Staying Negative

Introduction

This passbook has been prepared for ALL gay men to provide essential information about Sexually Transmitted Infections (STIs), their treatment and prevention.

This section provides information about some of the most common Sexually Transmitted Infections (STIs) found among gay men (HIV+ or HIV-). For information about HIV and Safe sex just flip this passbook over and read from the other side.

Not everyone with an STI will show the symptoms described in this booklet. Some people may have no obvious symptoms, others mild symptoms and some more severe.

Even without symptoms, you may still have an STI and still be able to pass it on-only testing will let you know.

If you think you have an STI, get a check up. If your regular doctor doesn't see many gay men or you don't want them to know you're gay, try a more gay-friendly doctor or go to a sexual health centre (See Contact Details pages 22-23).

STIs are infections that are transmitted through close body contact, usually sexual. Sexual contact includes fucking, sucking, as well as touching, fingering or kissing/licking a cock, arse or vagina.

While the best way to prevent HIV is to use a condom and water based lubricant while having anal sex-safe sex for HIV does not necessarily mean that condoms will prevent all other STIs.

What are STIs?

STIs can be caused by

• Viruses (eg. HIV, herpes, genital warts)
• Bacteria (eg. chlamydia, gonorrhoea)
• Fungi (ie. thrush)
• Parasites (eg crabs, scabies)

HIV+ men and STIs

If you have HIV, here are some things you might consider:

• The infection may be more severe and more difficult to treat. It is also more likely that viral infections like herpes will recur more often than for an HIV Negative person;
• Infection with some STIs, (e.g. hepatitis A or B), can dramatically increase the HIV viral load (the amount of virus) in bodily fluids-including cum and pre-cum-because the immune system is fighting both the HIV infection as well as the other STI. An increased viral load means a greater risk to an HIV Positive person's health and makes passing on HIV more likely if you are having unsafe sex.

Even if you show no symptoms, it is possible to have an STI and pass on the infection.

When to have a STI test

If you are having sex with different casual partners, it is a good idea to get tested at least every six months. Even if you show no symptoms, it is possible to have an STI and pass on the infection. Testing is the only way to know.

Indications (i.e. symptoms) that you may have an STI include:

• An unusual discharge from your cock;
• Itching or stinging when you urinate;
• Sores, blisters or rashes in the genital area.

If you are in a new relationship, monogamous or otherwise, it is advisable to get a checkup as you may have contracted an STI from a previous partner.

Routine sexual health screens may include blood testing for syphilis and the hepatitis A, B and C viruses.

Crabs

Crabs: are tiny mites that live on the skin at the base of pubic hair. Crabs lay eggs that are attached to the hairs and are usually seen in the pubic area. Crabs can also be found in beards, armpits, chest hair and eyelashes.

Transmitted: by close physical contact, sharing clothes, bed sheets or towels.

Signs symptoms: Crabs can cause an intense itching in the pubic regions. Close examination of the pubic hair should find tiny brown lice and/or white eggs, called nits, attached to the pubic hair. May take 3 days to several weeks to show up.

Treatment: You can effectively cure crabs yourself with appropriate genital lice shampoos and creams available at pharmacies.

Prevention: There's no way of preventing the initial infection of crabs. To prevent crabs from recurring after an outbreak, wash everything that may have come into contact with the lice in warm soapy water including bed linen, clothes, towels and underwear. Partners and anyone in close physical contact should also be treated. It is advisable to repeat the treatment after 7 days.

Telling

If you have an STI, talk to all the people you've had sex with recently and suggest they get tested. Sometimes this isn't easy. You might find it hard to tell your sex partner you have an STI. Discuss how to talk to partners about STIs with your doctor, counsellor or friends.

It's important to talk to your sex partners so they can get tested and treated too.

Scabies

Scabies: is an infection caused by tiny mites, (smaller than crabs) that burrow under the skin.

Transmitted: by skin to skin contact, sexual or otherwise.

Signs/symptoms: Scabies are tiny and hard to see. The most common symptoms are a rash or itching caused by the mite burrowing under the skin to lay eggs. The mites prefer warm areas such as the armpits and groin but are also commonly found in the spaces between the fingers and the toes.

Scabies usually gets noticed within 4 weeks.

Treatment: You can effectively cure scabies yourself with appropriate scabies lotions available at pharmacies.

Prevention: It is difficult to prevent catching scabies because it is passed on by close physical contact. To prevent scabies from recurring after an outbreak, wash everything (including bed linen, clothes, towels and underwear) that may have come into contact with the mites in hot soapy water. All contacts, including people you live with, need to have treatment and it is advisable to repeat it after 7-10 days.

Molluscum contagiosum

Molluscum Contagiosum is a common skin growth caused by a viral infection in the top layers of the skin. It is transmitted by direct skin-to-skin contact with someone who has the infection. It can be transmitted through sexual or non-sexual contact with infected areas.

Symptoms: The lesions look like waxy pimples that have a dimple in the middle. Lesions can appear in the genital area as well as other parts of the body. Sexually transmitted lesions are usually found on the lower abdomen, pubic area and thighs. They usually show up between 2 - 12 weeks after transmission.

Treatment: Molluscum is treated by medical professionals, who can freeze the lesions off the body. Alternatively, the core of the lump, which contains the virus, can be extracted with a fine needle.

Prevention: Only the area covered by a condom, glove or dam is protected from the virus.

Molluscum & HIV: If you are HIV positive you may be more susceptible to acquiring molluscum. Molluscum is also more persistent in people with a weakened immune system. Some antiviral drugs taken by HIV positive people appear to considerably lessen the severity of Molluscum infection.

Hepatitis A

Hepatitis A is a virus that causes inflammation of the liver. It can be transmitted by small particles of infected shit entering a person's mouth through activities like arse-play and rimming, or by not washing your hands after sex with an infected person. However, it is most often passed on through using eating and drinking utensils previously handled by an infected person, or by sharing a joint or bong.

Symptoms: mild flu-like illness, vomiting, abdominal pain and jaundice. These generally take 2-4 weeks to show up after transmission. Hepatitis A can be a serious and debilitating illness.

Treatment: A blood test is required for all types of hepatitis. People who get hepatitis A will recover and develop immunity to the virus; they can never be infected with the virus a second time.

Prevention: includes an effective hepatitis A vaccination. A combination Hep A and B vaccination is also available. There is an effective vaccination for both hepatites A and B
Hepatitis A & HIV: If you are HIV Positive one of the consequences of also having Hep A infection is often having to go off anti-HIV medication, and sometimes drugs for opportunistic infections as well. Many HIV drugs pass through the liver and so cannot be tolerated during acute hepatitis infection. Getting immunised is a sensible move (the vaccination is not a live one).

Hepatitis B

Hepatitis B: is a virus that causes inflammation of the liver.Transmitted: by infected blood or cum through activities like unprotected fucking, sharing injecting equipment, toothbrushes or razors, oral sex, tattooing and body piercing with un-sterile equipment.

Signs/symptoms: may include loss of appetite, tiredness, nausea, yellowing of the skin and eyes (jaundice) and dark urine. These can take 1 - 6 months after exposure to show up.

Test/Treatment: A blood test is required for all hepatites. There is no cure for hepatitis B. There are some treatments available. Most people experience acute infection with no chronic consequences. See your doctor.

Prevention: There is an effective hepatitis B vaccination. A hepatitis A and B combination vaccination is also available.

Hepatitis B & HIV: If you are HIV+ one of the consequences of also having hepatitis B infection is that it may necessitate having to temporarily stop taking certain kinds of anti-HIV medications and drugs for opportunistic illnesses.

Many HIV drugs are metabolised through the liver, and cannot be tolerated during acute hepatitis illness.

Studies have not reliably shown any link between hepatitis B and more rapid HIV disease progression-though some have suggested such a link could exist.

Hepatitis C (HCV)

Hepatitis C (HCV): is a virus that can cause serious damage to the liver, with some people developing cirrhosis of the liver.

Transmitted: by HCV Positive blood entering another person's bloodstream. The majority of people in Australia with HCV have been infected by sharing needles and syringes and other injecting equipment. HCV can also be spread by:

• Using instruments such as tattooing and body piercing equipment which haven't been properly cleaned and sterilised.
• Sharing razor blades or toothbrushes.
• One person's blood coming into contact with open cuts on another person.

SymptomsThere's only a very small risk of catching HCV during sex. These transmissions usually involve blood. Blood donations for transfusions are screened for HCV.

Signs/symptoms: In many cases people infected with HCV may not become ill. Others may experience a minor 'flu-like' illness that does not require treatment. When first infected some people may find their urine becomes dark and their eyes and their skin may turn yellow (jaundice). Hepatitis symptoms may disappear within a few weeks but this does not necessarily mean that the infection has also disappeared. If you have hepatitis symptoms you should consult your doctor. A blood test can determine if you have been infected.

When liver inflammation lasts more than six months the illness is called chronic hepatitis C.Symptoms of chronic hepatitis C may be:

• Mild to severe lethargy (tiredness).
• Loss of appetite.
• Nausea and vomiting.
• Soreness in the upper right part of the abdomen (under the ribs).
• Fever.
• Pain in the joints.

Test/Treatment: A blood test is required for all hepatitis. The only drugs that are currently approved for the treatment of chronic hepatitis C are Interferon (IFN), a protein substance which inhibits the synthesis of the virus, and Ribavirin, an antiviral drug. The effectiveness of IFN has been widely debated. IFN has a number of potentially serious side effects, including severe depression, which are common.

Complementary therapies are also an option.
At present there is no vaccine available to prevent a person from being infected with hepatitis C.

Prevention:

• Always wash your hands before and after injecting.
• Never share needles and syringes and other equipment such as spoons, swabs, filters, and tourniquets. NEVER share ANY equipment. ALWAYS use new equipment. Remember that HCV is a lot stronger than HIV.
• Do not share personal items such as toothbrushes, razors, nail files or nail scissors, as these can puncture the skin and become contaminated.
• If you are involved in body piercing, tattooing, electrolysis or acupuncture, always ensure that any instrument that pierces the skin has been sterilised since it was last used.
• Health care workers should follow standard infection control guidelines.
• Wear disposable gloves if you give someone first aid or clean up blood or body fluids.
• Use condoms every time you have anal, oral or vaginal sex. People in long-term stable relationships may need to consider and discuss condom use
• If you are infected with HCV, you should take the following precautions:
• Consider discussing your condition with your health care provider when undergoing any medical or dental procedure, though there is no legal obligation to do so.
• Wipe up any blood spills carefully with household bleach and disposable paper towels, wearing disposable gloves.
• Completely cover any cut or wound with a wound dressing.
• Place bloodstained tissues, sanitary towels or other bloodstained dressings in a plastic bag before disposal.
• When having sex ensure that no exchange of blood occurs.
• You should never donate blood or body organs

Hepatitis C & HIV
Studies have found a higher prevalence of HCV in people who are also HIV Positive. This might be because a number of risk factors for HIV, are also risks for HCV. HCV in a person who is already HIV Positive can lead to a higher concentration of HCV in bodily fluids than other people with HCV.

However a high HCV viral load does not necessarily mean a high HIV viral load, nor does it link in with a low CD4 count.

Having HIV may lead to an increase in false-negative and "indeterminate" test results for HCV. Evidence also shows that a person who is co-infected can have an increased HIV viral load. No relationship has been found between HCV and the acceleration of HIV-related disease.

HIV and HCV can be safely treated in people with both infections. However, HIV is usually the first priority, because untreated HIV may cause HCV viral load to rise. Some people do need to be treated for both infections, especially if there are HCV-related liver problems.

Some anti-HIV drugs can cause liver inflammation and other problems, which can be even life threatening. Starting treatment for both HIV and HCV at the same time is not generally recommended, since it may increase likelihood of side effects. Starting on combination HIV antivirals may cause brief symptomatic reactivation of HCV.

There are a number of common drugs, many of them HIV treatments, which carry a risk of liver inflammation or damage. People with both HIV and HCV are advised to regularly and carefully take account of liver enzyme levels, and avoid HIV antivirals most strongly associated with liver problems.

Chlamydia

Tip-Urinating after cumming (or having sex) will reduce your risk of getting chlamydia.

Chlamydia: is a very common infection and is caused by bacteria. Chlamydia can also cause infections of the urethra (the tube that runs on the underside of the cock), the throat and in the anus, creating symptoms similar to gonorrhoea (see 'Gonorrhoea').

Transmitted: by giving or receiving anal sex, oral sex, and arse play such as fingering and fisting with an infected person.

Signs/symptoms: It is quite common to have no symptoms. Symptoms often show up 7-21 days after being exposed. These include:
a watery, white discharge from your cock which is most noticeable in the morning;
itching or pain in the opening of your cock which often fades after you urinate.

Test/Treatment: Chlamydia can be diagnosed from a urine test, a throat swab or an anal swab. It can be treated with a course of antibiotics.

Prevention: Sex that prevents HIV being passed on is not completely safe for chlamydia. Chlamydia can be transmitted by the contact of an infected area on one person another person.

Chlamydia & HIV: If you are HIV Positive, Chlamydia massively increases the viral load in semen -without affecting the viral load in blood, which is the one that is normally tested. This means that it is easier to pass HIV on to other people while you have Chlamydia.

Genital herpes (HSV)

Genital Herpes: is caused by the herpes simplex virus (HSV). There are two types of HSV. Type 1 is usually found around the mouth and is commonly known as cold sores. Type 2 is usually found around the cock or arse areas.

Transmitted: both sexually and non-sexually during skin to skin contact by:

• direct contact with a sore,
• mouth (cold sores) to genitals
• genital herpes to mouth
• genital to genital

Herpes can also be passed on when there are no obvious symptoms present.

Signs/symptoms: There may be no symptoms but symptoms include:

• Itching or tingly feeling around the infected area,
• An outbreak of painful blisters or sores which later form scabs
• A Flu like illness

If symptoms are going to occur they generally show up between 2-7 days after you have been exposed to the virus, but it may take much longer.

Treatment: There is no cure, but there is treatment that can reduce symptoms and speed up the recovery. The possibility of repeated outbreaks varies from person to person, but outbreaks may become less frequent and in time may stop altogether.

Prevention: Condoms can reduce the risk of transmission but do not always cover the infected area. The virus may be present on the balls or arse area. If you are HIV Negative and you have genital herpes, you should be aware that a herpes flare-up makes you far more vulnerable to HIV infection.

Herpes (HSV) & HIV

If you are HIV+ and you also have herpes you may experience recurrent genital HSV flare-ups that are more serious than those experienced by people without HIV, or those with HIV who have high CD4 counts.

Laboratory studies of HIV and herpes have shown that the herpes virus may increase the replication of HIV and therefore raise viral load, but this theory is yet unproven in human studies. If you are HIV Positive and also have genital herpes, you may be able to control your herpes effectively. However the severity and frequency of outbreaks of anal and genital herpes may increase as the immune system is weakened, so treatment can be more difficult in people with AIDS.

Gonorrhoea

Having gonorrhoea increases the chances of both passing on and getting HIV.

Gonorrhoea: is a bacterial infection of a person's cock, arse, throat or eyes.

Transmitted: by giving or receiving anal sex, oral sex, and arse play such as fingering and fisting with an infected person. Touching an infected cock or arse and then touching your own cock, arse or eyes can transmit gonorrhoea.

Signs/symptoms: It is quite common to have no symptoms. However symptoms can include a dry, sore throat; itchiness and pain during bowel movements, a clear or yellow discharge from the cock and pain or burning when urinating. These take 2 - 10 days to show up after being exposed.

Test/Treatment: It can be diagnosed from a penile swab, a urine test (which is less precise), a throat swab or an anal swab. It is easily cured with antibiotics.

Prevention: Using a condom and lube might help, but safe sex for HIV isn't completely safe for gonorrhoea.

Gonorrhoea & HIV: If you are HIV Positive, gonorrhoea massively increases the viral load in semen -without affecting the viral load in blood, which is the one that is normally tested. This means that it is easier to pass HIV on to other people while you have gonorrhoea.

Gonorrhoea, particularly anal gonorrhoea, causes inflammation which makes that person more susceptible to being infected with HIV.

Shigella (and other gut bugs)

Shigella (and other Gut Bugs): are bacteria that cause bowel infections. These include amoebiasis, giardiasis and salmonellosis.

Transmitted : Shigella is very infectious and therefore easily passed on. The bacterium is present in the shit of an infected person. Spread of infection takes place when tiny particles of contaminated shit enter the mouth. This can happen in three ways:

• Through rimming,
• By getting shit onto your fingers and then touching your mouth or;
• By putting contaminated objects like food, pens and cigarettes into your mouth.

During sex shit can get onto the hands while fucking, fingering and fisting and by handling things such as used condoms and sex toys. Once it is on your fingers it can easily get into the mouth. Gut infections can be passed on sexually or otherwise through food and water.

Signs/Symptoms: Symptoms include stomach cramps, diarrhoea (sometimes with blood and or mucous), fever and nausea. These can appear between 12 hours-4 days after exposure. A person with shigella may experience no, mild or severe symptoms. In most cases recovery takes 4-7 days but some take longer. Giardia can cause cramps, swelling of your bowel and can make you shit frequently. Amoeba can cause diarrhoea, stomach pain, swelling of your colon and bleeding from your bowel.

Treatment: Generally shigella is left to run its course. In severe cases, especially for HIV Positive people, hospitalisation may be needed. If you have diarrhoea drink lots of fluids to avoid dehydration. Chefs, waiters and others involved in food handling are advised not to work while they have shigella and for 7 days after the symptoms stop. Avoid sex with anyone until 7 days after the symptoms have ceased.
Anti-diarrhoea treatments are often enough to treat gut infections, but antibiotics can also be used.

Prevention: Lots of thorough hand washing, using latex barriers for rimming, and remembering 'what went where' in a sexual encounter can provide a degree of protection-we are talking about unpleasant, but not life-threatening, illnesses. Gut infections can be avoided by wearing gloves for arse play or by using a dam for rimming. You should wash your hands after handling used condoms or after having sex involving arse play.

Be aware of the ways that tiny particles of shit can enter your mouth. These include:

• Biting your nails;
• Lighting up a cigarette or
• the like;
• Eating unwrapped lollies, nuts, fruit or other food;
• Preparing food
• Sharing cups, bottles, cutlery, plates or other household equipment.
• shigella (and other gut bugs) & HIV
• To prevent infection during sex
• Use a dam or cut open a condom for rimming;
• Use gloves for fisting and
• fingering;
• When handling the dam or removing the glove, don't touch the area that has been in contact with the arsehole;
• Wash your hands.

Douching doesn't help in limiting the spread of shigella as it brings bacteria to the surface of the arse.
Shigella (and other Gut Bugs) " HIV: If you are HIV Positive you are more likely to have severe symptoms, which may result in a prolonged illness and hospitalisation. Both HIV negative and HIV Positive people respond equally well to the standard treatment for giardia, which is very effective.

Proctitis

Proctitis: is an inflammation of the rectum.

Transmitted: bacterium that lives in the body's cells and surrounding fluids. Close contact is needed for transmission to occur. This includes oral, anal and genital contact; the risk may extend to fingering arseholes and the sharing of sex toys. The three main causes of proctitis are gonorrhoea, chlamydia and herpes (see more details under these headings).

Signs/symptoms: These can be very mild or totally absent, especially if you have had the problem for a long time. Symptoms to look out for are diarrhoea, mucus streaking of shit, anal pain and a sensation of needing to go to the toilet again shortly after your last visit.

Test/Treatment: The test for proctitis involves the doctor gently looking at the appearance of the anal lining through a small instrument called a proctoscope. If you prefer you may simply have some swabs taken from the entrance to the anus-these can also screen for gonorrhoea and chlamydia.
The treatment for proctitis is a short course of antibiotics. You should take the complete course, even after the symptoms disappear.

Prevention: See sections on gonorrhoea, chlamydia and herpes and prevention.

Proctitis & HIV: If you are HIV Positive, Proctitis can increases your viral load. This means that it is easier to pass HIV on to other people while you have Proctitis (see also gonorrhoea, chlamydia and herpes & HIV sections)