Guide to Safe Sex Part I: Risk

Since the eminently unqualified Betsy DeVos is taking over our public schools and sex-education is already shitty, I’m performing an end-around by just tackling it myself.  I’m not straight, polyamorous, and kinky.  I’ve been with men and women of many types and my current partners are a trans man and cis woman.  I don’t have all-encompassing sexual experiences but I do have a wide range of them.  This is going to be a multi-part series that will talk about a variety of topics including but not limited to risk, consent, kink, pleasuring your partner, polyamory, and several other things.

I’m going to start with the topic that many of us get in high school health (if we get sex education at all).  Risk, specifically the risk of STIs and pregnancy.  To hear many health classes tackle the subject, genitals are cauldrons of disease and sex is a one-way ticket to STI-town or a baby.  Well, people with STIs aren’t “dirty” so avoid using the contrasting term “clean” when talking about STI status and they’re not as transmittable as health teachers would have you believe.  And not every unprotected sexual encounter leads to pregnancy, despite what movies might have you believe.

I’ve been with 11 people over 8 years and remain STI and baby free.

I get tested every 3-6 months (urine and blood) generally though I have gone longer when I can be assured there are no new risk factors among me and my partners.  I would recommend regularly getting tested and making it a point to ask to see test results for any potential partners.  I also always use condoms unless I have a high degree of trust for a partner.

Risk

STIs

As many know STIs are transmitted through the sharing of fluids such as blood or seminal fluid. They need a way to enter the body and open wounds and the mucus membranes found in body cavities are the way they do that. The larger the mucus membrane the greater the likelihood of transmission so it’s much more likely to contract an STD through the mouth, vagina, or anus than it is through the penis via the urethra. As such many studies focus on heterosexual couples and male to female transmission through vaginal sex.

Anal sex is more risky and oral sex is less risky generally, but no sexual practices are completely risk-free.

For STIs the best way to minimize your risk is to use condoms and to use them correctly. Good studies on condom use are difficult to come by.  They rely on self-reporting, correct usage, and it’s difficult to decipher if ineffectiveness was due to human-error or condom-error (or limited usefulness as is the case with some STIs).  I’m not going to crunch the exact numbers for you but if you want to, this is a good place to start.

Before getting started it’s important to make the distinction between prevention and risk reduction.  If a condom is 99% effective in preventing the spread of an STI it means transmission will occur 1% of the time.  If a condom reduces risk by 90% it means that using a condom is 90% more effective than not using one. The actual likelihood of transmission may be less than 10%.  (A 10% transmission rate among non-condom users and a 1% transmission rate among condom users is a 90% reduction of risk, for example.)  STIs also aren’t transmitted every time you have sex.

HIV

In the collection of studies tracked in the previous link condoms were 98-99% effective in preventing the transmission of HIV and provided a reduced risk of 79-93% versus inconsistently or not using condoms. Additionally Pre-Exposure Prophylaxis (PrEP) has been shown to further reduce the chances of transmitting HIV 90-100%.

Gonorrhea

Again, the data is limited and dependent on self-reporting and tracking infection rates among large populations. Tracking the effectiveness of condoms against a given STI is difficult because making a bunch of gonorrhea-negative people fuck a bunch of gonorrhea-positive people to see what happens is deeply unethical.

However the limited data suggests that condoms are 90% effective in reducing the risk of contracting gonorrhea. Some studies found zero transmissions when condoms were used correctly.

Chlamydia

Condoms were shown to reduce the risk of chlamydia from 26-50%.  One study found that when condom use rose by 20% among participants, chlamydia, gonorrhea, and trichonomiasis rates fell by 75%.

HPV

HPV is a complicated disease and can be spread by touch so condoms are less effective.  However one study found a 73% risk reduction in HPV contraction with consistent correct condom use. You can also get vaccinated.

Syphilis

Condoms tend to be less effective against syphilis because syphilis can be transmitted through contact with sores in addition to the entrance through a mucus membrane.  Still studies have shown a 43-66% reduction in syphilis transmission rates when condoms are used correctly.

Herpes

I saved herpes for last because (aside from HIV) it tends to be peoples’ primary concern.  It is also much more common than any of the other STIs, and more complicated.  Most people know that there are two types of herpes, HSV1 and HSV2.  They’re generally referred to as oral and genital herpes but you can get both variations both places.  Tests for herpes also carry the greatest degree of uncertainty as it is easier to detect some times than it is others.  Some reports say as many as one in four people have some version of herpes and one in two people over the age of 49.

There are a lot of misconceptions regarding herpes. The important factor is the viral load, the amount of the virus in a body fluid. Most know that open sores appear during outbreaks, which is known as shedding. This is when the viral load is highest. Some assume that this is the only period of contagiousness, but that is FALSE.  Some people with herpes can transmit the virus when there are no symptoms. The viral load is lower in these cases so herpes is less likely to be transmitted. Anti-virals also further reduce the viral load and thus the likelihood of transmission.

A study of several couples over the course of a year saw transmission rates of 10% male to female and 4% female to male when the only precaution taken was avoiding sex during outbreaks. Antivirals reduced the risk 48% (to 5% and 2% respectively).  Condom use reduced the risk another 30-50% (to 2.5%-3.5% and 1%-1.4% respectively).

Herpes is common not so much because it’s easily transmittable, but largely because it is incurable and its transmission has been misunderstood for so long.

Pregnancy

This chart from the CDC is so good there’s not a whole lot I can add to it.

Quick Points

  • Use condoms, they’re effective in reducing the risk of every STI.
  • Use condoms CORRECTLY.
  • Get tested. Ask your doctor if you have any questions.
  • Talk about these things with your partners.
  • Demand accountability from your partners.
  • Use multiple methods of birth control (say an IUD and a condom).
  • Don’t use more than one condom (the friction makes them more likely to break).
  • Only use water or silicone based lubricants.  Other lubes may break down the condom material.

 

 

 

 

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About Alex

I am awesome.

One comment

  1. Pingback: Guide to Safe Sex Part II: Consent | Alexander Bauer, Author

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