Dating a gay male - advice please on STD prevention

[confused_uk]

Dear Dr Handsfield,

I am a bisexual male.

I actually posted a year ago and you really helped me (I caught NSU during my first ever gay encounter: oral sex - unlucky!)

I have not had any other sexual encounters since. I am negative for all STDs.

Well, one year on, I just met a really nice gay guy on an internet dating site. Problem is, he is quite open about being promiscuous. He has had 5 partners. Regarding his first sexual encounter, he could not even remember whether he used a condom (too drunk).
His other sexual encounters have ranged from one night stands (presumably, protected, but who knows) to a longer relationship with a guy who he found out has a reputation for being promiscuous. They used condoms for anal sex, but when I asked him if any broke, he said "you can't worry about that as you will be constantly anxious".
He told me he tested negative for STDs a few months ago and is looking for a proper relationship now.

Well, here I am dating this guy (who, despite the promiscuity, is an exceptionally nice person)

I have not done sexual with this guy yet and wanted your advice before I do anything.

I have told him I am very concerned about his promiscuity and would want him to be tested 3 months after his last encounter (which was a month ago) before I do ANYTHING sexual with him. (I will get his response in a few days when I see him).
My intention is only to go as far as oral sex (I don't want to do anal sex), but I realise oral sex still carries some risk.

So, my questions are as follows:

1. Am I over-worrying here or do you think I being sensible asking him to wait for testing after 3 months?

2. In the meantime, I would like to engage in deep kissing with him. I know you have said clearly that deep kissing poses no risk for HIV, but I do believe I have read elsewhere that it is a "possible" risk (bleeding gums??) and that there has been a reported case of HIV transmission through this route. Please remember that this will not be a one-time deep kissing encounter. It is likely to be repeated many times and potentially each "session" may last several minutes. Also, I do suffer from inflamed/bleeding gums. Also note that his toungue is pierced and he wears a tongue ring.

3. With deep kissing, what STDs can be caught?

4. From reading your replies, I can see that STDs are more prevalent in gay men than heterosexuals. Is there anything else I should worry about, like for example syphlis? (I did read something about "prozone", so was curious whether a negative syphlis result can be confidently relied on (if he undergoes testing).

Any advice you can offer would be appreciated.

Thanks very much in advance.
Ben

[H. Hunter Handsfield, M.D.]

Some users of this forum might take exception that you seem a bit surprised that your prospective partner is "nice" even though he is "promiscuous".  Of course choosing a multiple-partner lifestyle and being a caring, friendly, or otherwise nice person are entirely compatible personality characteristics.

"Promiscuous" doesn't necessarily mean unsafe.  However, this guy probably is not consistently safe and likely is at high risk of acquiring HIV someday.  If you have a longstanding relationship with him, and do not use safe sex consistently, you have a good chance of acquiring HIV yourself. My advice is that if his lifestyle isn't going to change, you should seriously consider whether you want to get into an ongoing relationship with him.  If you do, I suggest scrupulous use of condoms for anal sex (giving or receiving).

In the meantime, neither HIV nor any other STDs are transmitted by kissing.  In addition to HIV, your friend probably is at especially high risk for all STDs:  syphilis, gonorrhea, chlamydia, herpes.  (The odds are that he already has HSV-2, regardless of whether he has symptoms.)

Bottom line:  If you are confident your friend's lifestyle is going to change and you enter a committed, mutually monogamous relationship, all should be well.  But you would be wise to be skeptical that this leopard can change his spots.

Good luck--

HHH, MD

[confused_uk]

Just to clarify, he has had 5 partners in the space of about 1 year.

[Brian123]

I myself am a gay male.  Some considerations that I "personally" have regarding gay men:

(1) I would never have unprotected sex unless I know the person longer than 3 months. And I would also ask to see verified test results for HIV, Hep B, etc...(for all STD's)
(2) You mention that he was/has been highly permiscuous....what makes you think he will not be against  a relationship with you.  I know I am sounding like Dr. Ruth here, but...I know what it is like sweating out several weeks to get tested after having sex with someone who may have had HIV.
(3) Deep-kissing poses know real threat.  The one and only reported case seems shady to me,...I believe there were other factors/sexual relations involved other than "deep-kissing".
(4) Had you never engaged in anal sex before I would also be caution of other STD's like herpes, genital warts, etc.  Anal fissures are also possibilities for gay men, and also not uncommon....so beware.  

I wish the best for you, I know that I am now "overly" cautious. Nonetheless I am aware that HIV carries a much higher HIV risk with gay men than the heterosexual crowd. Nontheless, everything after unprotected sex is based on "trust", which honestly, for me, went out the window with gay men quite awhile ago!

If he chooses not to show you written, verified results of being HIV-, I would personally be a little weary of this man.

Good Luck.

B.

[confused_uk]

Brian, thank you for your advice.
Written confirmation of the test results would be a lot more reassuring than the person's word, particularly when you do not know them well.
As you say, trust is ultimately a big factor.
Thanks again

[Brian123]

No problem.
Whether or not I get berated by other forum users is irrelevant to me.
Having been in the gay lifestyle (and to only others that are) know that the gay/alternative lifestyle is filled with promiscuity...for the most part.
I have had many friends/acquaintances who have/had HIV/AIDS. Some who were promiscuous, and to be honest....some that were indeed not. Their partners were promiscous...only to bring HIV home to the bedroom.

I have nothing to warrant/benefit by telling you "how it is"....as you may know yourself.

"My soapbox":
I find it extremely hard (and I have known quite a few) that claim they want a "relationship" only to find that it goes awry because the other person gets tired of the person. To only find out the "true colors" of this individual...do not let sex be the priority at the onset of the relationship,....see if he still sticks around.

Also, if you had not yet been vaccinated for Hep B, now would be the ideal time.

B.

[JohnnyV]

Hi,

Bi male here, in a LTR with a female for almost 10 yrs, but I've had tons of experience with men....

Five partners in one year doesn't sound promiscuous to me, by anybody's standards, gay or straight or bi. Before I met my wife I used to have more female partners than that in a year, let alone my male partners which were more numerous. I think you might be scrutinizing the man's life a little too harshly.

Do the basic things we all should do in a new relationship -- use condoms and get tested together. But you want to respect him and not think of him as dirty simply because of his (and your) lifestyle; that may take an emotional toll on your connection. So I wouldn't spend too much time talking about STD issues.... Enjoy the love and build a strong relationship. Being in an LTR will be one form of reducing your risk anyway.

Good luck,
J

[WorriedUS]

Wow..JohnnyV's comments are awesome. Discretion is great in choice of a partner and sexual habits, but man, you can't let that bog you down in the good parts about a monogamous relationship.  Great thread!!

[confused_uk]

Thanks Dr. for your helpful reply.

I do have one question regarding your comment: "neither HIV nor any other STDs are transmitted by kissing"

I do recall reading an earlier post in which you mentioned that syphlis can be transmitted via kissing. Perhaps it was a different context, but I just wanted to clarify.

Thanks
Ben

[H. Hunter Handsfield, M.D.]

Theoretical only, too rare to worry about. In 3 decades working in a busy STD clinic (13,000-15,000 patient visits per year), I have never seen a case of syphilis or any other STD that seemed to have been acquried by kissing.

HHH, MD

[confused_uk]

Thank you all for your valuable advice.

[Steve458632]

Dr. H:

I didn't realize you worked in an STD clinic.  If so, have you ever seen HIV and other STD transmitted via masturbation?

Thanks,
Steve

[monkeyflower]

This is a joke, right? Seriously, there are no STDs (or anything else) transmitted by masturbation.

[Brian123]

I am assuming he means mutual masturbation?
Hand (of another individual) to the opposing partner's genitals.

[sparkeler]

It could be a joke.  Keep in mind that there are parts of the world and our own country where people are just not that educated in sex ed.

[WorriedUS]

Steve,

Do you mean mutual masturbation where one partner masturbates the other partner's genitals?  I believe the risk for that would be completely 0.

To give you perspective, insertive (penile-vaginal) sex WITH an HIV+ person WITHOUT a condom is 10/10000, fellatio performed (receptive oral sex) on a male is 1/10000 (10 times LESS the risk of unprotected penile-vaginal sex with an HIV+ person) and the lowest studied/research risk is insertive oral intercourse with an HIV+ person (.5/10,000 = .005%).

If those are ALL low risk in your book Steve, I wouldn't worry too much about mutual masturbation which I KNOW is lower risk that those I mentioned above.  In fact, if it isn't studied, then it is probably infinitesimally low.

Regards,

WorriedUS