Anal

[aboy2223]

Hello doctor. What are the STD risks, if any, associated with protected anal intercourse? I'm a MSM who is the insertive partner, and I always use condoms for this activity without exception with partners who claim to be HIV negative. I do not engage in oral. Is there anything I should watch out for or ought to be aware of? What STDs am I at risk for?

Thanks for the input in advance.

[Edward W Hook, MD]

Yes there is risk for HIV acquisition if the encounter is not condom protected.  Risk for acquisition of HIV through rectal sex with an HIV infected partner is about 1 infection per 100-200 exposures.  Condom use however makes the exposure safe.  

Water based lubricants are recommended.  You are correct that oil/peteroleum based lubricants increase the risk for condom breakage.  EWH

[aboy2223]

In addition, I do in fact use a water based lubricant. It is my understanding that oil based lubricants degrade latex.

[aboy2223]

Thanks for your comments. Is HIV a risk at all?

[Edward W Hook, MD]

Good questions.  The risk of getting an STD is affected somewhat by the site of exposure.  Part of the variation is due to the fact that STDs occurring at the rectum are more likely to be undetected by infected persons than penile or, in women, vaginal infections.  Thus an anal sex partner may be somewhat more likely to have an asymptomatic STD than occurs with infections at other sites.  Proper condom use however converts this risk into a close to no risk situation as long as the condom remains intact.  Condom breakage rates are a little higher for anal intercourse than for vaginal intercourse unless a lubricant is used so, in addition to urging you to continue using condoms, I would suggest you consider using lubricant as well.

Virtually any STD can occur at the rectum.  Your risks from insertive anal intercourse with a male partner include most STDs- gonorrhea, chlamydial infections, syphilis and herpes.  Trichomonas is not a concern for MSM.  

Hope these comments are helpful.  Keep using condoms to stay safe.  EWH