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What is Safe Sex and What Are My Options?

What is Safe Sex and What Are My Options?

Dear Doctor Freier,
I have been widowed for a number of years, but have recently begun seeing a wonderful woman. She is younger, and my concern is that she may have been with a number of men in the past, and I want to practice safe sex to protect both of us. I have not been single in a long time, and I may be a little rusty on what are my options to protect us against sexually transmitted diseases? Thank you in advance!

Kenneth
Naples

Dr. Freier:

Dear Kenneth,

Congratulations on your new relationship, and thank you for your question. Sexually transmitted diseases are on the rise in the United States, so your question is timely. “Safe sex” …… the buzz words that have become a household phrase since the early 80’s after the Human Immunodeficiency Virus (HIV) and its associated disease GRID, which later became known as AIDS, showed up in the United States and gained global attention.  “Safe sex” has been taught by the medical community, especially the public health sector, for decades.  However, it’s only been in recent years, since AIDS became a political issue, that people started heeding the warnings.  This has fueled the term to lose its taboo status, become mainstream, and finally be taught publicly.

Most of us assume “safe sex” simply means using a condom during sexual intercourse, but what is its true definition?

Safe sex is defined as a combination of practices or behaviors that can be utilized with or without devices and/or medications to help prevent pregnancy and/or the spread of sexually transmitted infections (STIs).  These practices help to limit the exchange or potency of body fluids during sexual contact.  Body fluids include saliva, urine, blood, vaginal fluids, and semen.

STIs can be caused by bacteria, viruses, or parasites.  There are multiple STIs besides AIDS which include, but are not limited to, gonorrhea (i.e. The Clap), chlamydia, genital herpes, human papillomavirus (genital warts or cervical cancer), trichomoniasis, hepatitis, and syphilis.  Some STIs can be cured with a simple course of antibiotics while others have no cure. STI symptoms range from no symptoms at all, to pain while urinating, vaginal discharge, urethral discharge, sterilization, skin lesions, dementia, and even death.

Any type of sex can spread STIs, including oral (including kissing), vaginal, and anal sex.  Several devices can be utilized to limit the exchange of body fluids with any type of sex.  Examples of devices include male and female condoms, dental dams (a small square of thin latex that can be placed over the clitoris, vulva, or anus area during oral sex), and medical gloves.  Medications, such as hormonal birth control pills, spermicidal lubricants, vaccines, and anti-retroviral medications (PrEP) are used to prevent pregnancy, immunize against HPV, and inhibit replication of HIV.

There are many different types of HPV.  Some types can cause genital warts while other types can cause cancers.  There have been some advances made in the realm of vaccines against specific subtypes of HPV that cause cervical and anal cancer.  HPV is the most common sexually transmitted infection and is responsible for genital warts, cervical and anal cancers.  79 million Americans, most in their late teens and early 20s, are infected with HPV.  You can contract HPV by having vaginal, anal, or oral sex with someone who is infected with the virus.  It is most commonly spread during vaginal or anal sex.  HPV can be passed even when an infected person has no signs or symptoms, which is often the case.  Most people with HPV do not know they are infected and never develop symptoms or health problems from it.  Some people find out they have HPV when they get genital or anal warts. Women may find out they have HPV from an abnormal Pap test result.  

Others may only find out once they’ve developed more serious problems from HPV such as cancers.  The Gardasil 9 vaccine can be given to children as young as 9 years old and adults up to 45 years of age as a preventative measure to guard against the Human Papilloma Virus.

Pre-exposure prophylaxis or “PrEP” is the use of medications intended to prevent disease in people who have not yet been exposed to the disease-causing agent.  The term typically refers to the use of antiviral drugs as a strategy for the prevention of HIV/AIDS.  TRUVADA is a novel drug in this category.  It is produced by Gilead Sciences and is the combination of 2 drugs, specifically tenofovir and emtricitabine.  These drugs prevent the replication of HIV by inhibiting an enzyme called reserves transcriptase which the virus needs to replicate its RNA.  This medication is highly recommended for people who are HIV negative and have a higher than normal risk of contracting HIV. This group includes sexually active adults that have an increased risk of HIV (e.g. men who have sex with men), people who engage in I.V. drug use, and serodiscordant (one partner is infected by HIV and the other is not) sexually active couples.  PrEP has been shown to reduce the risk of contracting HIV by 92% when taken as prescribed and used along with other risk reduction strategies, such as condoms.  Condoms should still be used because people taking PrEP are still at some risk of contracting HIV, especially those who do not take PrEP as prescribed, and because people on PrEP remain at risk for other types of sexually transmitted infection.

There is also research into post-exposure prophylaxis by using antibiotics such as doxycycline.  Although this research is in its infancy, there have been some promising studies that show mild reduction in chlamydia and syphilis infections in groups that take doxycycline immediately after a sexual encounter.  There are many more studies that need to be completed before anything will be approved for this specific purpose.

This being said, “safe sex” should more correctly be referred to as “safer sex” or “protected sex” as people may still be exposed to some amount of bodily fluids and run the risk or becoming pregnant or infected with an STI.  The only true “safe sex” is to abstain from sex.

I would encourage all sexually active men and women to be tested for STIs on a regular basis.  Talk to your primary care physician and let them know if you have a new sexual partner, any STI symptoms, or if you believe you have been exposed to an STI.

As always, if you have any questions or concerns regarding your sexual health, Optimal Male Performance Center is here to help.  Call us today to schedule an appointment.

Be Safe and Live Well!

Richard Freier, M.D.
Medical Director
Optimal Male Performance Center
1-844-MAN-CURE

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