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

Trichomoniasis (Trich)

Photo of trichomoniasis courtesy of the CDC
Photo of trichomoniasis courtesy of the CDC

Trichomoniasis (trich) is a parasitic infection of the genital area. It has only minor (and often no) symptoms, and can only be diagnosed with a blood test or other bodily fluid sampling. While trich itself is a relatively benign infection, it has some serious complications.

Prevention:

Trich is transmitted through PiV intercourse and (more rarely) vaginal-to-vaginal contact. Based on the nature of the parasite and the way it is transmitted, I believe it might be possible to be transmitted through penis-to-penis.

Prevention basically comes down to not having sex with someone who is infected (but chances of knowing if you are infected are slip unless you get tested regularly), or using condoms/other barrier method which covers majority of genital area.

Treatment:

Trich is treated with a single does of antibiotics. Reinfection within 3 months is very common. Reinfection occurs when you get treated but your sexual partners (or their sexual partners) do not. If someone in your sexual network refuses or is unable to seek treatment, then your entire network can be reinfected within a year. 

Symptoms:

Trich rarely has symptoms, and when it does the symptoms are mild. Over two-thirds of infected people don’t have symptoms.

Symptoms for people with a penis include:

  • Irritation inside the penis
  • Mild discharge
  • Slight burning after urination or ejaculation

Symptoms for people with a vagina include:

  • Greenish-yellow, frothy vaginal discharge with a strong odor
  • Painful urination
  • Vaginal itching and irritation
  • Discomfort during intercourse
  • Lower abdominal pain (rare)

Complications:

Trich has two common (and serious) complications. In a pregnant person it increases the chance of premature birth.

It increases everyone’s chance of getting HIV. The inflammation and irritation of tissues make it much easier for HIV to enter the body.

STIs: Syphilis

For centuries syphilis was the bogey-man of Europe (and probably other parts of the world—but I can only speak of Europe for a certainty). In fact, it would not in anyway be an exaggeration to call syphilis the HIV of 15th century Europe.

Today, syphilis is far less of a threat. The development of effective antibiotics in the early 1900s turned what had been a horrific death sentence into, for many people, a minor annoyance. However, if left untreated the “French Disease” is just as deadly as ever.

Prevention:

Prevention of syphilis is brutally simple: don’t have sex with anyone who has syphilis. If you don’t know whether or not someone has syphilis either don’t have sex with them of use a condom. Using a condom reduces your risk of infection, but does not eliminate the risk. Syphilis can be transmitted through vaginal, anal, and oral sex.

Treatment:

Syphilis can be cured with antibiotics, no matter how long you have been infected. However, if left untreated for too long syphilis can cause permanent damage.

Symptoms:

Syphilis occurs in several stages.

  1. In first stage syphilis an infected person develops sores in the area where they were first infected. Usually the sore will appear in or on the penis, vulva, vagina, anus or mouth, but can appear anywhere on or around the genitals and mouth. These sores are red, firm, and painless and will fade on their own after a few weeks. These sores are the primary source of contagion, but they can be hidden in vaginal folds, under foreskin, inside the anus, under the tongue, and in other areas. Lack of visible sores does not mean an infection isn’t present.
  2. Second stage syphilis occurs within six months of the infection. The most common symptom is a rash on the hands and feet, though rashes can occur on other parts of the body as well. Some people have no rashes and no symptoms. When other symptoms do occur they include:
    • fever
    • swollen lymph glands
    • sore throat
    • patchy hair loss
    • headaches
    • weight loss
    • muscle aches
    • fatigue
  3. After second stage syphilis will go latent for 10-30 years. Sometimes it stays latent, but often it develops into late stage syphilis. This is the scary one. In late stage syphilis symptoms include loss of muscle coordination, paralysis, numbness, blindness, and dementia. Additionally, the disease will attack and damage internal organs. Disfigurement can occur as the disease eats away at muscle and bones.

Complications:

The biggest “complication” of syphilis is death as the internal organs shut down and your body just stops working. If the infection is treated during the first, second or latent stages, the possible complications are usually minimal. If treatment doesn’t occur until the late stages, then there are innumerable possible complications depending on the type and severity of damage done by the infection. Loss of heart or lung function, nerve damage, paralysis, muscle weakness, and a number of other complications are possible.

 

Syphilis may just be the post child for STI testing—easy to treat if caught, easy to miss if you aren’t looking for it, and absolutely devastating if untreated.

 

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STI: Scabies

Scabies is the common name for a parasitic infection, specifically this parasite:

The human itch mite. Also known as Sarcoptes scabiei var. hominis.
The human itch mite. Also known as Sarcoptes scabiei var. hominis.

These microscopic invaders not only make a meal of dead skin, like most mites, they actually burrow into human skin to create little dens for laying eggs.

Picture a field for of rabbit burrows. Now picture that field is your skin and the rabbits are these guys. This is scabies.

As you might imagine, our bodies don’t like having lots of tiny holes dug in them. The result:

ScabiesD03Those red itchy looking patches? Those are mite burrows. And this is scabies.

Like PID and a few other infections on our list, you don’t need to have sexual contact to ge scabies, but sexual contact does make it a lot easier.

Prevention
Avoid prolonged skin-to-skin contact with anyone who is infected or might be infected. Thoroughly clean the bedding, clothing, etc of anyone with crusted scabies. Unless you know that it is definitely not contagious, don’t have sex (or naked cuddling) when you or your partner has a skin condition.

Treatment
Symptoms usually don’t show up for 2 to 6 weeks after a first time infection, so treatment is usually recommended for all household members and all sexual partners of the infected person. Treatment consists of lotions or creams to kill the mites. While scabbies is usually only transmitted through skin-to-skin contact, it is recommended to wash all bedding, clothing, towels, etc in water 72 degrees Farenheit or hotter to prevent reinfection.

Symptoms
The primary symptoms are the raised red bumps caused by the scabies burrows and prolonged itching. The itching is an allergic reaction which will often last several days or weeks after treatment. If it continues more than 2 weeks after treatment you should contact your doctor.

Complications
The most complication of scabies are skin sores from frequent scratching. These sores may become infected leading to further health problems.

People who are immunocompromised, have nerve damage that prevent them from itching, and the elderly may develop crusted scabies. Per the CDC crusted scabies “is characterized by vesicles and thick crusts over the skin that can contain many mites.” Crusted scabies is highly contagious because of the extremely large number of mites present.

More information on scabies

As always, this post is provided for information purposes only and should not be considered medical advice or a replacement for getting professional medical care.

Long List of STIs

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STI: Pelvic Inflammatory Disease (PID)

(Edit: Sorry for the late post! This was supposed to go up yesterday but didn’t due to a technical glitch.)

Pelvic inflammatory disease (PID) is an infection of the cervix, uterus, Fallopian tubes and/or ovaries. PID is not a specific sexually transmitted infection, it is more like the common cold or pneumonia—a disease that can be the result of a variety of different infectious agents or other causes. PID most often develops as a complication of other STIs such as chlamydia and gonorrhea.

PID is one of the poster children for why everyone should get tested regularly. Catching other STIs early can seriously reduce your risk of getting PID, and catching PID early is critical to avoiding severe complications.

You do not need to have sex to get PID. While it is most often associated with sexual transmission, diseases that are not sexually transmitted can also cause PID. The most common non-sexual causes of PID are childbirth, abortion, insertion of an IUD, and “pelvic procedures.” Basically, if it impacts or affects the cervix it may transfer bacteria through the cervix and cause infection. A regular vaginal infection can (rarely) become PID if the cervix is weakened or damaged.

Prevention:

Outside of being celibate (and never getting any pelvic procedures), you can’t prevent PID. You can reduce your risk in several ways. Get tested for chlamydia and gonorrhea regularly,  don’t douche, don’t get IUDs, and (as always) be in a sexually monogamous relationship. And of course anything that prevents other STIs (like using condoms) is a good way to prevent PID.

Treatment:

PID is caused by bacterial infections, so it can be treated with antibiotics. It is very important to continue treatment even after symptoms go away. If you don’t finish the treatment, the PID may come back and cause further complications.

If you and your partner both have PID it is very important not to have sex during treatment or you might reinfect each other (I hope it goes without saying that you probably shouldn’t be having sex with anyone else either.)

If the disease is too far advanced, doctors may recommend surgery to remove abscesses. In extreme cases, a hysterectomy may be necessary.

Symptoms:

PID does not always cause symptoms, and symptoms may be mild. Symptoms include

  • Pain in your lower abdomen;
  • Fever;
  • An unusual discharge with a bad odor from your vagina;
  • Pain and/or bleeding when you have sex;
  • Burning sensation when you urinate; or
  • Bleeding between periods.

 

Complications:

Any STI where possible treatments include the word “hysterectomy” obviously has some pretty severe complications. Swelling, abscesses and scar tissue may block the Fallopian tubes leading to infertility and/or ectopic pregnancies.  Scarring of the uterus may also lead to infertility. Recurring abdominal pain is also possible.

STI List

Molluscum (Molluscum Contagiosum)

Slightly pink nodules, a few millimeters across.
Molluscum bumps

You probably haven’t heard of this one before. I never had, and I think I may have it.

Molluscum is a virus that affects the skin, creating tiny nodules where ever it colonizes. It has no real side effects, and as far as I know is not tested for in any regular STD screening (It certainly was never included in any testing I’ve had.) I seriously debated whether to include it in this list, partly because it really isn’t an STI anyone has to worry about, partly because there are a number of ways it can be transmitted other than sexual contact. I decided to include it mainly because I am tired of the hysteria over STIs, and want to clearly show that there are STIs that are not in any way dangerous or worrisome.

Transmission: Molluscum is transmitted through skin contact. If you brush up against a molluscum sore on someone else, the virus transfers to your skin. Among adults, the virus is most often transmitted through sexual contact, though it can be transmitted by sharing towels or clothes, or just sharing a bear hug. There is some evidence that hair waxing may increase the risk of viral skin infections, including molluscum.

Children usually contract molluscum from their parents, but can pick it up at public pool and other areas where people share chairs or towels and don’t wear many clothes.

Symptoms: The main (and practically only) symptom of molluscum is a small bump which can be white, pink or flesh colored and is usually slightly shiny. The bump is dry and may have a dimple or pit in the center. On average, the bumps are 3-5 mm in diameter, though size may vary. Bumps are usually painless, but may be itchy or sore.

Scratching at a bump without washing your hands may cause the virus to be transferred to other areas of your body, leading to more bumps developing. Bumps usually disappear on their own in 6 to 12 months, but have been known to remain up to four years.

Prevention: Condoms can prevent molluscum spreading in the genital regions which are covered by the condom. Watertight bandages over the bumps can prevent spread from casual contact. Don’t share towels or clothes. Wash your hands regularly, especially if you itch a lot or touch someone else near a bump.

Treatment: Bumps should only be removed by a health care professional. Prescription skin treatments and oral medicine may get rid of the bumps without scarring, though it takes longer that other methods. Treatment is recommended for bumps that are in the genital area.

Complications: Scratching at the bumps may lead to bacterial infection. Removal of the bumps may cause scarring. That’s it.

People with HIV/AIDS or other immune suppressing conditions may be at risk of serious illness from bacterial infection.

 

Go back to The Long List of STIs

STD/STI: Human Papilloma Virus (HPV)

HPV isn’t in the news as much as it was a few years ago when the vaccine first came out. But it is still one of the STD/STIs that most people are familiar with. It is also one that I think people make way to much fuss about. According the CDC “…almost every sexually-active person will get HPV at some time in their lives…” That said, the possible complications of HPV are real causes for concern. As always, educate yourself so you can protect yourself.

Prevention: Condoms provide some protection, but aren’t perfect. Don’t have sexual interaction with anyone who has visible warts and make sure you and your partners get tested regularly. The HPV vaccine protects against some forms of the virus, including those most likely to cause cancer. Given what the CDC says about everyone being infected at one point or another, don’t drive yourself crazy with this one.

Treatment: If warts develop, they can be treated by a doctor. Do not try to use over the counter wart treatments – they are not designed for genital warts. If you have HPV, additional tests can determine if you are infected with one of the varieties linked to cancer. Your doctor can advise you on any additional precautions you can take if those tests come back positive. Most HPV infections clear up on their own within 6 months.

Symptoms: Genital warts may look like cauliflower heads or flat, raised areas of skin. They are often microscopic. Many people don’t develop any symptoms.

Shaved base of a penis, with genital warts
Used under CC 3.0, by Rrreeewww

Complications: Some forms of HPV can cause cancers, include cervical, anal, vaginal and others. The HPV vaccine protects against some forms of HPV that cause cancer. If an expectant mother has HPV during labor and delivery, the baby may (rarely) be infected. If you are pregnant make sure your doctor is aware if you have been diagnosed with HPV, so precautions can be taken.

Back to the Long List of STD/STIs.