!
• Don’t suck if you’ve got cuts, sores, or
inflammation in your mouth or throat. It’s also
best not to suck if you’ve just brushed your
teeth (because your gums might be bleeding).
38
Current evidence suggests it’s best to wait 1
hour after brushing your teeth.
• Lick the shaft of his penis or suck his balls
instead of putting the end of his penis in your
mouth (especially if you’re worried about precum).
• You may decide to reduce the number of
partners whom you have oral sex with.
• You may decide only to have insertive oral sex
(being sucked), as this is safer than receptive
oral sex (sucking).
• Take regular sexual health screening. This will
show if you have any STI’s which may increase
the risk of you transmitting HIV to a negative
partner, and reduce the risk of you contracting
HIV if you are HIV negative.
• You can cover the dick, which is being sucked
with a flavoured condom. Using a condom for
sucking is the best way to minimise any risk
(unless you choose not to suck at all). Women
can also carefully split a condom or use a
dental dam to cover the vagina. Split condoms
or dams can also be used when rimming (anal
stimulation using the tongue).
39
CONDOMS
Why use condoms when having
sex?
Condoms are still the most effective barrier to
HIV and other STI’s during anal or vaginal sex.
Condoms help prevent the transmission of most
sexually transmitted infections (STI’s), for example
HIV, Gonorrhoea, Syphilis, Herpes and Chlamydia.
Sensation and safety when
using condoms.
Nobody has ever suggested that condoms are
perfect, or that sex feels the same if you use
them. Lots of men think that condoms are
uncomfortable, can ruin the sensation or even
interrupt the fun, but lots of men don’t find using
condoms a problem at all. You may have heard
about condoms splitting or not being strong
enough, there is some truth in this. Condoms are
not 100% safe. However, the main reason that
condoms fail is because they are used wrongly, for
example oil based lube is used, tearing them when
opening the packet or they are put on incorrectly.
Some brands you may be familiar with are:
Pasante Regular, Boys Own Regular, Mates
Natural, ID Skins and Durex have a large range
of condoms. There are many different types of
condoms for sale including Ribbed, Extra, Trim
and Large, you may want to look for a condom
that’s more suited to your needs, experiment and
find the best type for you. We recommend that
you use regular condoms for anal sex (as long as
they carry the Kite or CE mark shown above) but
some people feel the need to use Extra or Strong
condoms (slightly thicker), this is entirely up to
you. Regular condoms are widely available in gay
bars, clubs and saunas throughout the North East.
They are also available to 13-25 year olds at C
Card outlets.
There are also ranges of flavoured condoms
available, these are recommended for use when
having oral sex.
Which condoms are best?
It is best to look for condoms that
carry a Kite mark or CE mark.
40
41
Keep it wrapped up!
One of the best ways you can improve your safer
sex life is by spending a little time to get it right.
Research suggests that when people have negative
experiences with condoms it’s because they have
been used wrongly.
The following is a step-by-step guide to getting the
most out of your condom.
• Store your condoms in a cool place away from
extreme temperatures as this can cause damage to
the condom.
• Open the packet carefully to prevent damaging the
condom (don’t rip it open with your teeth)
• Only put the condom on when your dick is hard,
place the condom over the end of your dick with
the roll on the outside. If you have a foreskin pull it
back before covering the head of your dick with the
condom.
• Use only 1 condom at a time, it’s unsafe to use one
condom on top of another as this cases friction in
the rubber making it easier to split.
• Don’t put lube on your dick before putting the
condom on as this could cause the condom to slip
off inside your partner.
• Squeeze the tip of the condom between your thumb
and finger to expel the air.
• Holding the condom in place, carefully roll it down
to the base of your dick. It might sound ridiculous
but don’t try to cover your balls. Smooth the
condom to get rid of any air bubbles.
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• Spread plenty of water-based
lube over the condom on your
dick and on your partner’s
anus or vagina. DON’T use
Vaseline, massage oil or
moisturiser – these make the
condom weaker so they are
more likely to split.
• While you’re having sex check
occasionally that the condom
is still in place, and use more
lube if necessary.
• If your dick goes soft during
sex, the condom might slip off
so put your fingers round the
base and this will help it stay
put. If the condom does split
or slip off during sex, then
withdraw as soon as you find
out.
• After cumming withdraw your
dick before it goes limp (this
can prevent leakage). Hold
onto the base to make sure it
doesn’t slip off.
• Dispose of the condom
carefully in the bin NOT down
the toilet as it could contain air
and would be difficult to flush
away.
• Always wash your hands
with soap and warm water to
remove any bacteria!
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Practice makes perfect
If you’re not very good with condoms or feel
clumsy when putting them on, why not try
practicing with them yourself? By making
condoms a part of your sex play you will get used
to them and might even find the condoms a turn
on themselves. Take your time and follow the
instructions step-by-step so you know what you are
doing. You could also practice putting condoms
on your partner, it’s another way of getting used
to it and it can also be part of your foreplay.
You should also use condoms on sex toys, not
only does it keep them cleaner but it helps with
the spread of STI’s, these should be changed
regularly.
What is lube?
Lube (or lubricant) is available in small sachets,
usually alongside condoms in the various venues
mentioned earlier. It can also be bought in small
bottles with a pump dispenser. Lube is made up
of water-based ingredients and is put directly into
the bum hole to make it easier for penetration to
take place. Sometimes people use condoms for
anal sex without any lube on them; apart from
being painful this can also create other problems.
The condom is more likely to rip, tear or slip off
because of the increased friction. Having sex
without lube greatly increases the chance of tears
or cuts to the lining of the anus as well as tearing
the condom.
44
The most important thing to remember is
DON’T USE ANY OIL BASED LUBRICANTS WITH
CONDOMS, they weaken the condom within
minutes and it may well split while having sex. If
you’re about to have sex and you realise you have
no water based lube, you should still never be
tempted to use oil based or anything that has oil
in it - it will make the condom useless. If there’s
no other alternative you can use spit but it’s not
ideal because it dries out quickly.
There are many brands of water-based lube
available. Some people like different types of lube
because of the colour, consistency and sensation
so just experiment until you find the one you’re
happy with.
DON’T USE
DO USE Water-based lubes
like:
Baby oil
ID Glide
Butter
KY
Margarine
Boys Own Lube
Vaseline
TLC
Vegetable oil
EXS Lube
Moisturiser
Body lotion
Lard
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SEXUAL HEALTH SERVICES
The best place to go if you think you’ve got a
sexually transmitted infection, or if you want
a sexual health check-up, is your local sexual
health service.
Sexual health clinics are completely confidential,
so information isn’t accessible to your partner(s)
or family for example.
However, if you’ve been referred to the clinic by
your GP or a hospital in writing, they’ll be kept
informed about your diagnosis and treatment. If
confidentiality is particularly important to you, go
straight to the clinic without seeing your GP.
Sexual health clinics see lots of gay and bisexual
men and other men who have sex with men;
for example, around 10% of the men attending
New Croft Sexual Health Clinic in Newcastle are
gay or bisexual. It will help the staff if you’re
honest about the kinds of sex you’ve been having,
because they’ll be able to do the right tests and
treat you more promptly. Many gay and bisexual
men and other men who have sex with men
outinely have check-ups, some every 3 months,
even if they feel perfectly well.
Others like to go if they’re starting a new
relationship. This way you’re reassured that
you’re free from any infections and that you’re not
passing anything on to your partner(s).
46
WHAT HAPPENS AT THE CLINIC?
At Sexual Health clinics you often have to make
an appointment but lots now have drop in
sessions. Procedures vary a little from one clinic
to another, but you’ll be asked to give a name
(though you don’t have to), and you’ll be given a
clinic identification number. You’ll then be asked
to wait till you’re called (either by your name or
by the number you’ve been given). If you ask for a
check-up, or you have something wrong with you
but don’t know what it is, the doctor is likely to do
the following:
• Examine your cock, balls, arse, and general
groin area to look for scabies (little mites
which burrow under the skin) or crabs (pubic
lice), and to see if there are any warts, sores,
or moist discharges.
• Ask you to pass urine into 2 glasses; they’re
looking for signs of infection in your urethra
(the tube you pass water through).
• Use a small cotton bud or plastic ‘loop’ to take
a swab of the end of your urethra if you have
any symptoms
• Look up your arse for warts or evidence of
infection; the doctor might use an instrument
called a proctoscope to help them do this, this
may be uncomfortable but does not hurt.
• Take a swab from your throat with a cotton
bud.
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You will be offered a blood test for Hepatitis B and
C, and vaccination if you need it. You’ll be asked
if you want a test for HIV, the virus that can cause
AIDS.
This is optional and you can refuse the test. If you
decide to take the test, the doctor or nurse will go
through a pre test discussion with you, this has
to happen on every occasion a HIV test is done. If
it’s your first attendance or if you are seen as high
risk or anxious you’ll be offered the opportunity
to speak to a Health Adviser who’ll make sure you
know about the advantages and disadvantages of
having an HIV test before you make your choice.
AFTER THE CHECK UP
If there is anything the doctor or nurse is able
to identify on the day you can start treatment
immediately. All medication prescribed by sexual
health clinics are free of charge. Your results are
usually available over the phone and by text. While
waiting for your results you should avoid having
sex that could put others at risk but you can still
have safer sex. Ask the doctor or Health Adviser if
you aren’t sure what’s risky.
Sexual health clinics should treat gay and bisexual
men with the same courtesy as anyone else, and
you should never be made to feel guilty for having
sex, or for being gay or bisexual. If you feel that
you’ve been badly treated, ask to make a formal
48
complaint. Alternatively MESMAC or other local
gay men’s services can take up the complaint on
your behalf.
1 HOUR HIV TESTING
A FREE and
CONFIDENTIAL 1 hour
HIV testing service is
available through MESMAC
North East. The test is a
simple finger prick test with a pre and post test
discussion and results within the hour. There are
also other 1 hour test services available in the
North East and it is worth checking on line if
you can or by calling us for the most up to date
information on the number at the back of this
booklet.
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49
SEXUAL HEALTH AND HIV SERVICES
IN THE NORTH-EAST
If you have difficulty contacting any of the
services, please contact MESMAC for the latest
up to date information.
Newcastle:
New Croft Centre, Market Street East. NE1 6ND
Call: 0191 229 2999
Durham:
University Hospital of North Durham, North Road.
DH1 5TW
Call: 0191 333 2660 or 0191 333 26601
Darlington:
Darlington Memorial Hospital, Hollyhurst Road.
DL3 6HX
Call: 01325 743203 or 01325 743616
Bishop Auckland:
Sexual Health Services, Bensham Hospital.
NE8 4YL Call: 0800 42 20 200
Bishop Auckland General Hospital, Escomb Road.
DL14 6AB
Call: 01388 455700 or 01388 603180
North Tyneside:
Middlesbrough:
Gateshead:
One to One Centre, Brenkley Avenue, Shiremoor.
NE27 0PR
Call: 0191 297 0441
North Ormesby Health Village, 11a Trinity Mews.
TS3 6AL
Call: 01642 459583 or 0333 000 0014 option 3
Northumberland:
Redcar:
Carlton Street Clinic, 27-29 Carlton Street, Blyth.
NE24 2DT
Call: 01670 543131
South Tyneside:
Department of Urinary Medicine
Stanhope Parade Health Centre, Gordon Street,
South Shields. NE33 4JP
Call: 0191 2832525
Sunderland:
Sunderland Royal Hospital, Kayll Rd. SR4 7TP
Call: 0191 569 9021 / 0191 569 9022
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Redcar Primary Care Hospital, West Dyke Road.
TS10 4NW
Call: 01642 511156 or 0333 000 0014 option 3
Hartlepool:
One Life, Park Road. TS24 7PW
Call: 01429 285719 or 0333 000 0014 option 3
Stockton:
Lawson Street Health Centre. Lawson Street.
TS18 1HU
Call: 01642 704314 or 0333 000 0014 option 3
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This leaflet and others are available in other
languages as well as in large print, Braille and on
tape for people with visual impairment
Phone: 0191 233 1333
Email: [email protected]
Website: www.mesmacnortheast.com
www.facebook.com/MesmacNorthEast
www.twitter.com/TeamMesmac
MESMAC would like to thank the New Croft Centre
Newcastle for their assistance in developing this
booklet.
MESMAC North East is funded by Public Health from across the North East
June 2012
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