STIs Protection (Introduction)

Minimal changes here. Mostly just changed STD/STI to STI. The biggest change is the last sentence of the post, which wasn’t there in any form in the original. I intend to spend a bit more time directly addressing STI stigma this time around, starting with a new post inserted into the series next week.

The bit at the end about a trip is from when this post was first written. I’m leaving it there bc it’s part of the history of the blog and why the hell not? updated 11/16/17

Protection against STIs

If you grew up in the 80s and 90s you likely heard the refrain of ‘barrier method’ (a euphemism for ‘condom’) as the only way to have sex without risk of STI. Like many simplistic answers to complex problems it is partly accurate, but leaves out a whole lot.
In theory, the best way to avoid STI is to not have sex with anyone who has an STI. If you and all your sexual partners are regularly tested for STIs, you shouldn’t need to worry, right? Unfortunately, this only works in theory.
The truth is that while STI testing is available at reasonable cost or free in most areas of the US, Canada and Europe (can’t comment on the rest of the world) that it is rare for STI testing to cover all possible infections. For instance, most don’t bother testing for herpes unless you have visible lesions. (Why? Because the test is notoriously unreliable otherwise. More on that another week.)
In addition, as mentioned last week, there are STIs that can infect you without any sexual contact. So even not having sex at all doesn’t provide 100% protection. The most important thing you can do, for yourself and your sexual partners is get it through your heads that there is no such thing as fully protecting yourself from STIs. All you can do is manage your risks.
The second most important thing you can do is understand that most of the time, getting an STI is not the end of the world. Or even your sex life. (More on this next week.)
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Sorry for the late (and short) post. Getting ready for this trip has cut unto my time and sanity, I’m afraid. So rather than write a shitty post, I’m stopping here and I’ll continue the topic next time.
Be well all, I’ll be back in two weeks.

What are STIs?

Expanded the “what are STIs” bit to make it clearer that there are infections which aren’t considered STIs that you can still get from sex, because language is weird that way. Other than that mostly cleaned up typos and grammar. Updated October 20, 2017
If I’m going to spend the next couple months discussing STIs, it seems like a good idea to start with what exactly they are, but first let’s take a look at terminology.

STD or STI?

STD stands for sexually transmitted disease. STI for sexually transmitted infection. STD is an old term, that many doctors no longer consider accurate. Basically, in medico-speak, a disease is something that causes symptoms which affect your health and well being. If you get hit with a virus, bacteria or fungus that doesn’t cause any symptoms, it’s an infection, not a disease. A lot of sexually transmitted stuff doesn’t cause symptoms, so many doctors now use STI instead.

Since this kind of change in medical terminology doesn’t make the headlines, non-medical websites, books and pamphlets that discuss sexually transmitted infections sometimes use STD, sometimes use STI and sometimes use both.

When I first write this blog series I used the slashy version ‘STD/STI’ on this blog, so that people who come into the series in the middle and might not have come across ‘STI’ would still know what I was talking about. Now that ‘STI’ has become more familiar, I’ll be changing the series to use just ‘STI’.

What Are STIs? And Why Do We Care?

STIs are pretty much just what the name says: infections that are transmitted sexually. Some viruses and bacteria really like the genitals. They are moist and warm and perfect breeding grounds for bacteria. They have mucus membranes, making them good places for viruses to invade cells.

And unlike the inside of the nose, other warm, moist mucusy areas come into contact with our genitals, making it possible for infections to jump from one person the another.

An infection whose primary means of moving from person to person is genital contact is caused an STI. That means there are many infections (mononucleosis, for instance) which you can get from sex but are not considered STIs, becuase usually people are infected some other way. And there are some STIs that have other means of jumping from person-to-person.

It is a basic fact: a person who never lets anyone else touch their genitals will probably not get an STI. Similarly, if people (of what ever number) who have no STIs are sexually exclusive for their entire lives, it is unlikely that any of them will ever get an STI.

Please note ‘probably’ and ‘unlikely’. As mentioned above, there are several STIs that can infect a person through other avenues. Blood borne STIs are the classic example of this.

It is, however, a reality of non-monogamy that having multiple sex partners makes STI infection easier. Thankfully, openly non-monogamous folks are pretty good at taking precautions against STIs.

Next week I’ll be taking a look at ways you can protect yourself and your partners against STD/STI infection.

STIs

Biggest change here is removing references to “safer sex” where ever possible. As I discussed Sunday, I’ve recently come to the realization that by equating “protecting against STIs” with “safer sex” we’re missing a big part of the safer sex discussion. So I am no long referring to discussing STIs as discussing safer sex, etc etc. Probably when I’m done with the Finances blog series I’ll start writing about the wider aspects of the safer sex discussion that are usually forgotten or ignored. YOu may notice that I’ve also stopped doing “STD/STI”. When I started this blog series “STI” was a relatively new and unknown term and I felt I needed to use both to be everyone understood. These days STI is well known and the most used term in the polyam communities I am part of. So I can stop using STD and just go with STI, which is the term I prefer. I’ll note here that the medical community is not in agreement about which term to use and both terms are perfectly acceptable. Updated oct 20, 2018.

If you’ve been involved in polyamory for any length of time, participated on any forums, read any blogs or books, eventually you will have come across topic of STIs. It is a medical fact that by having more than one sexual partner, you increase your risk of getting a sexually transmitted infection. If by some chance you haven’t already run across a good discussion of the hows and whys of discussing STIs, I suggest you take a brief detour to More Than Two’s Negotiating Safe Sex. It’s on the short side, but hits the basics of discussing STIs very well. You might also find some other good info there on dealing with jealousy and other relationship-related polyam stuff (as opposed to practical-type stuff I try to focus on here).

Still, even most polyam folk who know and follow standard s and staying healthy. Just as a for instance, I had a first meeting with a potential partner once, who when we discussed safer sex said he had no objection to getting regular STI testing if I could pay for it – since it cost over $100 a person. What he didn’t know, and I turned up in a 5 minute web search, is that the local health department offers STI testing for $10 a person.

I’ve also run across a frightful amount of misinformation over the years on polyam forums about STIs, how they are prevented, how common they are, and, oh, lots of stuff.

So, next week I’m beginning a new series on STIs. I’ll be covering what STIs are, finding places to get tested in your area, and brief introduction to the various STIs, how they are treated, and just how much of a concern they are. Along with some other semi-random stuff.

In the meantime, if you want to do some research of your own, the American Sexual Health Association is a decent place to start.

Defining Safe Sex

Last week I said safe sex means different things to different people. On a personal level, that means each of us needs to define safe sex for ourselves. Today we’re going to walk through defining safe sex. What is means to you, and how you can take steps to keep yourself safe while enjoying the sex life that suits you.

How Safe Do You Want to Be?

An Indie driver and a commuter both try to be safe when they drive–but what an Indie drive considers “safe” most commuters would consider suicidal. Race car drivers wear fire-proof undies for a reason.

Do you want to be completely protected from any risk of STIs? Are you comfortable with maybe getting herpes but want to be sure you are safe from HIV? Maybe you know your statistics and just want to get tested once in a while so you can get treated for anything early.

In addition to STIs, there is also pregnancy. Unlike STIs, how protected you want to be when it comes to pregnancy may vary from partner to partner.

As far as pregnancy goes you can opt entirely by never putting penis and vulva together. Or (slightly less extreme) never have PIV and except the infinitesimal risk that sometimes comes with getting semen on the outside of the vulva.

You can use various forms of birth control, which has more risk that not having PIV sex at all, but way less risk than going without birth control.

Or you can say fuck it, I don’t care about starting a pregnancy (or fuck it I WANT to start a pregnancy) and go for all the PIV sex with no birth control.

STIs are complicated–maybe there are some STIs you are willing to risk (Personally, I don’t give a fuck about herpes) but others you want to be protected from. What protects against some STIs won’t offer protection against others.

In general terms, you can choose not to have genital contact at all, and that will reduce your chance of getting STIs to almost nothing. (Sexually transmitted infections can be transmitted other ways–they aren’t exclusive to sex. For most STIs however, non-sexual transmission is rare.)

You can only have genital contact with people who get tested regularly and weren’t infected at the time they got tested. This offers significant protection, but not perfect protection. The more frequently you and your sex partners connect with new sex partners, the less protection it gives.

You can use barrier methods such as condoms and dental dams. This provides some protection against some STIs. It provides significant protection against HIV and Hep B, two of the STIs that are the most worrisome in terms of treatment and long-term impact.

You can combine STI tests and barrier method for more protection than either alone.

You and your partners can do visual checks of each other for outward signs of infection, which provides some protection against a few STIs.

You can not worry about protection for most STIs ahead of time. Truvada will protect you against HIV.

You can just get tested yourself regularly so you can catch and treat any infections early.

Which of these options sounds like “safe sex” to you?

Once you have a general idea of how you would define safe sex, it’s time to do some research. Learn about the different STIs and how they are transmitted. Learn about different birth control options. As you learn, you are further defining safe sex for yourself.

Maybe you started with wanting the protection that comes from only having sex with partners who test regularly and test STI negative. But as you learn more you decide that you really aren’t concerned about herpes and genital warts, so you’re comfortable being with a sexual partner who has either one of those STIs. Maybe you aren’t worried about barrier methods as protection from STIs, but as you learn about birth control options you decide that you definitely want to use condoms in addition to any hormonal birth control. That extra protection is reassuring.

Make sure you take the time to talk with your partner(s) about how they define safe sex. You don’t need to agree, you do need to respect each other’s definitions. Always remember that people need to be able to consent to risks. Don’t put your partner at risk in ways they don’t consent to, and if a partner puts you at risk without your consent, it’s time to get out of that relationship.

This post is part of the Safe SEx and Polyamory blog series.

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Zika Virus: A New STI?

Over the past several months, new reports in the US have focused on a “new” threat: the zika virus. Until recently, zika was believed to be transmitted only by mosquitoes, but there is now new evidence for sexual transmission.

Some History

The zika virus has been around at least since the 1950s. It was originally found in rhesus monkeys in the equatorial regions of Africa and Asia. Very rarely it was spread to humans in the region. Sometime in the early 2000s it made the jump to humans as a preferred host and began spreading. Between 2007 and 2014 the virus spread through Micronesia and Oceania before appearing in the South America in 2014. From South America it spread north, and the first cases appeared in the US in 2015.

Symptoms

Zika fever, caused by the virus is usually very mild. Headache, rash and fever are common symptoms. It is estimated that 1 in 5 people infected with the zika virus develop zika fever.

Long Term Complications

Since the zika virus appeared in Brazil there has been spike in cases of microcephaly. Microcephaly is defined as a skull that is within less than 2 standard deviations of normal for size and age. In other words, a skull that is too small for the brain to develop properly. Children with microcephaly frequently suffer from neurological disorders and shorter lifespan.

We do not know if zika causes microcephaly. At this time, scientists have proven that it is possible for zika to be transmitted from mother to fetus. This means that zika may be the cause of these birth defects. Other possible causes have been proposed. It is notable that increases in microcephaly are not being reported in other areas with the zika virus. For the time being, governments in South American countries with zika infections are advising their people to avoid pregnancies until the epidemic is under control.

Zika fever also appears to be connected to the development of Guillain–Barré syndrome in adults.

TransmissionUpdate May 12, 2016

Scientists have recently determined how the zika virus causes birth defects. We can now say with certainty that zika causes birth defects, and is most damaging during the early stages of pregnancy.

HIV PrEP: Truvada

Of all the sexually transmitted infections out there, HIV is the biggest concern for most people. That’s why in the US the FDA’s approval of a drug to help prevent HIV infection was greeted with such relief. Several other countries have also approved Truvada to help prevent the spread of HIV.

Truvada is the first medication approved as a pre-exposure prophalyxis (PrEP) for HIV. That means taking Truvada before being exposed to HIV protects you against infection.

Truvada is actually a combination of medications. Tenofovir and emtricitabine are both anti-retroviral drugs which have been used to treat HIV/AIDS for years. They are most often used in combination with protase inhibitors, which use a different biochemical process to attack HIV.

For people who are not infected with HIV, but might be exposed, Truvada is believed to offer significant risk reduction. However it has some rare adverse effects that are extremely damaging. For this reason, the FDA recommends it only for people who are at high risk of infections:

  • Gay or bisexual men who have either have had anal sex without a condom or been diagnosed with an STD in the past 6 months
  • Heterosexual men or women who do not regularly use condoms during sex with partners of unknown HIV status who are substantial risk
  • Injection of illicit drugs in the last month with sharing of equipment
  • Discordant heterosexual and homosexual partners where one partner is HIV-positive and the other HIV-negative

Taking Truvada consistently can reduce your risks by up to 92%. However PrEP is like the birth control pill. Not taking it consistently leaves you unprotected. Benefits of taking Truvada take affect after 72 hours on the medication. It is necessary to continue taking Truvada for 30 days after a high risk exposure to be sure HIV transmission levels stay reduced.

Your doctor will not prescribe Truvada unless you have tested HIV negative in the past month. While on Truvada you will need to be tested regularly, and if you do become infected with HIV will need to stop taking Truvada immediately.

This is very important. Anyone taking Truvada during stage 1 of an HIV infection is putting themselves at risk of developing a drug resistant strain of HIV. This means during later stages, when you actually need the medications, they won’t work.

As I mentioned before, Truvada has some risks associated with it. If you look up side effects of Truvada you will get a long and scary list of potential side effects. It is important to realize that this list is a combination. It includes side effects of taking Truvada in combination with other drugs for treatment of HIV/AIDs and side effects of taking Truvada as PrEP. The most common reported side effects for taking Truvada as PrEP are headache, abdominal pain, and decreased weight. Truvada can in rare circumstances cause loss of renal function. People taking PrEP are advised to get their renal function tested every 3-6 months while on Truvada.

Whether or not Truvada is of benefit to someone in a polyamorous relationship will largely depend on your approach to safe sex. If you take a low risk approach–only having sex with people who are tested regularly for STIs, using condoms, etc, Truvada is probably not right for you. If you are comfortable with a high risk approach to safe sex–going bareback with multiple partners, getting tested infrequently or having sex with new partners often enough that testing is not effective for protection, than Truvada may be a good idea. As always, talk with your doctor, I am not an expert.

Standard Disclaimer

This post is part of the Safe Sex and STIs blog series.

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Safe Sex Vs Safer Sex

I don’t know about the rest of the world, but in the US over the past ten years or so, it has become common to speak of “safer sex” instead of “safe sex.” The idea, apparently, is that sex is never 100% safe, no matter how careful you are there is always the risk of getting an STI or someone getting pregnant, and, therefore, it is misleading to speak of “safe sex,” we should always and only speak of “safer sex.”

I’m calling bullshit.

When I was learning to drive I didn’t take a “safer driving” course, I took a safe driving course. The mandatory certificate for food handlers is called ServeSafe, not “ServeSafer.” Neither driving nor food handling can ever be made 100% safe. In the case of driving, because no matter how careful you are, some other idiot on the road can ram into you. In the case of food, because if the spinach came into your kitchen with e coli already on it, no matter how carefully you wash the leaves, someone might get sick from your salad.

In every similar context, American English is happy to use “safe” to mean “making the best effort to be safe.” But suddenly, when it comes to sex, “safe” can only be used to mean “100% without risk.”

Folks, show me anything 100% without risk and I will show you where you are wrong. Life doesn’t work that way. But in the rest of life, we are comfortable saying, “Yes, there is risk, I accept that and do my best to reduce the risk.” The push to use “safer sex” is coming from the same sex shaming viewpoint as the pamphlets at the local anti-abortion place that tell people you should never have sex outside of monogamous marriage or you might get an STI.

Like I said at the beginning, this may be just a US thing. God knows we have sex stigma to spare here. But it needs to stop. Which is why throughout this blog series I talk about safe sex. Not safer sex.

This post is part of the Safe Sex and STIs blog series.

Fluid Bonding and Safe Sex

Fluid bonding is a common term in polyamory safe sex discussions. Fluid bonding commonly means having sex without a condom or other barrier method. The idea being that your fluids are mingling and joining together.

In hierarchical poly relationships, fluid bonding it usually reserved for the primary couple or group. In egalitarian or solo poly fluid bonding is a sign of a highly entwined relationship and a great deal of trust. It is also a potential minefield.

Fluid Bonding and STIs

One of the more popular discussed reasons for fluid bonding is it reduces the risk of getting infected with an STI. By only having barrier-free sex with people you trust, you get some of the benefits of a closed relationship (barrier free sex, lack of worries about infection with the people you have sex with most often) while still being open. So far so good, right?

Here’s where the trouble comes in: barriers are not 100% effective in preventing STIs. For instance, the last time I checked the research, male condoms were believed to be 80% effective in reducing transmission of HIV. 80% risk reduction is damned good—but it is not risk-free. And barriers still only protect against some STIs. It is still possible for people in fluid bonded relationships to pick up an infection and spread it to their fluid bonded partners.

Whether or not you are fluid bonded, you still need to get tested, regularly.

Fluid Bonding and Pregnancy

Whether or not you prefer to practice fluid bonding, pregnancy throws a wrench in the works. Some people rely on fluid bonding to prevent pregnancy outside the “main” relationship. Some people prefer not to fluid bond, but want to have a baby. In both cases, it is vitally important to remember that there is no such thing as 100% effective birth control.

I’ve harped on this point until I’m blue in the face. The vast majority of people who think they are protected from unexpected pregnancy, aren’t.

This doesn’t mean you shouldn’t use fluid bonding as part of your birth control plan. It does mean you need to be honest with yourself about the risks of whatever approach to birth control you choose.

Fluid Bonding and Assumptions

Fluid bonding requires using barrier methods with everyone other than your fluid bonded partners. Simple, right?

Well, if your partner agreed to fluid bonding because they were worried about pregnancy, they may not see a need to use dental dams. You, in the meantime, are trying to reduce your STI exposure and assume barrier methods are being used with all genital contact. Can you say “Recipe for drama?”

Whatever your reason for fluid bonding, check your assumptions at the door. Make sure you and your partner(s) are on the same page about what you expect. Whether your relationship is built on agreements or boundaries, don’t let assumptions bite you on the ass.

What Do You Want to Learn About STIs and Safe Sex?

I’m going to pick up and finally finish my extremely drawn out blog series on safe sex and STIs. Last spring I finally finished a run down of various STIs and their symptoms, causes, treatments, etc. Now I want to go back to that series and talk a bit about options when you or someone in your polycule has an STI, communicating about safe sex with your partners and a few other things.

But before I get too deep into that, I’d love for you to tell me if there is anything you really want to know about STIs and safe sex in polyamorous relationships. I can’t promise to have an answer, but I’ll damn well try. Leave a comment below, or contact me privately!

Posts so far

(Updated February 8, 2016)

  1. STDs/STIs
  2. What are STD/STIs?
  3. STD/STIs Protection (Introduction)
  4. Protecting Against STD/STIs: Barrier Method
  5. Preventing STD/STIs: Testing Agreements
  6. Preventing STD/STIs: Be a Smart Slut – Open Relationships, Promiscuity and STD/STIs
  7. Protecting Against STD/STIs: Abstinence/Closed Relationships
  8. STD/STI Testing: Introduction
  9. Polyamory and STD/STIs: Getting Tested
  10. What Does STD/STI Testing Involve?
  11. STD/STIs: How often should I get tested?
  12. The Long List of STD/STIs
    1. Bacterial Vaginosis
    2. Chancroid
    3. Chlamydia
    4. Crab lice
    5. Cytomegalovirus (CMV)
    6. Genital Warts
    7. Granuloma Inguinale
    8. Gonorrhea
    9. Hepatitis (A, B & E)
    10. Herpes (1 & 2)
    11. HIV & AIDS
    12. Human Papillomavirus (HPV)
    13. Molluscum Contagiosum
    14. Pelvic Inflammatory Disease (PID)
    15. Pubic Lice (Crabs)
    16. Scabies
    17. Syphilis
    18. Trichomoniasis (Trich)
  13. Fluid Bonding and Safe Sex
  14. Safe Sex Vs Safer Sex