Sexually Transmitted Diseases

Trichomoniasis

Trichomonas vaginalis was first discovered by a young Frenchman in 1838. Interestingly enough, he thought he had discovered the causative organism for gonorrhea, and the differentiation of the two organisms took another 50 years. Both are caused by organisms, gonorrhea by a gram negative intracellular diplococci, originally called Neisseria gonorrhea, and trichomonas by a protozoa.
Before antibiotic therapy developed, trichomoniasis was dramatically different from what it is today; patients sometimes came in with difficulty walking because the genital area was irritated, and the vaginal discharge was so profuse that it literally ran down their legs when they stood up. The discharge, when viewed with the aid of a vaginal speculum, was seen to be thick, frothy, and yellow-green, and it was extremely smelly.

The diagnosis for this particular infection is made by the physician on the spot, who does a microscopic test called a “wet mount,” using a slide with either saline or a stained laboratory vehicle for easier microscopic identification. The protozoa can be easily seen moving around on relatively low-power magnification of the microscope. There are occasional false-negative readouts, probably due to overwhelming activity by the body’s white blood cells, so that no actual trichomonal organisms can be seen during a test, but are visible at a later examination. This particular test usually gives an instant diagnosis.

The disease is easily treated using metronidazole. This particular drug has been used worldwide for over a quarter of a century. It has an inherent clinical safety record, never having caused death. When a woman who walks into the gynecologist’s office has a trichomoniasis diagnosis made and is given the proper medication, that medication is doubled in amount so as to include her sexual partner (or tripled if there is more than one sexual partner). The same procedure is followed for a man at the urologist’s office. The urologist writes a prescription not only for the man but also for the woman if she is not being seen by her physician.

Trichomoniasis is not a reportable disease. It is, however, a disease that can be fairly drug resistant, so in the United States the patient is asked to return to the office for a repeat test to make sure that the problem has been solved.

Chlamydia

Another common STD seen in the health care practitioner’s office is chlamydia trachomatis. Public health experts currently list this particular disease as the most common disease in the United States, with more than five million new cases discovered and treated each year. Until recently, it was not a reportable infection. One of the reasons it was not reportable is that many if not most physicians treat it on the basis of a sexual and social history, combined with the suspicious physical and microscopic findings. They do this because it is extremely difficult to obtain a good culture result (the cultures have a very high percentage of false-negative readouts). The CDCP and the U.S. Public Health Service have now asked that positive serologic tests for chlamydia be reported. Experts on this particular infection indicate such serologic tests are sometimes reported falsely as positive. This can cause legal problems for the patient and the physician.

The real problem with this obligate intracellular parasite is that it causes infertility in women. It is, however, easily treated. The use of tetracycline for seven to ten days by both partners will clear up this infection. If the tetracycline, a most inexpensive drug, causes severe stomach discomfort or other side effects, erythromycin or doxycycline will achieve the same result. However, chlamydia has a strong silent component to its clinical picture; it is often ignored or interpreted by the person who has acquired it as something else. Consequently, no physician is consulted or asked to run a confirmatory culture, and the infected individual unwittingly spreads the disease to others.

Because it is so common, its presence should always be considered, and, of course, the presence or absence of this particular infection is always considered in the many infertility clinics. Women who have the disease and are unaware of its presence may experience significant damage to the interior of the Fallopian tubes. Normal Fallopian tubes are necessary for fertilized-ovum transport. If that reproductive highway has been destroyed, the patient is rendered unable to have a fertilized egg move down her tubes and into her uterine cavity to begin a pregnancy.

Men with chlamydia may see a urethral discharge, so this infection is a common reason for their seeking medical advice. It is not now presently known whether most of the physicians in the United States who treat this problem of chlamydia discharge in men either double the medication and insist that the woman be also treated, or refer her elsewhere.

A variation (there are three variants of this particular infectious disease) is capable of producing blindness, since it causes a disease of the eyes called trachoma. The presence of chlamydia trachomatis is the most common cause of blindness throughout the world. The United States has several well-known research centers working on this disease. One is at the University of California at San Francisco, and the other is at Indiana University-Purdue University Medical Center in Indianapolis, Indiana.

Herpes

Another common sexually transmitted infection in the United States is herpes genitalis. In 1980, when herpes occurred in an epidemic form, its presence made the cover of Time magazine and the front page of the Wall Street Journal. It is a viral infection transmitted by sexual activity that causes blistering discomfort. Acyclovir is effective in suppressing the circulating activity of the herpes virus, decreasing the discomfort and making the individual less likely to transmit the infection to others.
It is almost uncivilized in the current era, with acyclovir available, to know that one has herpes and yet to deliberately not take the medication and hence infect others. It is an STD that has active states and inactive states, and the level of discomfort varies widely among individuals. Some men have only mild urinary complaints and do not know they have the disease until they accidentally infect a new female sex partner. The infected woman most often experiences flulike symptoms, has pain urinating, and is covered with blisters on her swollen genital area. The resultant discharge is frequently infected with other organisms and can be quite odoriferous.

If the individual is careless in personal habits and touches the areas of the genitals that are involved, then rubs his or her eyes, the disease can be transmitted to the eye, causing a severe form of conjunctivitis that produces blindness. The problem with the eyes can be arrested by using intravenous acyclovir, but it certainly requires the expert attention of an ophthalmologist just to save the eyesight. If one acquires this infection, soap-and-water hand washing and scrupulous attention to all the details of personal cleanliness are extremely important to confine the blisters and the disease activity to the original site.

The disease can produce mental problems or a severe headache, as well as the aforementioned generalized flulike picture. It is also capable of affecting the long nerves of the legs so as to produce sciatica plus a pain with bowel movements.

Herpes is seen in the office involving all ages and all kinds of health complaints and problems. Clinical diagnosis can be made quickly by anyone who has spent several years practicing medicine. Inexperienced nurses and physicians may, however, misdiagnose it as a chronic yeast infection. However, the obverse of this statement is also true: women with chronic yeast vulvar infections will present the clinical picture similar to a chronic deteriorating herpes infection. The test for herpes is a positive vaginal culture. The culture, however, is not 100 percent correct. It is perfectly possible to have herpes and have a negative culture. This can be a serious problem for the pregnant woman, because if the mother has an acute attack of herpes while she is in labor, the infant, who has no immunity to the disease, will acquire the herpes, and before the advent of intravenous acyclovir therapy most would die.

With acyclovir, herpes has come to be an annoying accompaniment to sexual activity, and its only serious problem now is the transmission of an active infection to a newborn infant. Herpes was originally proposed as the infection causing cancer of the cervix, but that has been demonstrated to be scientifically untrue. Herpes is not now believed to cause cancer.

Gardnerella

Another commonly acquired bacterial infection with a reputation for easy diagnosis (i.e., not requiring an expensive laboratory culture test) is gardnerella vaginalis. For many years, this infection was known as hemophilus vaginalis, but Eldon J. Gardner, a physician who spent his life observing, collecting data, and testing for this infection, was honored posthumously by having his name attached to the genus of bacterium involved. Gardner argued that this was an important reproductive tract organism although often overlooked by many practicing physicians and a real troublemaker for a newborn infant. He felt that it was a major cause of problems in the reproductive system and that it could be very easily diagnosed by well-trained physicians when alerted by the presence of a unique vaginal, fish-like odor.

Prior to the work of Gardner, physicians in positions of authority promoted the infection as a silent infection, or an organism that was thought to be a normal inhabitant of the vaginal vault. Such descriptions still exist and are extremely confusing to laypeople doing library research and to medical students and residents trying to figure out how a troublemaker could be normal. It is not a reportable infection. It is easy to treat using metronidazole (see trichomoniasis, above).

Group B. Beta Hemolytic Streptococcus

A very important infection, which also has the distinction of arising from a bed of disinformation labeled “normal vaginal flora” (and similar confusing clinical designations), is group B. Beta hemolytic streptococcus. The importance of this infection to Americans was worked out by the National Institutes of Health and the U.S. Public Health Service under the influence of Dorland J. Davis, an epidemiologist. In the early 1940s, the disease was observed as a cause of death in new-born infants at Harvard’s clinical facilities and at Johns Hopkins Hospital, in Baltimore, with the number of infant deaths attributed to it hovering around 40 a year. As the years went by and constant and progressive observation of the clinical phenomena occurred, it became obvious that the behavior of the organism was that of a sexually transmittable bacteria. Gradually, the number of deaths rose to between 3,000 and 4,000 a year, a number that, unfortunately, still prevails in spite of extensive literature and extensive publicity concerning its damaging effects on new-born children. Apparently, a major reason for the indifference to the presence of such a harmful disease was lack of a requirement to report the infection, a problem now remedied. It is a major cause of mental retardation, cerebral palsy, and deafness. Some of the confusion about the disease is because it is a common inhabitant of the prepuce in the uncircumcised male infant as well as the uncircumcised adult male, in whose foreskin it flourishes. The lack of circumcision frequently predisposes young boys to hospital stays for severe urinary tract and kidney infections.

The acquisition by the woman of unusual forms of group B. Beta hemolytic streptococcus, subdivided into categories by Roman numerals, does not occur until they become sexually active, unless unusual circumstances prevail. Since it can be an STD, both sexual partners, or more if there are other partners, must be treated for this organism simultaneously. The organism remains sensitive to penicillin products, and so far it has not developed the usual picture of antibiotic resistance. If the acquisition of the infection occurs at the end of the pregnancy, or if it has been acquired in a form that absolutely refuses to be cured by means of antibiotics, the woman in labor can be given intravenous ampicillin, and the presence of that medication at the time of labor prevents the child from acquiring the infection. Until very recently, the newborn who acquired the infection died as quickly as the infants who acquired herpes from their infected mothers. Fortunately, it has been recently discovered that attention to the hydration of the infant victim gives a greater chance of survival.

The disease itself can cause a localized vulvar skin infection that looks like psoriasis, cervicitis with an abnormal pap smear, or involvement of the Fallopian tubes, so that the victim will end up with ectopic pregnancies as well as urinary and kidney infections, especially in a pregnant woman. Recent work at Parkland Hospital, in Dallas, suggests that it is a major cause of stillbirths in the United States.

Syphilis

Syphilis first appeared in Europe following the return of Columbus from his voyages. There have been extensive arguments as to whether it was a New World disease that was then carried back to the people of Europe. The answer, of course, lies hidden from our view forever. Suffice it to say that an enormous epidemic of syphilis occurred shortly after Columbus’s voyage.

The disease was regarded as revolting because it caused huge bony exostoses that were hideous to look at. In the immediate past, syphilis was the major cause of stillbirth and a variety of congenital malformations. It is so highly infectious that doctors and nurses could get syphilis delivering a newborn baby from an infected mother. The baby itself was highly infectious. Syphilis remained a major medical and social problem until the development of Salvarsan by Paul Ehrlich and S. Hata in 1910. Salvarsan rendered the victim of syphilis noninfectious, but the treatment demanded weekly doses of the drug intramuscularly for at least six to eight weeks. The ability of people to comply with such a laborious regimen was a major problem. The other problem was that the laws of the United States would not allow open discussion of this overwhelming health problem. Finally, in 1936, the surgeon general of the United States, Thomas Parran, was allowed to use the word “syphilis” during a radio broadcast, and the push was on, with federal laws creating clinics and funding for discovery of infected partners.

With the arrival of penicillin 50 years ago and the discovery that it could cure syphilis, public health service interest in this particular disease began to fade. In the 1980s, however, it was realized that individuals who suffer from AIDS are especially susceptible to acquiring syphilis, or vice versa. Syphilis has become a marker for the AIDS infection itself. In addition, the cheapness of crack cocaine and other addictive drugs has increased the number of young women prostitutes who fail to use adequate protection, with the result that syphilis is increasing in urban areas.

Syphilis, a reportable disease, starts out with a hard ulcer, called a chancre, which quickly heals on its own, but the spirochete then spreads throughout the body. In the second stage of the disease, it produces a rash, which can be seen even on the palms of the hands and the soles of the feet, but quite often people are not aware of their rash. The organism then starts to invade the tissues of the central nervous system (including the brain), the heart, and the bones and begins to do its chronic disabling feats of work. Syphilis, in fact, can invade every organ system and imitate almost any disease known to humans. It can, however, be diagnosed inexpensively by a blood test which today is called RPR. This test, approved by the CDCP, has many false-positives so that if the test is positive, another test, the FTA-ABS test, which is both more accurate and more expensive, is given. Sometimes early in the disease, the spirochetes themselves can be lifted out of the hard chancre and placed under the microscope in a visual process called a dark field examination where the spirochete can easily be identified by an expert microscopist, but not by amateurs or the family physician or nurse.

Treatment is by means of antibiotic therapy with very large doses of intramuscular penicillin still being the drug of choice. Treatment schedules and alternative medications are outlined in the guidelines for STDs published approximately every three years by the CDCP.

Gonorrhea

Gonorrhea, acquired in conjunction with syphilis, was also very common in the first part of the 20th century. The Frenchman who discovered the original trichomonad thought he had found the causative organism for gonorrhea. It was not until the German bacteriologist Albert Neisser identified the gonococcus in 1879 that this gram negative diplococcus was precisely defined.

Although gonorrhea can be identified in the doctor’s office because of its characteristic yellow discharge and the bacteria easily identified through a gram stain, a culture should always be done to confirm the diagnosis. A reportable disease, it, like chlamydia, is often asymptomatic in women, but it, like chlamydia, can spread into the internal pelvic organs, causing pelvic inflammatory disease. Unrecognized gonorrhea can be spread to newborn infants, causing conjunctivitis and blindness. Because of this, the practice of instilling silver nitrate drops into the eyes of newborns was made mandatory early in the 20th century. In men, gonorrheal urinary tract infections are acutely uncomfortable, so men are likely to seek medical attention. The incidence of gonorrhea fell after the antibiotics became available in the middle of the 20th century and the U.S. Public Health Service mounted a campaign to bring both syphilis and gonorrhea under control. However, success with the campaign brought complacency, and the incidence of both syphilis and gonorrhea has increased. Gonorrhea is as prevalent now as it was 50 years ago.

Venereal Warts

The most commonly discussed but least researched of the worldwide STDs is venereal warts, known since antiquity. Confusion, of course, can reign because there are some 60 different varieties of wart viruses, with each one affecting a specific site on the body. Some of the viruses that create warts in the genital region and around the rectum are not sexually transmitted. As a result, when laypeople set themselves up as experts on the subject of STD and discover that a small child has perirectal warts, guardians, friends, and parents are often falsely accused of childhood sexual abuse because of the widespread ignorance among the general public on the subject. The public is aware of the sexual connotation but totally ignorant of the natural history of the entire spectrum of the disease. We do not consider perirectal warts in little boys and girls sexually transmitted. They are ordinarily due to skin-contact organisms picked up by the child by touching a playmate on the hand or cheek, for example.
The causative organism of genital warts is a papilloma virus; certain strains of this virus are very dangerous and others are not. Although papilloma virus number 6 and papilloma virus number 11 are common causes of genital-area warts, they seldom spread to other parts of the reproductive system, and they cause little lasting damage. The viruses that cause urethral warts in the male are wart virus numbers 53, 54, 55, and 56, and they are not transmitted to the female during sexual activity. The wart viruses that produce cervical cell changes and abnormal pap smears are papilloma virus numbers 16 and 18, with a scattering in some of the other numerical categories; however, those two viruses (16 and 18) are the ones currently identified as being the main troublemakers associated with cervical cancer.

There is presently no cure for the virus and no vaccine to prevent acquisition of the virus. Currently available are various techniques for removing the warts when they grow. Since 50 percent of the people who have the virus do not grow the warts, the transmission of these warts is thoroughly confusing to ordinary people. It seems as though they simply drop out of the sky.

Removal of the obvious wart does not cure the systemic viral disease, so that other new warts can show up as time goes by. This reoccurrence is particularly depressing to the victims. They are extremely upset that the disease will not permanently go away and that repetitive surgical or chemical removal procedures have to be done. Podophyllin is considered to be the first-line office treatment in the nonpregnant female. Interestingly enough, when the warts are removed from the outside of the woman’s genital area with the use of laser surgery, that procedure sensitizes the warts to podophyllin treatment—an ancient American Indian remedy—so that, fortunately, in most cases, the subsequent reoccurrence of wart forms can be treated using that particular chemical after laser therapy. There is some evidence that getting rid of a yeast infection, keeping the area clean and dry, and taking vitamin A is also helpful. Podophyllin is now available for home self-treatment by prescription as Condylox.

Molluscum Contagiosum

Another common and frequently seen viral-caused skin involvement is called molluscum contagiosum. This is also a disease of great antiquity, whose early beginnings confuse observers. Quite often, it is mistaken for early new venereal warts when the skin lesions are small, and the white punched-in look in the center of a very red pimple is its common picture. The lesions become raised, and they will not disappear with any antibiotic therapy.

One cannot cure these skin spots (and often there are many) with antibiotics because the cause of the problem is a virus. It will, however, go away by itself. Sometimes, cryotherapy or cutting and lifting out the white plug will speed things up. The small white umbilicated lesions go away principally on their own. They are highly contagious. Cleanliness is important. It is spread by scratching.

Yeasts: Candida Albicans et al.

Candida albicans, one of the yeastlike funguses that reproduce by budding, was formerly called Monilia albicans. Yeast infections are considered by the World Health Organization as well as by the CDCP as an STD, although some women do have a few Candida as persistent inhabitants of their vaginas, and they develop infections when they take antibiotics for some other medical reason. The antibiotic kills the normal bacterial flora of the vagina, which has been inhibiting the overgrowth of yeast, and this allows the yeast to take over and run rampant.

The classification of various infectious agents as capable of sexual transmission is not made to encourage people to categorize themselves or others as good or bad people, but to force the treating practitioners to be aware of the fact that the sexual partners of the individual on whom the diagnosis is made must be considered. If the woman has a yeast infection, not only must she be treated, but inquiries must be made as to whether or not the individuals with whom she is having sexual activity are on antibiotics or have Candida infections of the mouth or genital organs, which should be treated to avoid a cycle of reinfection.

Yeast infections are diagnosed in the office with a wet mount using potassium hydroxide (KOH). Treatment is ordinarily with suppositories or creams containing one of the fungicides: nystatin, clotromazole, miconazole, or terconazole. New forms are being constantly introduced and some are available without prescription.

Mycoplasma and Ureaplasma Infections

Mycoplasma and ureaplasma organisms acquired with sexual activity can persist for years without their victims being aware of any problem whatsoever until they try to get pregnant and find themselves sterile, due to mycoplasma and ureaplasma. The natural history and clinical importance of these organisms are still a matter of argumentation within the medical profession only because they are organisms that are relatively difficult to identify in the laboratory. Hence, their true incidence is probably currently unknown, although it is believed that they are common and are considered a major cause of infertility. Treatment involves long-term antibiotic therapy. The infection can be silent or it can cause pelvic inflammatory disease or Reiter’s disease, as well as postpartum fever, kidney stones, male sterility, habitual abortion, and stillbirth. The diagnosis is made by laboratory tests.

Any individual walking into an infertility clinic is thoroughly checked for the presence of these infections. Their importance lies in the fact that if they are present, generic antibiotic treatment for seven or ten days will not even begin to cure them. The amount of time that must be spent taking the brand-name oral antibiotic Vibramycin is from four to six weeks. Therefore, the identification of these particular infections can be important to a woman, especially to make sure that she preserves her future fertility. Their presence in the male creates urinary problems. The diagnosis in the woman is made by vaginal culture.

Donovanosis

Donovanosis is a chronic destructive infection of the genitals, also called granuloma inguinale or granuloma venereum. It is sometimes misdiagnosed by untrained people as cancer or syphilis. It is prominent in New Guinea, Australia, India, the Caribbean, and Africa. It is only mildly contagious and apparently repeated sexual exposure is needed for infection. Long-term antibiotic therapy is needed. It seems, at this time, not to be an American problem.

Chancroid

The most common of the STDs worldwide is chancroid, caused by a gram negative bacillus, Hemophilus ducreyi. Although it is not a common infection in the United States, occasionally new emigrants from Latin America bring the disease in with them. It is treated with sulfa drugs, although it can be controlled with just about any antibiotic. It produces a soft, destructive ulcer and painful infections of the groin that can grow and rupture. If it goes untreated, it can destroy the genitals of the man but not those of a woman.

Viral Hepatitis

Hepatitis is a viral inflammation of the liver, characterized by jaundice. It is transmitted by contaminated food, needles, or sexual activity or from a mother to infant. Fecal contamination of food or water supplies and rectal or anal intercourse should be considered when the individual is seen in the office. Reports of hepatitis research are constantly updated in a data base at the National Library of Medicine, in Bethesda, Maryland. A vaccine has been developed for the type B form. Immune globulin given promptly after exposure will prevent hepatitis type A. Most hepatitis, however, is non-A, non-B, so prevention by the use of condoms for anal intercourse is important. Fatal fulminant hepatitis can occur. Even though this infection can be acquired in many ways, it is considered a major STD. This only emphasizes that an STD is not always transmitted by sexual activity.

Cytomegalovirus Infections

This infection was uncommon in Northern Europe and North America until the 1980s, when the virus was found in urine, saliva, breast milk, semen, feces, cervical mucous, and blood. Close interpersonal contact is necessary to be infected. It can be transmitted to an unborn child, causing severe problems. It can cause hepatitis, heterophile negative mononucleosis, pneumonitis, and Guilliain-Barre ascending paralysis. Anemia and its effects can be devastating in people who are immunocompromised. It has been related to Kaposi’s sarcoma in homosexuals who have AIDS. There is no cure.

Pubic Lice and Scabies

These microscopic insects move from person to person with intimate contact or through the wearing of another person’s dirty underwear. They burrow under the skin, causing a rash and intense itching. They can be visualized using an ordinary magnifying glass. Scabies is a great imitator, and its existence can be covered up by corticosteroid creams and lotions. It is cured with topical applications of lindane or Eurax. Over the counter treatments for pubic lice are available.

Enteric Infections

Giardiasis and amebiasis are due to rectal-oral sexual activity. They are diagnosed by special laboratory tests and are cured with the same therapy used for the treatment of trichomoniasis. Camplyobacteria are a major cause of the gay bowel syndromes of diarrhea and dysentery, or gastroenteritis in homosexual men. Identification is by laboratory culture. Antibiotic therapies are available for the cure. The infections can be transmitted to women, and pregnant women can transmit the infection to their newborn child.

AIDS

Finally, the last and currently most publicized STD is AIDS. This virally caused STD was first discovered among the male homosexual communities of the major cities of the United States—Miami, New York, and San Francisco. It was early determined using epidemiological methods that it was an STD. Eventually, because of the death and disease pattern, the male homosexual act, especially rectal intercourse, was held to be responsible for the transference of the infection to the uninfected. However, that pattern is now changing, as more women are being infected by heterosexual contact and newborns are exposed to in utero infection.

AIDS seems to be caused by a retrovirus that is constantly changing its characteristics, making it difficult to create a vaccine against the disease, because the moment the vaccine is created, the type and variety of virus involved in the epidemic turns out to be totally different from the one utilized in making the vaccine. (The flu vaccine, for example, acts similarly in that it is different every year.)
Treatment is palliative with various drugs, the original one being AZT, which arrests the replication of the virus. All of these drugs are, however, toxic products and, unfortunately, do not make the person who has AIDS incapable of passing the disease on. Therefore, the current treatment not only prolongs the life of the victim of AIDS but also allows him or her a great deal more time in which to spread the disease. The AIDS virus can also contaminate or attach itself to dirty needles that are used by drug addicts. It can be transmitted through blood transfusion as well as by infected semen. The spread of AIDS can be prevented with the use of condoms, especially those with Nonoxyl 9 plus vaginal contraceptive foam (either in tablet form or in pressurized containers). Condoms made of animal membranes do not work in preventing AIDS since microscopic pores exist in the animal membrane that allow the virus to escape.

Death is from one of the several diseases, which attack the body because of the compromised immune system. Such diseases include pneumocystitis carina, Kaposi’s sarcoma, tuberculosis, yeast infections, or other opportunistic infections.

www.sexarchive.info/GESUND/ARCHIV/SEN/CH22.HTM#b12-SEXUALLY%20TRANSMITTED%20DISEASES

Bleeding After Anal Sex What to Do

Seeing blood after sex can be a very scary thing.  Bleeding after anal sex is most commonly due to fissures, or small tears on the inside wall of the colon tissue. These can be very painful and make sex or going to the bathroom and future sex very uncomfortable.

In order to deal with bleeding and minimize pain there are a few simple things you can do to both stop the problem now and make sure it doesn’t happen again in the future.

Keep The Area Clean

The first thing you should do if you do have tearing or bleeding is to clean the affected area.  Like with any other injury consistent hygiene is the first step to healing.

I recommend taking a shower with warm water and using clean finger with clipped finger nails to wash away any excess blood or lubricant.

It will hurt, but it is important to prevent more pain in the future.  The key is to be gentle.  Slowly push outward with your abdominal muscles inner wall of the colon is exposed.

Wash the area well. Do not use soap for the first rinse as this will irritate the area and cause further discomfort.

Warm water works surprisingly well and will help you relax and cause some relief.

It is very important to try and do this everyday until the fissure has healed completely.  It will sting, but it will make the process of healing a lot faster.

Also, if you are able to, be sure to clean the fissure after you use the bathroom too.  It may seem like a lot of worse, but the best thing you can do is provide as much care as possible early on.

Use an Anal Relaxant

When going to the bathroom, I have found that applying a little lube before can also help make your next few days a lot less painful.

One of my saving graces has been Pour Backdoor.  It does a great job lubricating the area and the relaxing feature makes using the bathroom while dealing with fissures much easier.

Also, using anal relaxants are a great way to avoid fissures in the first place if you are extra tight or prone to getting them.

Lastly, make sure to get plenty of sleep.  Rest will promote healing and will let your body rest and rejuvenate.  If you keep on top of these steps then you should notice a big difference in a few days.

If the bleeding gets worse, or continues for more than three days, you may want to look into using medications such as nitroglycerin cream to help treat the cut.

If it has been almost a week you should contact a doctor, but in most cases you should be healed up before then.

Avoiding Fissures

Fissures occur when too much stress is placed on the colon wall, specifically the inner sphincter muscle when it stretches too much, too quickly.

As I have mentioned time and time again, anal sex should not hurt and if it does, then you are doing something wrong.  Discomfort is one thing, but pain is not good.   The key to avoiding fissure is to slow down, relax and use plenty of lube.

Eat Right and Keep Hydrated

Eating right and drinking enough water has a big effect on your colon health and can have a big role in how prone you are to fissures and bleeding.  The key is to eat lots of fruits and vegetables and to avoid processed and fatty foods.

Foods high in fiber promote good digestive health and help keep inner tissues healthy.  The stronger your colon wall, the better prepared you will be for sex.  You should be drinking water regularly throughout the day, and do your best to stay properly hydrated.

Be sure to also take your time when using the bathroom.  Straining is not good and can weaken your inner tissue or even make small tears even before having sex. Small fissures also have the potential to get worse with time.

You should also avoid drinking a lot of alcohol.   Alcohol lowers your body’s ability to repair itself quickly and is generally not good for your digestive system and immune system.

This doesn’t mean you can’t drink, just limit yourself.  Also avoid drinking before sex as this will make you less sensitive to pain, and therefore more prone to injury.

Go Slowly

Tearing happens most often when you or your partner rushes while entering.  Not being in the right state of my will lead to bad results.  Also be sure to communicate with your partner while having sex.

Take it slowly, use plenty of lube and do not rush. Remember, if it hurts, you are probably doing something wrong.

Bleeding After Anal Sex: Things to Remember:

Maintain a Healthy Diet
Drink Plenty of Water
Avoid Alcohol
Do Not Strain When Using the Bathroom
Clean the Affected Area Often
During Sex Use Plenty of Lube and Be Sure to Go Slowly
If Bleeding Persists Contact a Doctor

As long as you follow these steps closely you should heal very quickly.  Remember that the best way to prevent bleeding after anal sex and treat fissures is to not get them in the first place.

www.maleq.org/bleeding-after-anal-sex-what-to-do/

First aid (and BDSM)

Common sense

Common sense is one of the best safety devices around. Unfortunately it does not seem to be that common.

Think about what you do!

Always try to differentiate between FANTASY and REALITY. Although the line separating the two can be very slim indeed, it can be the difference between a scene which is perfectly safe and one which is potentially very hazardous.

Try to be aware of who you are playing with, both physical and psychological responses are very important. Try to be aware of your scene. Think of what you have done, what you are doing and what you are going to do. When you think about these things, also think about the physical and psychological consequences of your actions.

Try to consider the physical and psychological limitations of your partner and also your self. It may be necessary to discuss these limits before embarking on a scene.

One of the limiting factors is knowledge, and one of the ways around this limit is sharing knowledge. For some activities, you must be competent as well as confident.

What do you need to know?

As well as a person’s sexual likes and dislikes, fetishes, etc, it also helps to know if someone is likely to drop dead on you, or has a medical problem which could be relevant to something you are about to do with them. Most people regard their personal medical details as something very intimate, but there are one or two conditions which warrant discussion. Even little things like false teeth or contact lenses can bring a very sudden downer on what could otherwise have been a good sex.

Examples; Anxiety attacks, Arthritis, Asthma or other respiratory disorder, Circulatory disorders, Diabetes, Heart disorders, Neurological disorders. The list is probably endless. You should know if you have a medical condition that your partner should be aware of. If you do not tell them about it, it could have unpleasant, or potentially fatal results. This can work both ways.

Some people feel that HIV status is a relevant topic for discussion, but if you are practising safer sex it seems a little irrelevant. However, other STDs might be worth mentioning to prevent your partner getting a dose.

Pain

Pain is the body’s way of telling you it has a problem, damage  is being done! When you are hurting someone during a scene and  they are enjoying the pain, if it changes or another pain becomes present the scene may be going wrong. If the bottom is experiencing  pain which they are not enjoying, and you are not in control of  that pain, you must stop the scene immediately and find out what  is wrong.

Numbness/tingling/cramp

If something goes numb or tingly, it has probably been tied up  too tightly, or in the wrong position. Release the bondage and  massage the area. It should return to normal with five minutes. Cramp is due to reduced blood flow. This may also be caused by  bondage being too tight or the positioning being wrong, but it  can also be caused by sluggish blood flow due to immobility. In  addition to the above, try flexing the affected area.

Coping with panic

Panic is the mind’s way of saying ‘Get me out of here’, so if  a bottom panics that is the end of the scene. Stop the scene, release them from any bondage, and calm them down with a cuddle.

Fainting

Lack of oxygen or a drop in the blood pressure can result in fainting. If it’s the bottom, release them from any bondage. Check  the person’s airway is clear, that they are breathing and have  a pulse. If they are not breathing and/or do not have a pulse, call an ambulance and start CPR immediately. (See panel)

However if they are still alive, either sit the person down and place their head between their knees, or lie them down and slightly  raise their feet, whichever is easiest. They should recover quite  quickly.

Diabetes

Physical and mental stress results in an increase in metabolic  function. In diabetics, this can result in Hypo-glycaemia (Low  blood sugar). This can, with very little warning, cause the diabetic  to lose consciousness. Common symptoms are profuse sweating and  clamminess, sudden mood changes, appearing drunk, disorientation.

Unfortunately, just asking if they are OK will not always get  a sensible response because the brain needs sugar to function  properly.
Initial treatment is simple. Glucose! Any form as long as they  do not choke on it. So give them some chocolate, a jam sandwich,  glucose sweet, Lucozade, you name it.

Now get them lying down, keep them warm and continue feeding  them glucose. If they worsen, or have not begun recovering within  ten minutes dial 999.

Bleeding

Superficial bleeding will stop of its own accord; if you wish, apply antiseptic, but a good shower will probably do as much good.  Injuries above the neck tend to bleed more then other areas of  the body and this can make them seem worse than they actually  are.
If someone is bleeding profusely, apply firm pressure to the injured area using a clean cloth.

If the bleeding does not stop, it may be necessary to visit the local Accident and Emergency department.

If the injury was caused by something dirty or an old piece of  metal, it is a good idea to check that the person’s tetanus vaccinations  are up to date.

Burn

You should only attempt to treat localised and superficial burns (First degree) yourself. Hold the injury under cold, running water  or use an ice water compress (or a packet of frozen peas), until  the pain subsides. Cover the area with a sterile, non adhesive  dressing for a couple of days. If there is any sign of discharge,  seek medical advice.

Other problems

If you are in any doubt, if you think there might be a broken  limb or a spinal injury or concussion, just get the person to  lie still, keep them warm and dial 999.

Do not worry, whatever you have been up to the staff will have seen worse and they are bound by confidentiality regulations not to repeat what they see. However because of the current legal situation in the UK regarding SM you would be well-advised to stick to describing the nature of the problem and not say anything about its cause.

Other problems which warrant a trip in an ambulance include any prolonged bleeding from the vagina, anus or urethra. Also the irretrievable loss of any items up any of the aforementioned orifices.

smgays.org/info-sheets/first-aid

How risky is cum play?

Very high quantities of HIV live in a positive guy’s cum so getting it in any parts of your body that have easy access to your blood stream (e.g. your arse) is considered risky for HIV. Once cum leaves the body and hits air, HIV in it dies rapidly.



How do I reduce the risk?

If you enjoy playing with spunk but want to avoid catching or spreading HIV, there are ways you can play with it safely:

• Facials: HIV will die soon after it’s exposed to air so if you are into cum splatting all over your face or body then the risk is low. Ask him to fire away; just make sure you avoid getting cum in your eyes because it stings like hell.

• Felching: Sucking your own cum out of someone’s arse, even if the person you are felching is HIV-positive, carries minimal risk for HIV. You can however pick up other STIs including hep A and bacterial stomach infections, which can make you very sick. If you get involved in group sex and you felch someone else’s cum then you are putting yourself at risk, similar to the risks from rimming and oral sex, however the HIV risk is small.

If you like getting cum in your mouth, make sure you have healthy gums and avoid brushing your teeth at least an hour before sex. That reduces the risk of HIV getting into your bloodstream if it gets in your mouth.

Can I get other STIs from playing with cum?

Although HIV dies quickly after cum is exposed to air, other STIs, including gonorrhoea, chlamydia, herpes and hepatitis C can be in spunk and live longer. There is no exact time scale for how long HIV lives once it’s exposed to air.

How risky is swallowing cum?

Although high volumes of HIV live in a positive guy’s cum, research suggests that saliva has properties which will usually kill HIV. There have, however, been some cases reported where men have become HIV-positive from getting cum in their mouths so getting cum in your mouth and swallowing it isn’t entirely without risk. You can also get other infections from swallowing cum, including gonorrhoea, chlamydia and syphilis.

The risks involved with mouth-to-mouth cum swapping are the same as swallowing cum.

www.gmfa.org.uk/how-risky-is-cum-play

Gay check-ups & Personal Hygiene

Balls and Prostate

Two key aspects of staying physically healthy are caring about your personal appearance and ‘do it yourself’ body checks. If you look good you’re likely to feel better about yourself. A balanced diet and plenty of water during the day will help keep your skin, nails and hair in good condition, but it’s important not to neglect other parts of your body through inadequate personal care or other unhealthy habits.

Testicular cancer

Cancer is abnormal cell growth and may develop for a wide variety of reasons, some of which are known and others that aren’t. Normal cells have certain limits to their growth, cancerous cells continue to grow without controls, eventually causing serious and life-threatening damage. You can’t 'catch’ cancer and it is not a sexually transmitted infection. Testicular cancer is on the increase, mostly affecting younger men in their 20s to 40s. It’s easy to deal with when treated quickly so, in addition to regular sexual health check-ups, DIY ball checks can pick up early warning signs that something may be wrong.

Ball check-up

Check your balls monthly in (or just after) a shower or bath when your ball sack is relaxed and stretchy:

Rest your ball sack in your hand, feel its weight and use your fingers and thumb to feel each ball. It is normal for one ball to be slightly larger and/or lower than the other.

Gently roll each ball between your fingers and thumb. At the top you will feel the tube which it is attached to, and the firm, bumpy area where it joins on. The rest should be smooth without lumps or swelling.

If you feel anything that seems unusual or that concerns you, go to a clinic or to your GP.

Over time you’ll get used to how your balls look and feel. This way you will notice any differences and problems quickly. Though most lumps and bumps turn out to be harmless, you should get them checked. Remember, the earlier testicular cancer is found, the easier it is to treat.

Prostate problems

Situated just below the bladder, the prostate gland is 'hooked-up’ to the plumbing along which your spunk travels. It is responsible for producing the fluid in which sperm swim and a secretion which keeps the urethra moist.

It gets bigger as we get older and can sometimes begin to squash the tube that takes piss out of the body. It can become infected or inflamed, most common between 25-45yrs. It can get enlarged to the size of a small grape fruit if untreated. Prostate cancer usually occurs to the over 50s but can happen earlier.
Signs and symptoms that something is wrong include:

• Needing to piss often and getting little warning that you need to go. 

• Finding it hard to start or stop pissing.

• Lots of dribbling at the end of a piss. 

• Finding it a strain to empty your bladder properly.

• Leaking or dribbling piss. 

Prostate cancer

Early prostate cancer rarely causes any symptoms, these only occur at a later stage of the disease. The prostate - specific antigen (PSA) test may help to detect early prostate cancer but because many small prostate cancers are not dangerous, it is not yet known whether early detection and screening is worthwhile for prostate cancer. Studies are underway to find out, but until the results are known, screening for prostate cancer is not be routinely offered in the UK.


There are treatments for men with an enlarged prostate gland: contact your GP a sexual health clinic. Prostate cancer tends to affect men in their 40s onwards but can be treated effectively if found early. The symptoms above may point to prostate problems and are sometimes felt by men with prostate cancer, but not always. If you are aged 50 or over, you should have yearly checks which can be performed simply by a doctor or at a sexual health clinic.

peperonity.com/porn/sites/gaysexguide/11581687

Teeth

Adults have 28 to 32 teeth depending whether the person finally grows their wisdom teeth, which do not appear in everyone. In many cases, wisdom teeth don’t emerge fully from the gum because of over-crowding. Your dentist will determine whether they are best left alone or taken out. Teeth are largely made up of dentin on the outside and a pulp on the inside where blood vessels and nerve endings are situated. The crown, or visible part of a tooth, is covered with about 2mm of enamel. Below the gum line, the root of the tooth is made from cementum. Both dentin and cementum are tough bony substances. Teeth are 'glued’ by a special membrane that anchors them to the surrounding socket. Poor oral hygiene or the failure to clean and floss your teeth regularly weakens the mouth’s ability to fight off infections and the membrane that fixes your teeth to the sockets. Consequently, despite the best efforts of saliva, which is you body’s natural answer to bleach, you are more inclined to get mouth ulcers and bleeding gums - obvious gateways for bacterial infections like gingivitis and viral infections like hepatitis and HIV.

Bad breath

Bad breath is caused by bacteria, tooth decay, smoking or rich and spicy food. It can seem particularly unpleasant when you wake up in the morning after you’ve been drinking the night before. During the night your body produces less saliva (a natural mouthwash) and a thin creamy coating forms over your teeth, tongue and gums. Healthy bacteria break it down producing mild toxins which smell and taste horrid. However, in some cases bad breath can be caused by medication and stomach ulcers.

Plaque

Plaque is a sticky coating on the teeth made up of saliva, bacteria and particles of food. It is the main cause of tooth decay and gingivitis (an infection of the gums). If allowed to accumulate it will become hard and increasingly difficult to remove. Plaque begins to form within hours of cleaning and is responsible for the furry feeling of un-brushed teeth. If the gums are unhealthy the plaque tends to spread more quickly. The bacteria can also rapidly erode teeth enamel and voilà… a cavity! Or voilà, voilà, voilà… lots of cavities. Plaque should be removed at least twice times a day using a toothbrush and dental floss.

Gingivitis

Gingivitis is usually caused by a build-up of plaque. It is thought that the toxins produced by bacteria within the plaque irritate the gums causing them to become infected, tender and swollen. Gingivitis can also result from injury to the gums usually from rough brushing of teeth or flossing as if you’re lassoing a steer. Healthy gums are pink or brown and firm. Poorly gums become a reddish-purple, mushy, shiny and swollen. The gums bleed easily during brushing and are often tender. Good oral hygiene is the main means of preventing and treating gingivitis - and not letting the plaque form in the first place. In some cases, a special mouthwash will ease the symptoms.

Tips for teeth

You should visit a dentist every six months. If not, or if you leave it until pain and discomfort occurs you are storing up potentially horrific problems for later on.

Clean your teeth at least twice a day, ideally after each meal. This should take no less than 3-4 minutes.
Renew your toothbrush or electric toothbrush head every couple of months, or per instructions.
Electric toothbrushes are recommended, especially for removing plaque.
Floss your teeth at least once a day to help prevent your gums from receding (a major cause of tooth loss).
After meals use a tooth pick to dislodge food from between your teeth.
Chewing gum produces saliva which breaks down bacteria. Choose a sugar-free variety.
Sugar rots teeth so choose foods, sweets and drinks with reduced or no sugar.
Mouthwashes and freshener sprays mask bad breath, they don’t sort it out.
Teeth whiteners which use bleach can produce results but can damage the enamel. Check with your dentist first.

Nails 

Like skin, nails are made from keratin and protect our fingers and toes from wear and damage. They also help us pick up objects and allows us to scratch the little bastard’s eyes out when he cheats on us. Fingernails usually take five or six months to grow from base to tip (just under a millimetre a week). Toe nails take twice as long to grow which is why we don’t have to cut them so often(some of us seem to forget about them altogether).

Damage and indicators

Nails are susceptible to damage through injury, pressure or crushing (in a door, for example) but more usually through bacterial or fungal infections and general illnesses. Brittle or ridged nails, black splinter marks beneath the nail itself, blue and green discolouration may be signs of vitamin deficiency and generalised disease.

Nail biting

Nail biting is a nervous is nervous habit. A badly-bitten nail is more susceptible to infections, pain and bleeding. The usual treatment is to paint the nails with a clear solution which tastes horrible, but this has obvious limitations. Examining why you bite your nails can be helpful in devising a strategy to break the habit. Perhaps the best reason for quitting is being able to see a full set of neatly trimmed nails - it will only take a month to see significant improvements. Nail care tips

Clean your nails carefully by prising out dirt beneath them. (A nail brush may be helpful).


Soften your nails in warm water before cutting them.

Don’t cut your nails too short.

Cut your toenails straight across to stop them in-growing.

Don’t bite your nails. It doesn’t just look tacky, it really shows you up when you’re holding a glass, shaking hands or he’s trying to suck your fingers romantically. (He may as well nibble them for you).

To protect against nail infection, wear rubber gloves when your hands are being continually immersed in water.

See a doctor if your nails become discoloured or brittle as this could be due to a fungal infection or vitamin deficiency (which are usually easily treated).

Feet and toenail tips

If you shower (rather than bath) don’t forget to clean your feet, toes and toenails everyday making sure your dry them properly, particularly between the toes.

If you are prone to bacterial or fungal infections a range of creams, powders and sprays from your chemist can help combat this. Keep a separate foot towel (which you don’t use on your face).


Change socks daily to prevent foot odour.

Use a pumice stone to gently remove dead skin from the heels and balls of your feet.

Discard shoes that are worn beyond repair, or no longer fit properly.

Wear natural materials, such as cotton socks and leather shoes to reduce sweating. If you suffer from smelly feet, wear insoles made of activated charcoal, which absorbs sweat and odour particles.

If you develop a foot problem, such as a callous, bunion or verruca, see your doctor or chiropodist.

Hair 

Like skin and nails, hair is made from keratin. Hair acts as a protective barrier. For example, eyelashes protect the eyes, hairs in the nostrils and ears trap and prevent the entry of foreign bodies and eyebrows prevent sweat dripping into the eyes. Attached to the base of each hair is a minute strip of muscle which is stimulated by cold or emotional stress. When the muscle tightens, the hair stands up trapping air and conserving heat. Each hair grows for up to five years before entering a 'resting’ phase. As the growth stops, the hair falls out and after about three months a new hair begins to grow to take its place. Obviously, the number of hairs varies between individuals but, on average there are about 100,000 hairs on your head and you might lose anything between 40-120 hairs a day. Colour is determined by how much pigment hair contains. As we get older, we tend to produce less pigment which is why hair goes grey.

Hair loss

The reasons for hair loss are various including physical ailments, skin conditions, allergic reactions, and mental stress. The most common type of hair loss is baldness which is caused by hormonal change in the body as we get older. Unless you intend to stick the bum of a Canadian beaver to the top of your head - get used to it, it’s a fact of life! Shorter hair - properly groomed - can be dead sexy in a man of any age. For some men, however, hair loss is a major upset particularly when their young. If hair loss causes you stress, depression or makes you feel inadequate talk to your GP before spending money on potions or transplants.

Dandruff

Dandruff is a common but relatively harmless condition where dead skin cells are shed from the scalp. This produces white flakes which are best noticed on dark suits. The usual cause is a scaly rash called seborrhoeic dermatitis that can also affect the chest, face and back. Treatment involves regular use of a medicated anti-dandruff shampoo from your chemist although a cortico-steroid or anti-fungal drug are sometimes required (through your GP).

Hair care tips

• Shampoo your hair regularly to remove any build up of dirt and grease. 
• Beware of harsh anti-dandruff shampoos - ask your hairdresser, chemist or perhaps barber for advice. 
• When washing your hair massage your scalp to stimulate blood flow and to release tension. 
• Rinse your hair thoroughly (under a shower stream if possible). 
• Use a conditioner to smooth the outer surface of the hairs. 
• Keep hairdryers at least 15 centimetres away from the head to …

peperonity.com/porn/sites/gaysexguide/11581692

Skin 

Covering the surface of the body and weighing over 4kg (9lbs), skin is the largest body organ. Made from keratin, a hard protein, it provides a barrier against the environment, bacteria and other foreign organisms and keeps many organs from falling through the skeleton. Just as well then. Self-repairing and self-regenerating when damaged, unbroken skin is waterproof and protects the body from exposure to the sun’s harmful rays by producing melanin, a dark pigment, which forms a layer to absorb ultraviolet light; this is why we tan in the sun. Skin also plays a key role in controlling body temperature and water balance. For example, body hairs become erect in the cold trapping warm hair close to the skin, and sweat glands secrete sweat to cool the body when it’s too hot. Full of nerve endings, skin also helps us understand our surroundings as it constantly transmits information about touch, pressure, pain and temperature to the brain to interpret. So, in short: don’t leave home without it.

Skin is attached to deeper body tissues with elastic fibres called collagen which allows the body to grow and stretch. As we get older, those parts of the body which have been exposed to the ageing effects of sunlight (the face, neck and hands, for example) lose elasticity as the collagen fibres break down. This is what causes bagginess and wrinkles and turns some of us into prunes.

Since the purpose of skin is to protect us from the environment, it’s not surprising that - from time to time - it breaks down. While many skin problems are rarely life-threatening and are relatively easy to treat, their effects can be devastating particularly if you suffer from recurrent episodes. That 'hot date’ suddenly becomes a nightmare as you explode with spots or an unexplained body rash. Common skin problems include:

Acne (spots) - skin follicles blocked with excess sebum (which lubricates the skin) and infected with bacteria. Also known as white/black heads which usually affect men during puberty but can affect us later on in life as well.

Eczema or dermatitis - inflamed, irritable, flaky, dry skin sometimes caused by allergies, although in many cases the cause is unknown. However, skin tests can sometimes determine the cause.

Athlete’s foot - a fungal or bacterial infection causing itchy and sore skin between the toes usually associated with wearing shoes and sweaty feet.

Unless you know the cause of your skin condition (and any appropriate treatment) seek professional help - probably your GP in the first instance.

If you are an acne sufferer - avoid greasy skin and hair preparations that clog up the pores making it more difficult for your skin to breathe properly. A chemist should be able to suggest acne preparations which can be helpful in mild cases.

If you suffer from eczema or dermatitis an inexpensive moisturiser can help ensure your skin doesn’t dry out.

Changes in your diet can reduce the problem; for example, some eczema sufferers find that reducing dairy products can help.

Stress can trigger or exacerbate skin complaints - consider learning a relaxation technique. Many skin conditions can be helped by some exposure to sunlight - but we’re not talking suntanning or burning!

If you suffer from athlete’s foot, a range of over-the-counter creams, sprays and powders are available. Simply ask your chemist.

Skin cancer check-up

A regular check-up can help detect skin cancer. As with testicular cancer, the sooner skin cancer is discovered and treated, the more likely you are to achieve a complete cure. Warning signs to look out for include:

• A slowly growing lump or bump. 
• A change in skin colour or texture. 
• A mole or blemish that has changed in shape, size or colour or has started to itch, bleed or become sore. 
• The sudden appearance of a new mole. 
• A sore or ulcer that hasn’t healed with three weeks. 

Don’t become paranoid! You also need to bear in mind that your body’s appearance changes as you get older.

Skin care tips

Make sure your diet contains plenty of fresh fruit and vegetables.

Drink at least eight glasses of non-carbonated water every day; drinks containing caffeine, eg tea, coffee, and soft drinks don’t count.

• Give up smoking which can cause premature wrinkling. 
• Wash regularly with a mild soap and water to remove dirt and dead skin, rinsing off all soap thoroughly. 
• Don’t spend too long in the bath or shower and make sure the water is not too hot. 
• Use a moisturiser compatible with your skin type. 
• Dry carefully but thoroughly between your toes and fingers. 
• When you’re out in the sun, put on a sunscreen (with an appropriate factor) on exposed skin, wear sunglasses to protect your eyes and a cap to protect your head and the back of your neck. 
• Wrap up well in cold and windy weather. 
• Avoid direct contact with hazardous irritant substances such as household bleach and paint stripper. 

Tattoos

The word, tattoo comes from the Tahitian word tattau, which means to mark, and was first mentioned in explorer James Cook’s records from his 1769 expedition to the South Pacific. Some scientists have said that certain marks on the skin of a mummified human body dating from about 3300BC are tattoos. If that’s true, these markings represent the earliest known evidence of the practice. More widely recognised are tattoos found on Egyptian and Nubian mummies dating from about 2000BC.

Today, tattoos are created by injecting ink into the skin. The tattoo machine as we know it today has remained relatively unchanged since it was invented in the late 1800s and carries ink into your skin through a needle that moves up and down like a sewing machine. Today’s machines puncture the skin at the rate of 50 to 3,000 times a minute. The sterilized needles are dipped in ink, which is sucked up through the machine’s tube system. Using an up-and-down motion to puncture the top layer of the skin they drive the ink into the skin, to about one-eighth of an inch deep. What you see when you look at a tattoo is the ink that’s left in the skin after the tattooing. At this depth, cells of the dermis are remarkably stable so the tattoo’s ink will last, with minor fading and dispersion, for your entire life.
The size and type of your tattoo and the skill of the artist help determine the amount of pain involved. Pain also depends on the location of your tattoo: the lower back and ankle are popular places for tattoos but it’s much less painful to get one on your chest or upper arm. This is because skin right above your bones tends to be more sensitive to needles while there’s extra body mass in the upper arm or chest to cushion the bones.

You should think carefully before getting a tattoo and the following points may be helpful in coming to a decision. A tattoo is to all intents and purposes permanent, and what you want when you are younger usually changes as you get older. Tattoo removal is considerably more painful and expensive than tattooing. The process usually takes several sessions and offers varying results. Highly visible tattoos have been know to hinder career interests and plans. Speak to a friend who has a tattoo and ask him about his experience.

Check list

Ask your GP if there are any reasons why you shouldn’t have a tattoo (other than his personal thoughts on the matter).

If you need more than one visit to choose what you want, check over the clinic and discuss your needs with the studio - do so.

Believe it or not there is no uniform standard in the UK. However, studios have to be registered in London with their London Borough, elsewhere they are usually registered with the local council (where they have to have a licence) or the health authority.

Set sufficient time aside, it’s not a particularly intelligent idea to have a tattoo or piercing on your way to work!

Make sure the studio is covered by the appropriate health certification.

The studio should be scrupulously clean with separate waiting, tattooing/piercing and sterilisation areas.

Ask the studio to explain in advance the procedures involved, and answer any questions that you may have.

After the tattoo/piercing, the studio should provide you with a written aftercare sheet.

If you have any doubts - follow you gut instinct - and leave.

Tattoo aftercare

• Remove any dressing after two hours.
• Wash with warm soap and water and pat dry with a clean towel.
• Do not recover the tattoo.
• Do not get the tattoo contaminated with grease, dirt, paint etc.
• Do not expose the tattoo to the sun.
• Apply small amounts of Savlon cream to the tattoo for the first two days.
• Do not pick or scratch the tattoo.
• Wash the tattoo twice daily.

Piercings

These days, nipple, ear, navel and eyebrow piercings are relatively common. Nipple piercing goes back thousands of years, and is believed at one time to have been a sign of allegiance and manhood within Caesar’s Pretorian Guard. Many Roman statues are thought to show pierced nipples but they could be representing a lorica or breastplate. There are even suggestions that cloaks were fastened to them. If true, they would have been very lightweight particularly when in battle - for obvious reasons!

Genital piercings (through the cock and balls) also have a long history. The ampalang (a barbell placed horizontally through the glans) comes from Borneo, where the women of certain tribes will not marry a man who does not have …

peperonity.com/porn/sites/gaysexguide/11581694

Sexually Transmitted Infections (STI's)

Introduction

If you’ve ever thought that you were the first or only person to have had a sexually transmitted infection (STI) - think again; they have been around for thousands of years. Gonorrhoea was first mentioned in the Bible and the name of the disease was given by the second century Greek physician Galen. The origin of syphilis is less clear but by the 16th Century it was making its way across Europe. More recently, HIV has affected the lives of gay and bisexual men everywhere and has changed the way we think about sexual health. Not only do we have a better understanding of our health needs but many genito-urinary medicine (GUM) and sexual health services have responded to the need for improvement. None of us really want to dwell on STIs, but being aware on what’s going on leaves you free to concentrate on having a good time. Anybody can get a STI from someone who already has one. The trouble is that STIs are usually passed on by someone who doesn’t know that they have an infection and so just asking your partner won’t protect you.

The majority of STIs enter the body through tiny abrasions, sores or cuts in the body, many of which can be invisible to the eye. A few STIs only itch, some are painful, some are permanent and many can be serious if left untreated. Effective prevention, protection and treatment will significantly reduce the likelihood of getting STIs or if you do get them, will reduce or eliminate the harm they can cause.

Reducing the risks of infection

Being sexually healthy is not only about dealing with sexual problems as they arise, it’s also about avoiding problems in the first place. Most sexual activity carries some kind of risk of getting an STI and, while never pleasant, many gay men see them as an occupational hazard. You can significantly reduce the risk of getting or passing on STIs by:

• Vaccination against hepatitis A and B.
• Using condoms when fucking
• Routine clinic check-ups every four to six months.
• A prompt visit to a sexual health clinic if you think you have an STI.

Causes and common symptoms

Sexually transmitted infections are caused by:

• Bacteria which generally live and multiply in the warm and moist parts of your body like your throat, inside your penis and in your anus and rectum.
• Viruses which generally need to get into the blood stream before they can do harm.
• Parasites which live on your body in areas like your groin and armpits.

While some STIs have no symptoms, most do and can include:

• Itching in or around the penis, testicles or anus. 
• Burning or itching when you urinate or shit. 
• Needing to urinate or shit and then not being able to go, or only going a little. 
• Spots, scabs or rashes on the penis, testicles, or anus. 
• Pus from the end of the penis or from the anus. 
• Unusual lumps or bumps. 

If you have any of these symptoms, even if you have not had sex recently, you should be checked by a doctor. STIs don’t clear up on their own and can be serious if left untreated. It is worth examining yourself about once a month to make sure you haven’t picked anything up - apart from the man you always wanted. However, some STIs don’t have symptoms. You are recommended to go for a check-up at least twice a year at a sexual health clinic, some of which have specific services for gay men.

HIV and STIs

Having HIV already and getting an STI can put extra strain on the immune system and increase your viral load (the amount of virus present in the blood). This, in turn, can make you more infectious (in terms of HIV) to others. If you get infected with another strain of HIV, this could do more harm than the one you already have and increase the likelihood of disease progression. If you get infected with a drug-resistant strain of HIV, drug treatment will be less effective.

It’s therefore essential that you have regular sexual health check-ups to make sure that you haven’t picked anything up, particularly STIs which show few or no symptoms. Since most men find out that they have HIV at a clinic, you may already have a doctor who manages your sexual health. If you have any concerns or problems - don’t hesitate to pick up the phone or visit.

Sexually Transmitted Infection - Chlamydia, Lice and Gonorrhoea

Sorting out symptoms and what they may mean 

If you think you have an STI, you might wonder what kind of STI it is. The symptom chart opposite matches a range of symptoms commonly associated with sexually transmitted infections. By relating your symptoms with the chart, you should get an indication which STI you could have. Some symptoms can indicate other illnesses or medical problems. All the more reason to see someone as soon as possible. The chart is for guidance only and you should not attempt to diagnose or treat yourself. Always consult a doctor. Almost all STIs require a test at a sexual health clinic to determine whether or not you have a STI.

Chlamydia

Chlamydia is a bacterial infection which you get from unprotected fucking, fingering, rimming, deep kissing and oral sex. Symptoms show themselves one to three weeks after infection. It affects the penis, anus and the throat but can also spread to the bladder and the prostate gland. The body develops an allergic reaction to untreated chalamydia causing an acute form of athrirtis in the joints where it cause permanent damage. It is easily treated with antibiotics although you should go back to the clinic to check that it has cleared up.

Crabs Pubic lice

Pubic lice are small insects no more than 3mm across and under the microscope look very much like crabs, hence the nickname. They can be seen with the naked eye particularly when they’ve eaten your blood and are bloated. Crabs have a long sharp hollow nose which they use to pierce the skin and draw up a tasty meal . They live in hair anywhere on the body but you will usually find them first in the groin and chest areas. They move around like Tarzan, holding tightly onto a hair with their claws and swinging to the next. They can easily be passed on though close physical contact including shared bedding, towels and clothing. You don’t only get crabs through sex, so be careful before you point that finger! They are sometimes passed on through day-to-day social contact with friends, flatmates or anyone with whom you share your home. Crabs are easily treated with a special lotion, available from any chemist, or free, from a clinic. Even after effective treatment you can still feel itchy for a few days and - believing the crabs still there - some people re-treat themselves which can cause skin irritation. All bedding and clothes that have come into contact with you should be washed at no less than a 600 c wash.

Gonorrhoea

Gonorrhoea is a highly infectious bacterial infection which you get from unprotected fucking, fingering, rimming, deep kissing, and oral sex. Left untreated the infection can spread to the prostate gland, bladder, the balls and joints and cause permanent damage. Blindness has be known and in some cases, death. A course of antibiotics is usually prescribed.

Sexually Transmitted Infection - Hepatitis

Hepatitis is caused by a family of viruses - such as A, B and C - that affect the liver and reduce its ability to function. One of the largest and most important body organs, the liver makes and regulates many of the body’s chemicals and helps break down and eliminate drugs, toxins and others poisonous substances from the blood. When it’s infected, it becomes swollen, painful and doesn’t work properly which means that poisons - which would otherwise be processed by the liver - build up in the bloodstream. Recovery can take many months and the consequences of hepatitis can be serious, cause long-term damage and in some cases liver failure. (Hepatitis can also be caused by the side-effects of some medical drugs, overdosing on some drugs eg paracetamol, and long-term alcohol abuse - which put the liver under great strain).

Vaccination

Unlike the majority of STIs, Hepatitis A and B are preventable through vaccination. So with few exceptions you can virtually eliminate getting it in the first place, and it’s difficult to understand why so many gay men who know about it don’t bother. If you’re gay and sexually active, it’s essential!
How you get it and symptoms

Hepatitis A

Hepatitis A is most commonly associated with poor toilet hygiene and contaminated food and water although you get it from rimming, scat, and kissing. While some people don’t get any symptoms at all, they usually occur two to eight weeks after infection and include diarrhoea, loss of appetite, aches and pains, pale slimy shits, dark coloured piss and a yellowing or jaundice of the skin and eyes. Although very unpleasant, hepatitis A is rarely serious and the body usually fights off the infection within a few weeks, though some symptoms may persist for up to six months. 

Hepatitis B

Hepatitis B is much more serious than hepatitis A and can cause long-term liver damage. In a minority of cases, this can cause chronic liver damage leading to death. You can get hepatitis B from unprotected fucking and shared dildos, oral sex, watersports (if the piss gets into the eyes and mouth) and rimming. In fact, it’s a bit of an all rounder which is why vaccination is essential! Most people experience no symptoms but have a period of illness up to six months after infection. These include tiredness, jaundice, dark coloured piss, pale slimy shits, stomach pains and itching. The majority of people recover fully although a small percentage remain carriers of the virus and can …

peperonity.com/porn/sites/gaysexguide/11581672

HIV and AIDS

What it does

HIV stands for Human Immunodeficiency Virus. Isolated in 1983, it belongs to a family of viruses known as retroviruses. Although the syndrome of illnesses associated with HIV infection was only recognised in the early 80s, analysis of stored blood samples reveals it was present as long ago as 1959. A virus is a very simple organism, consisting of an outer coating enclosing genetic material. When a person becomes infected with HIV, the virus enters the cell and the viral genetic material is copied into the gene of the infected cell. These cells will remain infected for the rest of their lives, as HIV uses them as factories to produce more copies, which can then go on to infect more cells. Although many different cells within the body are infected with HIV, it particularly damages cells which are part of the body’s defences against infection (the immune system). This is why people with advanced HIV infection are much more susceptible to certain infections (and types of cancer) since the function of the immune system is progressively weakened by the damage done by HIV. AIDS (Acquired Immune Deficiency Syndrome) is the name given to the collection of illnesses (or syndrome) which someone can get if their immune system has been severely damaged by HIV.

How you get it

Fucking without condoms and sharing needles to inject drugs are the two main ways HIV is transmitted. While there is some risk with other sexual practices such as cocksucking, rimming, finger fucking and fisting, the risks are negligible compared to unprotected fucking, which accounts for a significant number of HIV transmission cases between men. The most effective way to prevent HIV transmission - and protect yourself against many other STIs - is to fuck with condoms or not to fuck at all. That said, it you are determined to fuck without condoms and you aren’t sure if you might get HIV or pass it on, there are things you could do that would make it less likely.

Treatment

While there is no cure or vaccine, there is a range of treatments which have improved significantly in recent years. Treatments to fight HIV work in different ways but many aim to make it more difficult for HIV to copy itself, so reducing the amount of virus in the blood. This in turn means that HIV does less damage and reduces the likelihood of an AIDS-related illness. While there have been major advancements in the way we combat HIV, there is neither a cure nor a vaccine and both are unlikely in the near future.

Sexually Transmitted Infection - Testing for HIV

Once someone is infected, the body will produce antibodies or markers in the blood and these can be detected, usually, after 8-12 weeks of infection, with a blood test. Symptoms associated with HIV are also common to many other medical conditions. A proper check-up and an HIV antibody test will only determine whether you have HIV, the common ‘flu or something else. If you are concerned, go to clinic. 

The HIV test detects HIV antibodies, not the virus itself. Antibodies are produced after someone has been infected with the virus. HIV antibodies do not effectively remove the virus from your system and so do not make you immune. It can take up to three months after infection for the test to detect antibodies. This means that if you have become infected within the last three months, a test will not necessarily be positive. If you decide to have an HIV test you should think carefully about the possible results. Positive means antibodies are present, negative means they are not. Some people are convinced they are negative but test positive and vice versa. It’s natural to speculate but you could be wrong.

A negative test result will mean that you have not got HIV (provided you have not put yourself at risk within the last three months) and that you cannot pass HIV on to anyone else. Recently there have been reports about certain people being immune to HIV. These cases are extremely rare, there are estimated to be only a handful of people in this country. For the majority of gay men, a negative result does not mean they are immune. If you’ve fucked without a condom in the last 15 years with someone you could not be 100% sure was HIV negative, then you’re probably lucky, not immune. A positive test result means you are infected with HIV and can pass it on to someone else. It does not, on its own, necessarily mean that you have AIDS, nor does it tell you if or when you will develop an AIDS-related condition.

If you go for a test at a GUM/sexual health clinic you should be offered the opportunity to talk to a counsellor, a health adviser or a doctor beforehand. Staff are there to ensure that you fully understand what the test involves. They are not there to tell you whether you should have a test or to pressure you into making a decision either way. There may be advantages and disadvantages to taking an HIV test. These will depend on you as an individual and what you think your test result might be. There can be no overall recommendation about testing, it is up to you. If you decide to have an HIV test, think about who you tell that you are having one. If someone knows you are going for a test, they might want to know the result. Would you really want them to know? If you or your partner are thinking about testing, don’t put pressure on each other to make a quick decision. Respect each other’s choices.

Sexually Transmitted Infection - After an HIV positive diagnosis 

Everyone’s experience of living with HIV is different. As the news sinks in and you start to come terms with what it means, you may feel like being by yourself or with your partner, chatting with a close friend or someone at the clinic where you received your diagnosis. There are also groups where you can share your experiences with other newly diagnosed gay men, although you won’t necessarily ask the same questions or all go through the same feelings and emotions. 'I feel so lonely…’, 'I’m so relieved…’, and 'there’s just so much to think about…’ are not unusual responses. And, ’…am I going to die?’… 'who gave me it to me?’… 'what am I going to do now?’ and ’…who should I tell?’ are commonly asked questions. The quick answers are 'yes’… 'why does it matter?’…'take your time’ and 'no one until you are ready.’ But you will also learn that the answers to these and other questions are not necessary black or white, right or wrong, or good or bad. Take things at your own pace. Don’t rush into taking decisions or allow yourself to be coerced or bullied into doing things you may later regret. Most things can wait for a while, this includes talking to you family or partner, seeking proper advice before telling your employer (though as a rule you’re encouraged not to) or leaving your job and becoming destitute. For some HIV positive gay men, telling others about their status can be as traumatic as coming out as gay. It is important to think carefully about who you want to tell and why. Once you have told someone about being HIV positive, you cannot take the information back. Coming out is a very personal process and should be your choice. Obviously, it can feel very natural to want to tell your partner and/or your family immediately but the response may not be what you expect. It certainly doesn’t help to be dealing with other people’s crap while still sorting out your own. If, however, you have decided to come out, the following may be helpful:

Be aware that telling people may affect you more than you think and they may not react in the way you expect.
Don’t ell people if you don’t want them to tell others.

Try and prepare yourself for the questions they may ask or the issues they may bring up.

Try and choose the right time and place.

People have different reasons for coming out. For some it may be to get support or health care whilst others might want their sexual partner(s) to know. Not telling someone about your diagnosis might prevent you getting the support, advice and services that are appropriate to your needs. Whatever reaction you get to coming out, being positive is nothing to be ashamed of.

This online advice guide is an extract from the book TOGETHER, by kind permission of Patriic Gayle and Gay Times Books. The book itself is over 300 pages long and contains:

• several chapters more useful advice and information 
• more in-depth information in some chapters 
• more pictures and tables 
• further contacts at the end of each chapter 
• a comprehensive listing of gay and health organisations 

Described by Qx magazine as a 'Gay Bible’, Together Book is a practical reference work no bookshelf should be without.

peperonity.com/porn/sites/gaysexguide/11581673

NSU, Scabies, Syphilis and Warts

Non-Specific Urethritis (NSU)

NSU is a bacterial infection that you get from unprotected fucking, fingering, rimming, deep kissing and oral sex. The pain and burning sensation when pissing is sometimes referred to as 'pissing razorblades’ or 'pissing glass’. Untreated, NSU can spread to the balls which can become inflamed and can be very painful during sex. Sometimes there are no symptoms and NSU will only be picked up by a routine test at a sexual health clinic. However, symptoms are very similar to gonorrhoea and only a test will tell them apart. A course of antibiotics will treat most NSU infections.

Scabies

Scabies is caused by a common mite, invisible to the eye, that burrows into the surface of the skin to lay its eggs. This causes severe irritation and small rashes and/or reddish tracks. You can find them almost anywhere on the body but you will often find them in the groin area, between the fingers, chest and stomach and feet. Like crabs, they can easily be passed on though close physical contact and shared bedding, towels and clothing, but this is less likely. The treatment is the same as for crabs - get hold of the appropriate lotion from the chemist, and follow the instructions. You must also wash all used clothes and bedding at no less than 60oc wherever possible to kill the mites and their eggs.

Syphilis

Syphilis is caused by a tiny corkscrew shaped bacterium which is invisible to the naked eye. You get it through fucking, oral sex, fisting and most other physical contact with the sores or rash which are highly infectious. A blood test through a sexual health clinic will tell you if you haves syphilis. Over a period of years, symptoms develop through three stages as it spreads through the body and, if left untreated, will cause madness, heart disease and death. During stage one, a small sore appears on the cock, around the arsehole or the throat, no more than 1cm across; this heals in a couple of months. During stage two, about three months later, there is a skin rash which can be severe and is accompanied by headaches, nausea, flu-like symptoms, and loss of appetite. In some instances people lose their hair in clumps. During stage three, which usually starts within ten years of infection several things happen: the nervous system breaks down, heart failure, large ulcerous sores, madness and death. Syphilis is one a range of STIs which are tested for routinely at sexual health clinics and is rare in the UK although it is becoming more common in gay men.

Treatment

If detected early, syphilis is treated with penicillin or and antibiotics for those who are allergic. However, As you progress through the stages, it becomes increasingly difficult to treat effectively.

Warts

Genital warts are caused by the papillomavirus which you get from fucking, oral sex and most skin contact with them including touching, rubbing and scratching. They appear as small fleshy whitish cauliflower-shaped lumps on the cock, balls or the anus. They can also appear in the mouth, on the face and inside the rectal passage. While they are not known to cause harm to men, they can be unsightly and can be itchy or uncomfortable. Warts can be single or group tightly together. If you already have warts, shaving them or scratching them and them touching other parts of the body will cause them to spread. Sometimes warts disappear by themselves although you will still have the virus and they may appear months or years later. They are usually treated with a wart-removing liquid that is painted onto the warts until they go. They can also be frozen off with liquid nitrogen, o, in some cases surgery or laser treatment is used. ‘


peperonity.com/porn/sites/gaysexguide/11581675

Step by Step

After your HIV diagnosis, several things are likely to happen: 

You will subjected to a flurry of medical tests to establish your state of health and to what extent virus is affecting your immune system.


If appropriate, you may be offered treatments to reduce or stabilise the level of HIV in your body or treatments to help prevent the development of opportunistic infections.

Depending on your needs, state of health and circumstances you will be helped to apply for benefits or put in touch with a social worker or home care support team.

There is sometimes an assumption by professionals that because you are gay you know what to do and where to go. This is, of course, not likely to be true where your new HIV diagnosis is concerned. Of course it may be difficult to gauge whether you’re getting the information you need and want, but if you have any doubts ask - or get a second opinion from a helpline or other organisation. This can be overwhelming particularly at a time when there is likely to be a lot on your mind and you may be feeling very stressed and emotional. Spare some thought for how you are feeling. Being HIV positive can play havoc with your emotions. Whether you chat regularly with a mate, attend a group, phone a helpline or seek professional help - don’t ignore your feelings. Some find it difficult to ask for help or accept it, but there’s nothing wrong with getting it or for asking for it. We all need help once in a while - it doesn’t mean that we are weak or incapable. Equally, saying 'no’ doesn’t necessarily mean you are being awkward - so don’t feel guilty or afraid about saying it. The following tips are designed to make getting help and support easier, and so you make decisions which suit you and meet your needs.

Try to deal with one thing at a time.

Find a doctor or clinic you like. If you don’t like them, change them.

Make decisions in your own time.

Take at least some time to learn more about HIV and how it could affect you. But you don’t have to become an expert or know everything at once. Knowing more will help you feel more in control.

Consider how you could make your lifestyle healthier. It may include, for example, changes to your diet, having more fun or doing relaxation exercises. Even if you think you’re a sceptic give it a chance; you can always go back to clubs, drugs, and ready-made-meals - they ain’t going nowhere!

Listen to your body, it’s usually pretty good at telling you what it likes and doesn’t like. You may take it for granted but it is your friend, get to know and understand it better.

If there are changes to be made to your life, they are rarely drastic or wholesale and you don’t have to make them all at once. You have time.

If you’re attending an appointment, there’s nothing to stop you taking someone with you. A little moral support and another pair of ears can be very helpful.

When you are speaking about your HIV, particularly in relation to HIV services, you may come across people whom you don’t know, don’t like or who don’t seem to understand what your needs are. Here are some tips to get you through:

Be honest and direct - say what’s on your mind.

Consider taking notes and preparing some questions beforehand. This way you can take the information away and understand it better in your own time.

Listen to what is being said and think what you want to say next before opening your gob.

If you’re getting irritable or angry say so, then take some deep breaths, take a break, or go to the toilet. If you really can’t handle it, leave. You can always go back when you’re ready.

If you’re told something which you don’t understand, repeat what’s been said in your own words and ask if you’ve understood correctly.

Sexually Transmitted Infection - HIV Treatment

Over the past 5 years, the development of HIV treatments has revolutionised the way HIV is managed. A new generation of drugs work principally by slowing down the rate at which HIV reproduces in the body. This allows the immune system to regroup and strengthen which means that the body can fight off infections more easily. Death rates have been significantly lowered and people with HIV are staying healthier for longer. Although there are many benefits from taking these drugs, there is still a lot which isn’t known about them - for example, doctors don’t know how long the drugs will be effective. Some people experience side effects with these drugs. Often these will be mild, or will only last for a few days or weeks after starting the drug, but in a small number of people these side effects may be more severe, causing them to change drugs. 

It’s vital to take these drugs exactly as prescribed. This is called being 'compliant’ or 'adherent’. For some of the drugs this means taking a specific dose at specific times during the day, and changing diet in order to increase the effect which the drugs have on the body. This can have an impact on people’s lifestyles, for example getting up early or staying up late to take a drug. However, if these guidelines aren’t complied with, there is a significant risk that some of the drugs will not be effective and you could develop drug-resistant virus. Resistance means that the virus has changed so that the drug will no longer affect it. Resistance may happen even if drugs are taken exactly as prescribed. Reinfection with HIV from someone who already has a drug-resistant strain may also mean that you might quickly develop resistance to the drugs - a compelling reason for having safer sex. Anyone considering taking anti-HIV drugs needs to think carefully about the advantages and disadvantages. Before you decide to take the drugs, you should talk to your doctor, and contact one of the organisations listed at the end of this chapter. Ask questions and find stuff out for yourself.

peperonity.com/porn/sites/gaysexguide/11581678