[Question #9438] Gay Men's STI Health

32 months ago

Hello Doctors!

You recently cleared up some confusion I had about HepB which was extremely helpful and I wanted to ask you another more general question.

I am an HIV negative gay man. I understand that unprotected anal sex carries a risk for basically any STI but am unclear on the risks associated with other sexual activities. You often make the point in answering other questions that x,y and z activity or STI is less of a concern to a straight questioner. That being said: I wanted to get your general STI risk assessments specifically for MSM.

1). Am I right that deep kissing is pretty much no risk for all STI's even for MSM? I know that syphilis is a much bigger concern for the gay community than the straight community and was wondering if I should be worried about the possibility of syphilis from deep kissing?

3) Am I right that non-intercourse body contact is very low risk in general?

2) What's the latest thinking on the risks of oral sex for STI's? The assessment of oral sex risk seems to evolve and become more nuanced over time. I wanted to get your thoughts on this in 2022.

I am recently single and back in the dating pool. The last time I was single, PREP was not commonly available and I find myself entering a world where many gay men have stopped using condoms completely. I'm guessing this has raised the rate of STI's among gay men (despite how amazing it is that we have PREP) and wanted to be as safe as possible in this new PREP era.

Thank you for this service!

32 months ago

I should have mentioned that I am HSV2 pos. So I'm obviously not concerned about getting that, although I want to make sure not to pass it.

Edward W. Hook M.D.

32 months ago

Welcome back to the Forum. Thanks for your questions. I appreciate your desire to avoid non-HIV STIs and support your desire to avoid infection. On to your questions:

Deep kissing is a very low, but not no risk event. Syphilis of the mouth is rare but if your partner has a syphilis lesion in his mouth or on his lips, there is a low risk of acquiring the infection. In addition, recent data suggest that if a partner has oral gonorrhea, it may be transmitted to a partner's throat through deep kissing as well to the penis if your partner performed oral sex on you. Chlamydia is very, very rare in the throat is not a concern. Overall, among risks, these risks are small but not non-existent. They are too uncommon to be able to give you are specific estimate of risk per exposure.

3) Am I right that non-intercourse body contact is very low risk in general?

Yes, very, very low risk. This is also true for mutual masturbation even if an infected partners genital secretions were to get on you.

2) What's the latest thinking on the risks of oral sex for STI's? The assessment of oral sex risk seems to evolve and become more nuanced over time. I wanted to get your thoughts on this in 2022.

I think I addressed this question above. If not, if you have specific questions, please use your up to two follow-ups for clarification.

Hope this helps. EWH

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32 months ago

Thanks Dr Hook!

One follow up:

If I noticed a chancre on my lip or in mouth I would, of course, run and get a syphilis test. But is syphilis always symptomatic? Should I be getting a syphilis test occasionally even if I don't see symptoms to be on the safe side?

And I guess I would ask the same about the oral gonorrhea.

Thanks again!

Edward W. Hook M.D.

32 months ago

Good questions.

Unless there is a second infection present, syphilis lesions are typically painless. There is a strong recommendation that sexually active men be screened regularly for STIs, including both syphilis and gonorrhea. The recommended screening interval varies dfepnding on partner numbers but are typically either every three or six months.

EWH

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32 months ago

Dr. Hook,

Am I reading correctly that even if a chancre were present in the mouth of a partner, kissing them wouldn't automatically lead to infection?

Thank you so much for the information about these STIs as well as your testing recommendations. I appreciate your time and expertise!

Edward W. Hook M.D.

32 months ago

You are correct. For ALL exposures to STIs including HIV at ALL potential sites of infection, most exposures to infected partners do not result in infections. Transmission is substantially less than 100% after a single exposure, but it does occur. The probability of transmission varies however by site: for instance receptive rectal or vaginal exposure is more likely to result in infection than insertive exposures. Receptive oral exposure is still less likely to lead to infection and kissing, including deep kissing is still lower (but not no) risk

I hope the information I have provided has been helpful. This completes this thread. Take care, stay safe. EWH

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