Category Archives: STDs/STIs

What is PrEP?: The Preventative HIV Drug

Dear Sexpert,

I’ve heard that more people are starting to use PrEP. What is it and should I start taking it?

-UnPrEPared

Hi UnPrEPared!

Thank you for your question! With acronyms flying here and there, it’s often hard to detangle what each one is and whether it is something to pay attention to. In 2012, the Food and Drug Administration (FDA) approved a first in class pre-exposure prophylaxis (PrEP) to prevent the transmission of human immunodeficiency virus (HIV), a sexually transmitted infection, in high-risk populations. (See, so many acronyms!) This simply means that the FDA approved a drug that can be taken on a daily basis to reduce the risk of contracting HIV. Only those that are higher risk for contracting HIV are encouraged to consult their doctor on whether PrEP is a good option for them.

PrEP (brand name Truvada ®), developed by Gilead Sciences, Inc., is a combination of two drugs, tenofovir and emtricitabine. These two drugs combine to provide the body the necessary fighting capabilities to attack the HIV virus once it enters the body and prevents the virus from multiplying and causing damage. Effectiveness of the medication is based on consistent and proper, daily use. For those who take PrEP every day, it is 92% effective at preventing sexually transmitted HIV infection and 70% effective at preventing HIV infection among people who inject drugs.

PrEP is only recommended for use among people at higher risk for HIV infection. This includes populations that engage in anal sex, engage with multiple sexual partners, engage with sex without a condom, or people that inject drugs and share needles. It is also recommended for people who are HIV-negative but in an on-going sexual relationship with an HIV-positive partner. Since PrEP is a preventative drug for people with on-going risk of HIV infection, it is not recommended for those who have had a single incidence of potential, high-risk exposure; a medication, called PEP, or post-exposure prophylaxis, is appropriate on that occasion.

Because it requires taking daily medication and regularly visiting a healthcare provider, PrEP is not right for everyone. Taking PrEP requires you to obtain regular lab tests and clinical visits every three months. Appointments for lab tests and clinical assessments for those required three month follow ups can be obtained at McCosh Health Center. Many private insurance companies and the University’s Student Health Plan (SHP) cover the cost of PrEP as long as the patient is considered “high risk” of contracting HIV. To figure out how much PrEP would cost, contact your personal health insurance provider, as different plans will vary in how much they require you to pay out of pocket. Gilead also may also provide helps with the cost of Truvada® through their medical assistance program.

Keep in mind that PrEP only protects against the transmission of HIV. To prevent the spread of other STI’s such as gonorrhea, syphilis, human papilloma virus (HPV), etc., PrEP should be used in tandem with condoms. If you believe that you are at a higher risk for getting HIV and can commit to taking PrEP daily, consult with a clinician at McCosh or your primary care provider to consider if you are a good candidate for PrEP. For more information, visit https://www.cdc.gov/hiv/basics/prep.html.

Best,

The Sexpert

Information regarding PrEP provided by the Centers for Disease https://www.cdc.gov/hiv/basics/prep.html Control and Prevention (CDC) and McCosh Health Center.

Handy: Is it bad if I masturbate every day?

Dear Sexpert,

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I masturbate every single day. I used to think this was completely normal, but after talking to my friends, it seems that I do it a lot more than others. I feel really embarrassed now. Is it dangerous to 

masturbate this frequently? Is there something terribly wrong with me? Please help!

-Handy

 

Dear Handy,

Rest assured, masturbation – the sexual stimulation of one’s own genitals— is a completely healthy and normal sexual activity. Unfortunately, society tends to treat the topic as a social taboo, making it unacceptable to discuss. Because of this, people often experience feelings of shame or embarrassment when their masturbation is brought to a public light.

Just as people have different food or movie preferences, people also have different preferences for how often they masturbate. Just because your friends report masturbating less frequently than you do does not mean that there is anything inherently wrong with your activities. Both men and women can find masturbation pleasurable, and it is a great way to explore and learn about your own body. Understanding your body’s likes and dislikes will improve all your sexual experiences – by yourself and with others.

Since masturbation is a solo act, there are no risks of becoming pregnant or contracting STIs. However, if you are using toys or objects while masturbating, be sure to clean them properly (wash with a gentle anti-bacterial soap and warm water) before and after use. And never transfer your sex toys from anus to vagina or penis without thoroughly cleaning them first. If you have an active infection (HPV (genital warts) or herpes lesions on the genitals) you may want to avoid touching lesions until they’ve healed.  If you do come into contact with any sores, wash your hands thoroughly. However, if you have a wart on your hand, you don’t need to worry about passing it to your genitals; genital warts are generally caused by different strains of HPV than warts on other parts of your body.

There do exist some prevalent notions that masturbating too frequently can affect things such as fertility, sexual ability and general health. Fortunately, these are all myths. However, just like any activity, it is possible to masturbate to excess. If you find yourself masturbating to the point where it’s interfering with the rest of your life – skipping classes to masturbate, for example – then you may be masturbating too much. In the event that this is the case, there are confidential counselors available in the McCosh Health Center with whom you can discuss your concerns.

I hope this overview of masturbation was helpful in quelling your fears. In short, masturbation is a healthy and safe way to enjoy sexual pleasure. Unless it’s interfering with your daily life, keep doing what feels good!

-Sexpert

Information retrieved from Go Ask Alice

Curious and Careful: About PrEP

Dear Sexpert,

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I’ve seen a couple of ads for a drug for people at risk for HIV. What exactly qualifies as “at risk” and how safe/effective is this drug?

Signed,
Curious & Careful

Dear Curious & Careful,

You’re right, PrEP, or Pre-Exposure Prophylaxis, can be used in prevention of human immunodeficiency virus (HIV). PrEP is a prescription pill (commonly sold under the name Truvada®) designed for daily use by people who are HIV-negative and at substantial risk for HIV exposure. PrEP is a combination of two drugs, tenofovir and emtricitabine. If used correctly and consistently, it has been shown to reduce risk by up to 92%. Additionally, many health insurance plans cover PrEP.

There are several situations that can qualify a person to be considered at substantial risk. The Centers for Disease Control and Prevention (CDC) recommend PrEP for anyone who meets any of the following circumstances:

  • is in an ongoing relationship with an partner who is HIV-positive;
  • is not in a mutually monogamous relationship with a partner who recently tested HIV-negative;
  • is a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the last six months;
  • is a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status, who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners); and
  • has injected illicit drugs in the past 6 months and who has shared injection equipment or been in drug treatment for injection drug use in the past 6 months.”

If you fall into any one of these categories, or feel that you may benefit from PrEP, schedule an appointment at Sexual Health and Wellness (SHAW) or your primary health care office to discuss with a clinician whether this is an option for you. It’s important to keep in mind this is solely a preventative drug for people with on-going risk of being infected with HIV, and is not recommended for those who have had a single incidence of potential, high-risk exposure.  (There is a different medication, called PEP, or post-exposure prophylaxis, in those instances.)

Additionally, PrEP is a drug that needs to be taken on a daily basis. Like birth control or other daily-prescribed drugs, irregular use will decrease its effectiveness. Anyone prescribed PrEP should return

to their health care provider every three months for consistent HIV monitoring and follow up. PrEP is not 100% effective at preventing HIV acquisition and does not protect you from other sexually transmitted infections (STIs). Precautions should still be taken to reduce your risks, including using a condom with every intercourse, getting HIV tested with your partner(s), practicing less risky sexual behaviors (e.g., oral sex while using a barrier method), reducing your number of partners, and/or sterilizing injection equipment or joining a substance treatment program.

Best of luck and be safe,
The Sexpert

Information regarding PrEP retrieved from Centers for Disease Control and Prevention (CDC).

Expanding My Horizons: How do I tell my partner I’m ready for oral sex?

Two heads facing away from each other with question marks followed by two heads facing each other with heartsDear Sexpert,

My relationship with my partner has become pretty serious and we’re ready to be more intimate with each other. While I’m interested in experimenting with oral sex, I’m still not ready to do more than that. How do I explain this to my partner without offending them?

Expanding My Horizons

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Confused Club Member: This my first time having casual sex–what should I do?

Dear Sexpert,

I just joined an eating club, and I’m already excited about all the new friends I’m making! I’ve also started hooking up with someone I recently met in the club. Our relationship is pretty casual, and for the most part, physical. In fact, when we’re eating dinner in a group or hanging around the club during the day, I feel like I’m barely acknowledged. We are both enjoying the physical side of our relationship, but I also feel confused about having casual sex. What should I do?

–Confused Club Member

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Looking for Someone: What’s the best way to use apps like Tinder and Grindr?

Dear Sexpert,

There are a lot of preconceived notions about Tinder and Grindr, and similar “matchmaking” apps. With all the hype surrounding Tinder and Grindr, I’m interested in trying them out. I think I know how these apps all work, but have concerns about their impact on my sexual wellness. Do you have any tips before diving in?  

–Looking For Someone

Continue reading Looking for Someone: What’s the best way to use apps like Tinder and Grindr?

Silent Sam: How do I tell my partner that I have an STI?

Dear Sexpert,

I just started hooking up with this girl I have been interested in for a while, which is great! The bad news is that I just got some results from an STI test I got just before this all happened and it looks like I might have a minor STI. I need to tell her because we didn’t use protection the last time we got together, but I don’t know how! I like this girl, and I don’t want to screw things up right off the bat with this. What do I do?

–Silent Sam

Continue reading Silent Sam: How do I tell my partner that I have an STI?

Trying Something New: Can girls give other girls STDs?

Dear Sexpert,

I just got out of a long-term relationship with a guy and I am looking to experiment with girls. I don’t think I am a lesbian, but I think college is as good a time as any to broaden my horizons. My boyfriend and I used a condom in the beginning, but once we got serious and I went on the pill, we stopped using one, because both of us had been tested and we’re both clean. Since I plan on only engaging in sexual activity with other girls, I don’t need to worry about protection right? I mean, I’m obviously not going to get pregnant, and my friend told me girls can’t catch anything from each other.

–Ready to Try Something New

 

Dear Ready,

That is great that you got tested previously—knowing your STI status is always a good thing, especially when engaging with a new partner. While you are right that you do not have risk of pregnancy with other women, there is still risk for contracting sexually transmitted infections. However, your level of risk varies depending upon what kind of activities you and your partner engage in.

Low risk activities include french kissing, massages, frotting, mutual masturbation, fingering (insertion of fingers into the vaginal canal) and performing oral sex on another woman through a protective barrier, like a dental dam.

Moderate and higher risk activities then include oral sex or rimming without a dental dam, fisting, and sharing dildos or other toys without thoroughly disinfecting between uses.

Fortunately, both UHS and the LGBT Center have a number of different protection implements available. Condoms are the most common method of protection, and they are available at McCosh for free. You may not think you need to use a condom if you are not engaging in sexual activities with a man, but you can use them on sex toys such as dildos to prevent the transmission of STIs and other infections. Latex condoms are most effective for the prevention of STIs, but if you or your partner has an allergy, polyurethane condoms are also available.

The Reality Condom, or internal condom, is available at the LGBT Center. Made of polyurethane, it can be inserted several hours before use. This can protect you and your partner from STI-transmission during fingering, fisting, and similar activities.

Latex gloves and finger cots are a good form of protection for activities where your fingers or hands come into contact with your partner’s bodily fluids, and vice versa. Cuts, lesions, and any other breaking of the skin can that comes into contact with your partner’s bodily fluids puts you at risk for infection.

For both vaginal-oral sex and anal-oral sex, the best form of protection is the dental dam. Dental dams are available at both McCosh and the LGBT Center. In a pinch you can use non-microwavable Saran Wrap (check the label), for protection during these activities, but latex or polyurethane dams provide the best protection.

While abstinence is the only way to ensure protection against STIs and pregnancy, the barrier methods I just mentioned are the best forms of protection available.  So have fun trying them out and finding what works best for you and your partner.

~The Sexpert