Ricardus touched on avoiding STDs a little in "Dodging the Dangers of Sex (and Dating)", though his focus there was more on some of the other dangers that can arise; and I have a post on the forums that covers a good chunk of what we'll talk about in this article here: "Re: The Dangers of Sex." However, I wanted to clean that information up and put it in a more presentable (and scannable) way - hence, this post.
When you're relatively inexperienced with women, it's easy to get freaked out about STDs. Typically, the more sexually experienced you get, the less of a "big deal" these seem like... and, generally, the more likely you are to run into them.
Yet, if you're smart, and you do your homework, it is possible to avoid STDs almost entirely, even while having lots of sex with lots of partners... BUT, you must do your homework, and you must be on top of the ball at all times, because if you're trusting your own sexual health will be looked out for by that pretty stranger you just met (after all, she seems so innocent...), you've got another thing coming.
The mainstream media is a stunningly poor place to learn how to avoid STDs from, for the same reasons that the mainstream media is a stunningly poor place to learn ANYTHING of much import from - media feeds off of scaring people into reading or watching with the most frightening, alarming, controversial stories it can possibly run - not off of educating people.
Newscasters are not there to inform. They're there to entertain - to suck you into a vortex of emotional highs and lows and keep you there glued to the screen taking in advertisements on commercial breaks.
So, it's disheartening to realize that most of what people know - or think they know - about sexually transmitted diseases comes from popular media.
Well, I've got news for you: many of the things you hear the drums beating so loudly about aren't that big of a concern... while there are other things you should be more worried about, that I'd bet you weren't even aware of.
How Dangerous is HIV for Straight Men?
Here's the HIV risk checklist:
Do you take injection drugs with used needles ever?
Do you allow other men to ejaculate semen into your rectum ever?
Do you have unprotected sex with open cuts or sores on your penis ever?
If the answer to all three of those questions is "no", then your risk of infection with the late 20th century's dread disease is almost zero.
Heresy, you say?
The risk of acquiring HIV is 1 out of 2,000 per exposure to an infected source for penetrative vaginal sex for men. That is to say, if a man has sex with an HIV-infected woman 2,000 times, on average, one of those times he is going to become infected with HIV.
That still seems scary high - but it says nothing about whether there is a difference between the 1 man who becomes infected and the 1,999 who do not. Might there be a difference?
In fact, there is:
“Antibodies to cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex viruses types 1 and 2 (HSV-1, HSV-2) in three sequential serum samples from 62 men who did and 61 men who did not develop human immunodeficiency virus (HIV) infection at the time of the final (third) serum specimen were studied. Antibody titers to CMV, EBV, and HSV-1 did not significantly rise in or differ between men who did or did not get HIV infection. However, we found that 32 (68%) of 47 HIV seroconverters had antibodies to HSV-2 at the time the third specimen was drawn, whereas only 26 (46%) of 57 men who remained HIV seronegative had HSV-2 antibody positivity. Seroconversion to HSV-2 between any two serum specimens was found in 11 (42%) of the 26 HIV seroconverters but in only five (14%) of 35 men who remained HIV seronegative. The association between HSV-2 seropositivity (or seroconversion) and subsequent or concurrent HIV seroconversion remained when we controlled for factors known to influence HIV infection, including age, number of sexual partners, and percentage of sexual acts involving receptive anal intercourse. These serologic studies do not support the role of CMV, EBV, or HSV-1 in HIV infection but do suggest that HSV-2 infection is a risk factor for subsequent or concurrent HIV infection.”
That's from "Prior Herpes Simplex Virus Type 2 Infection as a Risk Factor for HIV Infection", published in The Journal of the American Medical Association all the way back in 1988. The researchers here found that 68% of men in the study who came down with HIV also had genital herpes (and further that HIV did not correlate with any other of the tested viruses, including HSV-1, the other common strain of herpes - so this isn't just a "those who have a lot of partners will get both HIV and HSV-2" deal).
The men tested had genital herpes before they picked up HIV... and genital herpes appears to be a big risk factor for acquiring it.
Why does a disease that leads to open sores on the genitals increase one's risk factor for acquiring a fluid-based virus like HIV? Mainly because the virus simply apparently does not really have any inroads to a man's body other than through open wounds... of the sorts that you get through:
Injection with needles
The tears in anal tissue that occur during receptive anal sex
Open sores caused by herpes simplex 2 (genital herpes)
Is there some risk to a straight man who doesn't do drugs, doesn't receive anal sex, and doesn't have genital herpes (or refrains from sex during any outbreaks of it if he has it) or sleep with women when he has a cut or injured penis, of picking up HIV from sex without these things?
There might be... maybe. But if so, it's almost certainly vanishingly smaller than the CDC's 1 out of 2,000 number, which includes all manner of men with open cuts and sores on their members that predispose them to infection with HIV.
So far as I can tell, the risk of infection from this disease - that is the single most focused-upon STD by far in the media - is almost (or completely) zero for a completely straight man who doesn't do drugs or have sex when his member is wounded... whether he's wearing a condom or not.
(of course, if you're a woman, I'd still be worried - you can never
tell for sure if that handsome new beau you've just met likes to play
bottom to a top some of the time, or has a sore-producing STD he hasn't
told you about that might predispose him to this and just isn't flaring
up at the moment - no free pass for girls, I'm afraid)
How Hard is it to Avoid All Those OTHER STDs?
Now, here's where it gets interesting.
How worried are you about picking up chlamydia?
How about the clap?
How about HPV?
How about molluscum?
When most people worry about how to avoid STDs, these aren't the ones they're worried
But these are the real diseases you've got to worry about... and I bet you don't even think about these most of the time.
The good news is, almost all STDs are treatable, or clear on their own with time.
The bad news is, if you're having sex bareback with strangers, or even if you use condoms, you stand a pretty good chance of snagging one or more of these at some point or other.
Diseases like gonorrhea (the clap) and chlamydia are surprisingly common - about a third of a percent of the population of the United States gets the clap every year, and a full 1% of Americans get chlamydia. The most at-risk individuals in the States are teens, individuals in their early to mid-twenties, and African Americans... most likely because these are also the groups that engage in the most casual sex with the highest number of partners.
Some diseases - like gonorrhea and syphilis - can occasionally render you infertile or worse (syphilis can actually make you crazy, then kill you, though the disease isn't as common these days). Others, like chlamydia and HPV, are frequently going to be harmless and even symptomless to you, but may harm the women you sleep with if you transmit them. Still others, like molluscum, are not harmful, but are unpleasant to look at (and may get you some bad reactions if your sex partner decides to take too close a look at what's going on with you downstairs).
By age 25, half of the sexually active population has or has previously had at least one STD... but most of these are either HPV or herpes (oral or genital), both of which have no symptoms in the majority of individuals.
To my mind, the absolute SCARIEST STDs there are out there are these two:
HSV-2 (genital herpes) - for which there is no cure, only treatments that can suppress outbreaks of sores (called shedding), assuming you show symptoms, and
Drug-resistant gonorrhea - for which only cephalosporin remains as an effective antibiotic treatment option, and even that may soon fall if the disease acquires resistance to it
... and of those, one's mainly an annoyance, and the other's still treatable, if kind of scary about what it might potentially become in the foreseeable future.
Another key difference between the two, though, is that one of these diseases is skin-transmitted, while the other is fluid-based. There are important distinctions between these two avenues of transmission, and it's worth understanding them both to allow yourself to best guard against these two very different pathways to infection.
I went to Catholic school growing up, and what they teach you there about how to avoid STDs is to avoid sex altogether. If you don't want to get an STD, just don't have sex! I always thought this was a ridiculously brainless and unempathetic approach; kind of like the vegan telling someone that if he doesn't want to get fat, just stick to eating nothing but vegetables! Sure, a few individuals might pull that off, but most of us like our meats and complex carbohydrates a little too much... if someone forces me to choose between having very low body fat OR having steak, sweets, and other delicious foods... I'll choose a few extra pounds every time.
Dating without sex
is equally impractical, at least in the modern world, and probably
always has been, based on the statistics I've dug up (bet you didn't
know that 40% of American brides-to-be were pregnant on their wedding
days in the mid-1700s - those Puritans sure knew how to party).
The simple fact is, we are biological organisms whose genetic imperative is to mate, and trying to structure in some rigid vetting period of a year plus to wait for some artificial ceremony of vow-exchanging doesn't work for the majority of people with hormones (and erections, and sopping-wet vaginal canals) waiting to be unleashed.
So, from a practical point of view, we must assume you'll be having sex; the next question then becomes, "Assuming you'll be sleeping with other people, HOW do you not end up picking up something nasty?"
Avoiding Fluid-Based STDs: Using Condoms
Here's the one that everybody knows: condoms. If you don't want to get an STD, just use condoms, right?
In fact, these ARE very effective... most of the time, and against fluid-transmitted diseases. That includes:
(links are to the CDC page on each disease, if you want more
information / infection rates / graphic pictures)
Proper condom use (and we'll talk about what that is below) gives you more or less complete protection against these diseases.
There are other diseases whose chance of being acquired are reduced by condoms, though not eliminated altogether:
For HPV and herpes, condoms reduce the chance of transmission by about 70% - because it isn't the fluid you're protecting against, it's skin-to-skin contact, and some of that still occurs at the base of the penis even with a condom on. I haven't seen clear statistics on how much of a risk you're still at for syphilis, molluscum (harmless but ugly scales that form on the genitals and take a year or two to clear and go away), or trichomoniasis (a parasite that lives inside the reproductive and urinary tracts), but I assume their rates are something similar to that of HPV and herpes.
Proper condom use means wearing a condom during any kind of sex; vaginal sex, anal sex, and even (if you're serious about full protection) oral sex. Yep - you can get gonorrhea, chlamydia, HPV, herpes, and almost anything else from unprotected oral sex, too. And you thought that was "safe" sex, didn't you?...
The rules of condom use are as follows:
Get condoms that fit. Not too loose, but not too tight, either. If you have any difficulty rolling condoms up onto your member, try going a size up. Likewise if your condoms are slipping off during sex - this is often not because they are too loose, but because they are too tight, and they're getting squeezed off of you during intercourse. I'm only somewhat larger than average for a white man of my height, so never used to think I needed a bigger sized condom, and couldn't figure out why sometimes I just could NOT get condoms on, and why they slipped off so much - nothing helped (all kinds of different brands, types, etc.), until I switched up into larger condoms - and presto, all my problems getting condoms on and having them fall off vanished.
Trojan Magnums are my brand of choice; my general feeling these days are that regular sized rubbers are made for smaller men and men who are on the low-side of "average", while large-size condoms (which actually aren't any longer, just girthier) are made for men on the larger end of average. If you're especially big, they have XXL and up condoms as well, and if you're smaller than average, there are smaller varieties available too.
Do not use any single condom for more than one sex act. Once you've ejaculated, it's very easy for condoms to slip off if you start up having sex again with the same condom on; the semen inside makes things very slippery. Make sure you change rubbers between rounds if you don't want to lose your protection.
Don't use lubricants of a different base than your condom is. You may not realize it, but most condoms, being latex-based, do not agree with oil-based lubricants - and if you spread some petroleum jelly atop your condomed member to give yourself a little smoother of a time, you may very well end up having the lubricant eat through the condom. Get water-based lubricants (like Divine No. 9, mentioned below) if you want to use these with latex condoms, or get polyurethane condoms if you're dead set on using an oil-based lubricant (like Vaseline).
Keep plenty of condoms on you at all times. If you don't have any, or enough, condoms on you, that means one of two things will happen - one bad, and one risky:
You can't have any (or any further) sex
You decide to just chance it and go bareback
Keep your condoms easily accessible. In the heat of the moment, your first time getting together, do you really want to be telling her to hold on while you run back over to your coat to pull out a little square packet? Will you even have the discipline to (or the balls to - what if she loses her passion and desire for sex while you're running over there, and changes her mind)?
You should always have at least one condom somewhere that's easy access for you - a pants pocket, a convenient position next to your bed or sofa if you're at home in the bachelor pad - so that you never have to decide that, okay, just for this FIRST round you'll skip the condom, just to get it in her so as not to break the mood, and then for round 2 you'll go and get the condom because sex by that point is already a done deal. If you're going back to her place, take a moment to sneak a condom out of your jacket pocket and into your front pants pocket if you don't already have one there at some point before you start escalating. Make it easy for yourself.
no reasonable justification for not having enough condoms
on you - it's easy to stash one in your wallet, a few in an inner coat
pocket, and a pair in your pants pockets. If you're wearing swim
trunks, get a pair with a little pouch on the inside - you can put your
keys there, and a backup condom - nothing quite as exciting as beach or
ocean sex. Even if you're not planning
to meet women, you should have condoms in your wallet, jacket, and
briefcase that are just always there - maybe you only end up needing
them a few times a year, but those few times a year you need them,
you'll be very glad you have them.
Do all these things right, and you'll be covered like a sausage in a plastic bag.
Of course, condoms are only two-thirds of the battle; there are still things you can catch, even if you're doing everything sex ed told you to do back in high school... because sex ed didn't properly prepare you for dealing with skin-transmitted STIs.
But I will.
Avoiding Fluid-Based STDs: Using Carrageenan
Ever hear of carrageenan?
They didn't cover THIS in your sex education class!
However, I read Nature.com, and at just the right period in time for me in 2007, Nature Medicine published a paper on the effects of carrageenan on HPV transmission. At the time, a girlfriend had picked up a high-risk version of HPV, probably from her unfaithful ex-fiancé, didn't find out she had it until she was already with me (she blamed me at first, but I researched the dormancy period and found out it was highly unlikely to be from me), and now I likely had it too.
A quick note on HPV: there are a number of different strains, of primarily two different varieties: high risk (with no outward signs, but a risk for cancer), and low risk (with little risk for cancer, but a fairly high chance of causing genital warts). High risk increases a woman's chance of contracting cervical cancer, and also gives a slight risk of cancer of the various other places a person might contract it (mouth - throat, tongue; anus; penis). If a woman gets a pap smear and this shows precancerous cells in her cervix, that's almost always from high risk HPV; 98% of the time, these go away on their own, but 2% of the time they become cancerous, so standard practice is to cut out the chunk of the cervix that has them when they're found (the cervix heals itself, and the process is painless, but you can't have sex for 6 weeks after, and there's an unpleasant brown discharge from the vagina that means she's going to be running through a lot of Maxi pads).
HPV takes 1 to 2 years to clear from your system in 95% of the
cases; that is, unless you have an immune problem, your body's immune
system handles it effectively enough
that you're essentially clear of the viral load, and no longer
experience the symptoms - cancer risk from the high risk variety, or
genital warts from the low risk variety (both of these go away when the
virus clears). However, if
you keep having sex with someone with HPV, what happens is that you
continually reinfect each other, giving each other dose after dose of
fresh viral loads, so that your body has a much harder time and takes a
lot longer to get clear of it.
Back to that
paper I stumbled across in 2007 from Nature.com - here's the
“Genital human papillomavirus (HPV) infection is the most common sexually transmitted infection, and virtually all cases of cervical cancer are attributable to infection by a subset of HPVs (reviewed in ref. 1). Despite the high incidence of HPV infection and the recent development of a prophylactic vaccine that confers protection against some HPV types2, many features of HPV infection are poorly understood. It remains worthwhile to consider other interventions against genital HPVs, particularly those that target infections not prevented by the current vaccine. However, productive papillomavirus infection is species- and tissue-restricted, and traditional models use animal papillomaviruses that infect the skin or oral mucosa3. Here we report the development of a mouse model of cervicovaginal infection with HPV16 that recapitulates the establishment phase of papillomavirus infection. Transduction of a reporter gene by an HPV16 pseudovirus was characterized by histology and quantified by whole-organ, multispectral imaging. Disruption of the integrity of the stratified or columnar genital epithelium was required for infection, which occurred after deposition of the virus on the basement membrane underlying basal keratinocytes. A widely used vaginal spermicide, nonoxynol-9 (N-9), greatly increased susceptibility to infection. In contrast, carrageenan, a polysaccharide present in some vaginal lubricants, prevented infection even in the presence of N-9, suggesting that carrageenan might serve as an effective topical HPV microbicide.”
That is to say, researchers studying HPV transmission found that a popular spermicide increased the risk of transmitting HPV substantially, while carrageenan prevented transmission of HPV, even in the presence of the transmission-boosting spermicide.
After finding out my girlfriend had this and I did too, and coming across this study on carrageenan and HPV, I immediately dove into what little literature there was at the time on carrageenan, and discovered that several lubricants on the market were made from it. I bought four bottles of a brand called "Divine No. 9", and started using that, both to protect myself from reinfection, and to protect myself from infection by any additional strains - there are something like 100 strains of HPV, and anywhere from 50% to 90% of sexually active adults contract at least one strain of HPV at some point or other in their lives.
Subsequent research came out on carrageenan's impact on the transmission rates of both genital herpes (85% reduction in transmission - contrast that with condoms' 70% reduction in transmission; and assuming my math is right [UPDATE: Torus, in the comments below, pointed out that this math is correct only if condoms and carrageenan protect against completely separate risks; if there is overlap in the risk, which there very likely is, the protection rate is lower], condoms + carrageenan offer you 95.5% protection from HSV-2), and remarkably, when sprayed into the nostrils, the common cold, reducing symptoms and viral load in early stage common cold infections - the first substance ever to have been found effective vs. the common cold.
This stuff is like death liquid for viruses.
One thing it has distinctly been shown to not be effective against is HIV
transmission from men to women, so it isn't advised for women to think
they can use carrageenan to prevent that sort of infection - either
sperm is deposited too deeply into a woman for the lubricant to affect
it, or the virus is not affected by the carrageenan itself.
No research yet on other skin-transmitted STIs like molluscum or syphilis, or on parasites like trich, scabies, or pubic lice, but at least two of the most common skin-transmitted sexual diseases - HPV and HSV-2 - are covered.
My general recommendations for using carrageenan-based lubricants:
Apply the lubricant after putting on a condom. If you're using a condom - and if you want maximum protection (as well as protection from fluid-based STDs), you'll use a condom - put your lubricant on last. That's just simple common sense - if you lube up and THEN put the condom on, guess what stands a good chance of sliding right off?
For extended protection, apply lubricant to her as well. After you lube up the part of your skin that isn't protected by the condom, I'd recommend you lubricate the orifice you'll be penetrating as well - this offers both of you an extra layer of protection. You don't have to use a huge amount - you don't want it to be too slippery in there, after all! - but just add enough that there's a light covering of lubrication (that will get spread around further during sex).
Keep your supply of lubricant handy. I'd advise a bottle very near to your bed / couch / other seduction spot at home, and a bottle in your car if you drive (i.e., aren't in a city with lots of mass transit where cars are extraneous). If you're SUPER strict about this, you could always carry a bottle around in your coat, too, but while the bottles aren't THAT big, I suspect it'd get a little uncomfortable to carry around with you everywhere after a while. You could always buy a tiny refillable bottle, and just keep a small supply with you if you wanted to really never leave home without it.
Also, regarding HPV specifically, I'd STRONGLY recommend you get inoculated against the disease. The current vaccines on the market, Gardasil and Cervarix, vaccinate you against the strains of HPV that cause most cancers as well as the separate strains that cause most genital warts. HPV's more an annoyance than anything, but let me tell you, it SUCKS knowing that your penis is carrying something that potentially gives a woman cancer if you stick it into her. That girlfriend of mine had to have precancerous cells removed twice - the first time, from her earlier infection, but the second time may well be because she'd infected me and I'd reinfected her before getting serious about protecting against HPV transmission. There's no test for men, but I'm certain I cleared myself of HPV after a year of strictly using condoms and carrageenan like nobody's business, since girlfriends I was sleeping with less carefully after this period came back consistently negative on their pap smears... but that was not a fun time for me, sexually speaking.
The vaccines on the market are currently only clinically tested on women, and approved only for women under the age of 26, but administering them is at the physician's discretion; if you make it clear you want to be immunized, you won't have too much trouble finding a physician who will immunize you against HPV, even if you're male and 72 years old. The vaccination takes 3 shots administered over the course of a few months, but it's worth it to know you won't ever have to worry about walking around with a cancer-giving rod in your pants.
There's currently no vaccine to protect against herpes, and both strains - oral and genital - you can get orally or genitally (or anally, but let's not go there), however you're exposed - so if a girl with cold sores gives you a blow job without you having a condom on, and she's shedding (has open sores), you may very well end up with cold sores on your little man downstairs. Again, don't think you're safe because it's oral - you're not.
Fortunately, however, Yale
is hard at work on a herpes vaccine - here's hoping they can get
to market as soon as possible, and make mankind's favorite pastime a
little less risky.
How to Avoid STDs
If you want a 100% solution, I haven't got it for you. In that sense, the Catholic church is right - the only way to 100% avoid picking up a sexually transmitted infection is to not have sex. However, if you combine smart condom use with smart carrageenan-based lubricant use, you can reduce your odds of picking anything up dramatically. That doesn't mean zero; it just means near zero.
Don't forget to check out the lay of the land before you take the
grand tour - if you see any unusual bumps, sores, or discharges
(or get a whiff of an especially rotten scent), take a rain check. I'd
advise you also do a Google image search for pictures of what the
various STDs look like on genitals (herpes sores, genital warts,
syphilis sores, molluscum, scabies, etc.) - it won't be pretty to look at, but you'll
know what you're seeing when you see it if you run into it in real life.
Another big recommendation I have for you is this: avoid seriously seedy people. That sexy hood rat, or the hot mess with smeared makeup who loves cocaine and hooking up with random dudes? Pass her up. If she's a sketchy person, she sleeps with other sketchy people, and you're exposing yourself not just to her, but to everybody she goes to bed with. Just imagine 50 other sketchy guys giving you a shot at having whatever they have.
speaking, the more sexually experienced a person is, the looser they
tend to become with condoms - as partner counts go up, condom use
goes down - which is the
opposite of what you should want, all things being equal. According
to the research, 70% to 80% of teens used condoms during sex, while
men in their 50s used condoms during only 30% of their one night stands, and a mere 10% of sex with
dates or friends with benefits. As you get older, you just care less.
You also should not count on women insisting on you wearing condoms - if a girl is sufficiently aroused, she's even less in logical control of herself than you are, and in the heat of the moment, nobody WANTS to wear a condom - they want to fulfill their biological destiny and see eggs fertilized and babies made. It isn't until the cloud of sex has passed from their minds and they're thinking logically again that they say, "Oh crap... should've strapped up on that one." If you want a real wakeup call about where that innocent-looking girl lying there naked before you has been, read this article from the U.K.'s Daily Mail - "STD fears as 70% of single women admit to regularly having unprotected sex":
“Eighteen per cent of single girls said they are often too drunk to use contraception - and 8 per cent said they 'just don't like using condoms'.
Dr Tony Steele is co-founder of online doctor and pharmacy DrFox.co.uk, which carried out a survey of 2,000 women's attitudes to sex.
He said: 'Unsafe sex on holiday is a major concern, particularly where women plan ahead to have sex with new partners without using condoms.
'Women meet men on holiday who are complete strangers.
'They may know almost nothing about the men they meet, and having sex without contraception is a sure-fire way to increase the chances of contracting a sexually transmitted infection.'
The study also found 12 per cent think contraception is not always readily available when it is needed.
Despite being older and wiser, one in ten women over the age of thirty still feels embarrassed to bring up the subject of protection with a new partner.
The report also found women aged between 30 and 40 were the most likely to have contracted a sexually transmitted infection, followed by those in the 18 to 29 age group.”
Again, this is a situation where you need hard rules if you want to be consistent. You probably don't like condoms, and unless you're very young and inexperienced, don't have an especially burning desire to use them.
In truth, most STDs are more an annoyance than anything, easily resolved with some antibiotics or, in the worst case (herpes), with medication to suppress outbreaks when they occur.
Nevertheless, it doesn't take much effort to avoid them - don't sleep with sketchy people, use plenty of protection if you do, and use protection with new partners as much as possible.
And, of course, get tested regularly - many cities and countries have free clinics where you can go get tested at no cost. Just to make sure you haven't got anything clogging up the pipes or closing off the tubes... this is worth doing every half a year or so.
Most of all, stay safe - sex is supposed to be a wonderful, pleasurable, satisfying experience... do your best to keep it that way, both for yourself and those you share your bed with.
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