PozSwitch

Friday, February 13, 2009

Question

I live in a city where the HIV-positive guys have sex with each other without condoms. That's just what everybody expects. Now my doctor tells me I have chlamydia in my butt. I thought that was a "female problem." Can you give me any more information?

Answer

Look, you selective barebacker, you. If all of the HIV-positive gay men in your city decided they would dye their eyebrows green for Christmas, would you do that, too? Grrrrrrrrr.

As you probably know, some medical experts are afraid that this social trend for no-condom sex between HIV-positive men will result in the creation of a virus that is immune to all or most current treatments. The feared and dreaded "Super Virus" has not materialized so far, but research continues. Some health educators feel that this trend may also have lowered new HIV infections because so many gay or bisexual, HIV-positive men are deliberately excluding someone whose HIV status is negative or unknown as a candidate for unprotected sex. I can't claim that's a bad thing.

My concern is that when your immune system is already compromised, you may be more susceptible to other sexually-transmitted infections (STIs). If you are on medications to reduce your viral load, adding other treatments to that regimen is hard on your body and may trigger new side effects besides the ones you are already juggling. Some STIs are becoming drug-resistant. Gonorrhea and syphilis should no longer be viewed as the genital equivalent of a case of the sniffles. Some, like herpes or hepatitis, are incurable. Hepatitis has the added lovely bonus of potentially shortening your life. Fortunately, we have vaccinations that can protect you against some forms of hepatitis.

Lecture over. Let's talk about chlamydia. You are correct that this disease is known mostly for troubling the vaginas of adventurous young ladies and their older, but perhaps not wiser, co-genderists. But it can also appear in the rectum, urethral, eyes, or throat. It can be passed to a baby during vaginal birth if the mother is infected. It's caused by a bacterium, Chlamydia trachomatis. Initial symptoms can be mild or nonexistent, but if left untreated, this bad little bug can cause harm to the reproductive tract. It's the most common STI caused by a bacteria, and yet remains drastically under-reported because people don't know they have it, and many doctors do not do routine screening for it. BOTH partners have to be treated, or re-infection will occur. Over a million cases were reported to the Centers for Disease Control and Prevention in the USA in 2006. The actual number of infections is probably closer to three million. Sadly, this STI is most prevalent among teenagers, who are still getting rotten sex education and limited access to sexual health services.

It's estimated that three-quarters of the women who contract chlamydia and half of men experience no symptoms. If you are going to notice a change, it will be one to three weeks after infection. Women may feel a burning sensation when they urinate or have a vaginal discharge. A man might have pain upon urination, itching, or a discharge from the penis. Rectal chlamydia can cause pain, discharge, or bleeding. Oral infections are asymptomatic.

If untreated in women, chlamydia spreads to the reproductive organs and rectum and causes pelvic inflammatory disease (PID). This may cause low back pain, abdominal pain, fever, bleeding between periods or after intercourse, and pain during penetration. The reproductive organs and surrounding tissues can suffer permanent damage. This leads to chronic pelvic pain, infertility, or ectopic pregnancy (which can be fatal). A woman infected with chlamydia is five times more likely to contract HIV if exposed to the virus.

In men, an unchecked case of chlamydia can spread up the tube that carries sperm from the testicles (the epididymis), causing pain and fever. The prostate can be inflamed. Sterility can also result. In rare cases, this STI can even cause arthritis (in both sexes) that may be accompanied by skin lesions and inflammation of the eye and urethra.

It's not known exactly how a chronic case of chlamydia affects the bowel or throat, but I'm guessing it isn't beneficial.

Chlamydia can be diagnosed with a urine test. Samples should also be taken from potentially infected sites like the cervix, urethra, rectum, and throat. Treatment with antibiotics is simple and effective, but your sexual partner(s) must also be diagnosed and treated. ABSTAIN FROM SEX UNTIL YOUR TREATMENT IS COMPLETE. Retesting is encouraged three to four months after treatment. Better safe than asymptomatic.

Yearly screening is recommended, but any time you've got a sore, bump, discharge, bad smell, pain, bleeding, or itching in your sexual parts (however you may define that term), go to the city clinic and let the nice doctors check you out. They've seen it all; they won't be shocked by any sexual practice. Their only interest is to get you healthy again and see if they can't pass on a bit of education that will keep you that way. Pregnant women should get screened well before their due date as this STI may cause premature delivery and can cause pneumonia or eye infections in a newborn.

Be an informed health consumer. Don't just ask your doctor to test you for sexually-transmitted diseases. TELL them which diseases you want to be tested for and WHERE you might be infected. A recent research article that studied men who have sex with other men found that 53% of chlamydia infections in their sample would have been missed without a rectal swab and oral sample being taken. (Charlotte K. Kent, et al., "Prevalence of Rectal, Urethral, and Pharyngeal Chlamydia and Gonorrhea Detected in 2 Clinical Settings among Men Who Have Sex with Men: San Francisco, California, 2003," Clinical Infectious Disease, Vol. 41, Issue 1, July 2005, pp. 67-74.) There is still a shocking tendency for doctors to assume that men use only one part of their sexual equipment—the penis. So when looking for gonorrhea or chlamydia, they do only urethral sampling. If you know you like to suck cock or get fucked, honor your desire and defend it by educating your physician. A similar stereotype goes for women. But in a postmodern world, heterosexual/vaginal intercourse is not the only thing that sexually active women are practicing (and getting perfect). If you like oral or anal sex, let your doctor know that your cervix is not the only potential site of infection.

Condoms are just about the only way to keep this bacteria out of your body. There are no documented cases of chlamydia being transmitted by inanimate objects, but I HIGHLY recommend using condoms on any sex toys you enjoy putting inside of yourself or other people, and changing the condom AND washing the toy after use. This is especially important if one toy is going to pleasure more than one person. Douching or enemas may increase your vulnerability to infection, but there is little research on this point. So don't abstain from these things and count on that for protection.

Lest you think I have forgotten you, Dear Reader, the concluding paragraph is just for you.

What did a thin little penis-hugging latex condom ever do to make you reject it with such vehemence? Testosterone being the imperious horndog hormone that it is, I have rarely met a man who will refuse to use a condom once he knows that's all that stands between himself and getting laid. You didn't get to be gay by following the crowd and doing what everybody else was doing, queen! If it's raining men in your life, it's time to start handing out the rubber raincoats.

Live long and fornicate, honey.