Conflicted

[Simon Suraci]

I echo the many sound advice comments so far, but since what you’re looking for is relatively quite low risk, I recommend PrEP and DoxyPEP.

PrEP has no serious side effects or negative health consequences for most people. Your doctor will monitor your tests to confirm whether PrEP is safe for you to take.

Condoms won’t help you much because almost no men who have sex with men use condoms for oral sex or frottage. Condoms are a great idea for anal sex, though. 

All of the following you will find out at a sexual health clinic or by seeing your doctor, so you don’t have to take my word for it. For those of you not visiting health clinics or just curious, I am including a bit more detailed discussion to clarify some of the finer points brought up only in passing so far.

Minor correction in terminology. DoxyPrEP is not a thing. PEP stands for post exposure prophylaxis, not to be confused with PrEP (pre-exposure prophylaxis) which is used for HIV. DoxyPEP is for sexually transmitted bacterial infections. You don’t take DoxyPEP before (ie pre-), for reasons @BeamerBikes explained related to how the medication works, but also because you may not, for whatever reason end up proceeding with sexual contact after you take the pills. Your provider or hookup may flake. You may decide in the moment that you don’t want to proceed, or you end up not having direct contact… but it’s too late now because you’re already on antibiotics whether you have reason to be or not.

It’s bad for your overall health and immune system to frequently be on antibiotics. Not only does this accelerate antibiotic resistance for you and for the greater population, but it makes your body more susceptible to all kinds of infections besides the sexually transmitted ones.

I mention this to help you determine if DoxyPEP is right for you. I am not a doctor so take this with a grain of salt and talk to your actual doctor about it, but I will suggest that DoxyPEP is not a great solution for people seeking frequent encounters such as daily or weekly and also wanting to take the medication every time they have sexual contact. Even monthly encounters can be problematic because it takes a while for your system to fully reset after a round of any antibiotic, maybe a week or sometimes more every time. Taking DoxyPEP on perhaps a monthly frequency means that your body is operating in a suboptimal state for at least one out of every four weeks. If you’re having contact on a weekly basis and taking DoxyPEP every time, that means your body is perpetually in an suboptimal state. Some people can’t take DoxyPEP at all because they are immunocompromised or have some other health condition. Your doctor will advise you based on your medical history.

DoxyPEP is great for otherwise healthy people having less frequent encounters, like every few months, twice a year, etc, but also for those who have more frequent encounters but use DoxyPEP more judiciously rather than every time. For example, when seeing partners you believe are particularly higher risk for whatever reason. Or when a partner tells you after the fact that they tested positive for an STI and you are still in the window of time for which taking DoxyPEP is likely to prevent an infection. Or when having contact with multiple people over a short period. Think: bathhouse visits, cumdump situations (as a bottom OR top, because tops are exposed to a lot of other people’s cum) bukkake, or multiple separate encounters in a 24 hr period. These are higher risk because of the sheer number of points of contact and would be good times to use DoxyPEP, to reduce your risk of any one of these points of contact resulting in an infection. 

For the person having low risk sexual contact such as oral sex with one partner every week or two, I don’t see as much benefit for them in taking DoxyPEP every time. The drawbacks of chronic antibiotic use (in my layman’s opinion) outweigh the marginal benefit of reducing your (already low) risk of getting bacterial STIs through oral contact.

Nothing completely eliminates your risk. Someone unwilling to accept even a marginal level of risk has no business having sex with anyone. The key is to manage, reduce, and accept your personal level of risk.

Another few important points worth mentioning…

1) DoxyPEP reduces, but does not eliminate your risk of bacterial STIs. Some people treat it like it makes them invincible. This is not true. This is about reducing, rather than eliminating risk.

2) DoxyPEP, many of you may not know, is pretty bad at preventing gonorrhea infections. While it is pretty darn good at stopping chlamydia and syphilis infections when used as prescribed, it is NOT a good way to reduce your risk of getting gonorrhea. You get gonorrhea the same ways you get the other two, and it is possible to transmit all of these orally, not just anally.

Please note, the treatment for oral gonorrhea is different than for gonorrhea in your urethra or rectum. I mention this in case some of you are trying to treat an infection more discreetly through an online pharmacy service or black market drug peddler rather than through your doctor. Your doctor will know what to prescribe. Don’t try to treat infections on your own. It causes you and your partners more harm.

3) Other STIs exist. Just because they are less common doesn’t mean you can’t get them. Any man who has sex with men should talk to his doctor about vaccinations like Mpox, and Hepatitis A/B. Giardia is a thing, as are other lesser known sexually transmitted infections.

 

[Reggyreg56]

8 minutes ago, Simon Suraci said:

I echo the many sound advice comments so far, but since what you’re looking for is relatively quite low risk, I recommend PrEP and DoxyPEP.

PrEP has no serious side effects or negative health consequences for most people. Your doctor will monitor your tests to confirm whether PrEP is safe for you to take.

Condoms won’t help you much because almost no men who have sex with men use condoms for oral sex or frottage. Condoms are a great idea for anal sex, though. 

All of the following you will find out at a sexual health clinic or by seeing your doctor, so you don’t have to take my word for it. For those of you not visiting health clinics or just curious, I am including a bit more detailed discussion to clarify some of the finer points brought up only in passing so far.

Minor correction in terminology. DoxyPrEP is not a thing. PEP stands for post exposure prophylaxis, not to be confused with PrEP (pre-exposure prophylaxis) which is used for HIV. DoxyPEP is for sexually transmitted bacterial infections. You don’t take DoxyPEP before (ie pre-), for reasons @BeamerBikes explained related to how the medication works, but also because you may not, for whatever reason end up proceeding with sexual contact after you take the pills. Your provider or hookup may flake. You may decide in the moment that you don’t want to proceed, or you end up not having direct contact… but it’s too late now because you’re already on antibiotics whether you have reason to be or not.

It’s bad for your overall health and immune system to frequently be on antibiotics. Not only does this accelerate antibiotic resistance for you and for the greater population, but it makes your body more susceptible to all kinds of infections besides the sexually transmitted ones.

I mention this to help you determine if DoxyPEP is right for you. I am not a doctor so take this with a grain of salt and talk to your actual doctor about it, but I will suggest that DoxyPEP is not a great solution for people seeking frequent encounters such as daily or weekly and also wanting to take the medication every time they have sexual contact. Even monthly encounters can be problematic because it takes a while for your system to fully reset after a round of any antibiotic, maybe a week or sometimes more every time. Taking DoxyPEP on perhaps a monthly frequency means that your body is operating in a suboptimal state for at least one out of every four weeks. If you’re having contact on a weekly basis and taking DoxyPEP every time, that means your body is perpetually in an suboptimal state. Some people can’t take DoxyPEP at all because they are immunocompromised or have some other health condition. Your doctor will advise you based on your medical history.

DoxyPEP is great for otherwise healthy people having less frequent encounters, like every few months, twice a year, etc, but also for those who have more frequent encounters but use DoxyPEP more judiciously rather than every time. For example, when seeing partners you believe are particularly higher risk for whatever reason. Or when a partner tells you after the fact that they tested positive for an STI and you are still in the window of time for which taking DoxyPEP is likely to prevent an infection. Or when having contact with multiple people over a short period. Think: bathhouse visits, cumdump situations (as a bottom OR top, because tops are exposed to a lot of other people’s cum) bukkake, or multiple separate encounters in a 24 hr period. These are higher risk because of the sheer number of points of contact and would be good times to use DoxyPEP, to reduce your risk of any one of these points of contact resulting in an infection. 

For the person having low risk sexual contact such as oral sex with one partner every week or two, I don’t see as much benefit for them in taking DoxyPEP every time. The drawbacks of chronic antibiotic use (in my layman’s opinion) outweigh the marginal benefit of reducing your (already low) risk of getting bacterial STIs through oral contact.

Nothing completely eliminates your risk. Someone unwilling to accept even a marginal level of risk has no business having sex with anyone. The key is to manage, reduce, and accept your personal level of risk.

Another few important points worth mentioning…

1) DoxyPEP reduces, but does not eliminate your risk of bacterial STIs. Some people treat it like it makes them invincible. This is not true. This is about reducing, rather than eliminating risk.

2) DoxyPEP, many of you may not know, is pretty bad at preventing gonorrhea infections. While it is pretty darn good at stopping chlamydia and syphilis infections when used as prescribed, it is NOT a good way to reduce your risk of getting gonorrhea. You get gonorrhea the same ways you get the other two, and it is possible to transmit all of these orally, not just anally.

Please note, the treatment for oral gonorrhea is different than for gonorrhea in your urethra or rectum. I mention this in case some of you are trying to treat an infection more discreetly through an online pharmacy service or black market drug peddler rather than through your doctor. Your doctor will know what to prescribe. Don’t try to treat infections on your own. It causes you and your partners more harm.

3) Other STIs exist. Just because they are less common doesn’t mean you can’t get them. Any man who has sex with men should talk to his doctor about vaccinations like Mpox, and Hepatitis A/B. Giardia is a thing, as are other lesser known sexually transmitted infections.

 

I really appreciate your time and effort in this matter. You have given me a lot to think about. I am hesitant to take Doxyprep for several reasons including a pre existing condition I have and the fact that I am not very sexually active which makes me wonder if taking the medication will be most effective like you said. I will talk to my primary care doctor about it. Thanks so much!

[caramelsub]

I agree with Simon Suraci. I had a yeast infection/candida from being on two antibiotic courses back to back, (not from an std). My mouth was discolored and covered in yeast. I had rashes all over my body. I had to take antifungal mouthwash, and antifungal pill. Antibiotics kill the good bacteria and the bad. I can’t imagine going on Doxypep or antibiotic for std prevention, but I’m not a doctor. Yeast infections are troublesome and take time to get rid of, and they are a common side effect of antibiotics.

[+ JamesB]

47 minutes ago, Reggyreg56 said:

I am hesitant to take Doxyprep

As far as I know, there is no such thing as DoxyPrEP, there is Doxy PEP (Post-Exposure Prophylaxis). You take a dose of Doxycycline within 72 hours of potential exposure.

[+ SirBillybob]

1 hour ago, Reggyreg56 said:

I really appreciate your time and effort in this matter. You have given me a lot to think about. I am hesitant to take Doxyprep for several reasons including a pre existing condition I have and the fact that I am not very sexually active which makes me wonder if taking the medication will be most effective like you said. I will talk to my primary care doctor about it. Thanks so much!

I think what you are trying to say is not that Doxycycline would be relatively ineffective taken infrequently, but that the infrequency of oral sex in tandem with possible clinical contraindications in your case would steer you instead to regular STI testing and standard treatment should an STI occur. If you are under the impression that DoxyPEP infrequent uptake compromises its value pharmacologically check that out with your clinical provider. It’s the infrequent use that is more in favour. 

DoxyPrEP (daily, not on-demand) is a thing and is being studied as a comparator to DoxyPEP in a clinical trial. It may not shed much light on the concerns related to antimicrobial resistance development with widespread Doxy use, but there are ways to pick up some knowledge assessing AMR through lab analysis of research subjects’ specimens.

Finally, clinical expert panels remain divided over the language of guidance for Doxy prophylaxis and those that view it as a swing and a miss for many candidates relative to the merits of individual STI surveillance practice have steered the usage to ‘suggested’, not ‘recommended’. It’s off-label indication, an additional marker of hesitancy, and these factors will influence one’s shared decision with clinician.

Edited 10 hours ago by SirBillybob

[+ SirBillybob]

6 hours ago, Reggyreg56 said:

Thanks so much for giving me excellent advice. I haven't gone on prep because I am not a big fan of anal. Do you know if people go on prep if they do just oral?

Transmission is biologically plausible. The way I view it is that within the bounds of statistical confidence intervals, a type of math that plots probability across a range from lower to higher when true estimates not measurable in absolute and unambiguous terms, a very high seminal viral load shot against one’s oropharynx, in the absence of knowledge of inserter’s advanced disease or acute infection stage when viral load peaks, although naturally difficult to infect that specific mucosal tissue within one’s throat, gets close to the level of risk for women with respect to receptive vaginal sex with men with unsuppressed viral load but without the specification of very high seminal viral load.

I do not possess a vagina but happy to compare my deep throat to one. I realize that this mashup of risk metrics is complex to follow. In my case I use HIV PrEP on-demand on those rare occasions of condomless receptive oral sex but it doubles for the inclusion of receptive anal accompanied by condom use that often joins the choreography. Two birds one stone, so spared a decision about PrEP for oral exclusively. 

Canadian guidelines do not distinguish risk among oral and anal or vaginal but include payment exchange as within high-risk categorization. If integrated into my complex mashup the latter furthers justification for PrEP for oral. 

Edited 9 hours ago by SirBillybob

[Reggyreg56]

22 minutes ago, SirBillybob said:

Transmission is biologically plausible. The way I view it is that within the bounds of statistical confidence intervals, a type of math that plots probability across a range from lower to higher when true estimates not measurable in absolute and unambiguous terms, a very high seminal viral load shot against one’s oropharynx, in the absence of knowledge of inserter’s advanced disease or acute infection stage when viral load peaks, although naturally difficult to infect that specific mucosal tissue within one’s throat, gets close to the level of risk for women with respect to receptive vaginal sex with men with unsuppressed viral load but without the specification of very high seminal viral load.

I do not possess a vagina but happy to compare my deep throat to one. I realize that this mashup of risk metrics is complex to follow. In my case I use HIV PrEP on-demand on those rare occasions of condomless receptive oral sex but it doubles for the inclusion of receptive anal accompanied by condom use that often joins the choreography. Two birds one stone, so spared a decision about PrEP for oral exclusively. 

Canadian guidelines do not distinguish risk among oral and anal or vaginal but include payment exchange as within high-risk categorization. If integrated into my complex mashup the latter furthers justification for PrEP for oral. 

Ok umm..I didn't understand all of that but thanks..lol

[Reggyreg56]

1 hour ago, SirBillybob said:

I think what you are trying to say is not that Doxycycline would be relatively ineffective taken infrequently, but that the infrequency of oral sex in tandem with possible clinical contraindications in your case would steer you instead to regular STI testing and standard treatment should an STI occur. If you are under the impression that DoxyPEP infrequent uptake compromises its value pharmacologically check that out with your clinical provider. It’s the infrequent use that is more in favour. 

DoxyPrEP (daily, not on-demand) is a thing and is being studied as a comparator to DoxyPEP in a clinical trial. It may not shed much light on the concerns related to antimicrobial resistance development with widespread Doxy use, but there are ways to pick up some knowledge assessing AMR through lab analysis of research subjects’ specimens.

Finally, clinical expert panels remain divided over the language of guidance for Doxy prophylaxis and those that view it as a swing and a miss for many candidates relative to the merits of individual STI surveillance practice have steered the usage to ‘suggested’, not ‘recommended’. It’s off-label indication, an additional marker of hesitancy, and these factors will influence one’s shared decision with clinician.

I understand this message a little better. Lol. Thank you! 

[Reggyreg56]

1 hour ago, JamesB said:

As far as I know, there is no such thing as DoxyPrEP, there is Doxy PEP (Post-Exposure Prophylaxis). You take a dose of Doxycycline within 72 hours of potential exposure.

Yes that was a typo. My apologies.

[CuriousByNature]

7 hours ago, Walt said:

Part of it is having a personal relationship with the concept of risk.

Every year in the United States alone, 5 million people have injuries and 40,000 people die as a result of car accidents.

Never drive to an appointment with a provider... lol

[+ SirBillybob]

29 minutes ago, CuriousByNature said:

Never drive to an appointment with a provider... lol

Or pull over if horn blowing or front to back collisions are to occur on that drive. 

Edited 8 hours ago by SirBillybob

[seattlebottom]

I assume that everyone has something and act accordingly.