STIs

STIs are infections that are transmitted through close body contact, usually sexual. Sexual contact includes fucking, sucking, as well as touching, fingering or kissing/licking a cock, arse or vagina.

STIs can be caused by viruses (e.g. HIV, herpes, genital warts), bacteria (e.g. chlamydia, gonorrhoea), or parasites (e.g. crabs, scabies).

The presence of an inflammatory STI (chlamydia or gonorrhoea), or an ulcerative one (genital herpes, syphilis, etc) increases the risk of getting, or passing on, HIV, even when there are no symptoms.

In people with HIV, STIs can increase your viral load in your blood, anal mucus, pre-cum and cum, as well as in sores and lesions, which increases the chance of passing on HIV. They can also decrease your CD4 count. HIV is also more concentrated at the sites of STIs. If you have an STI as well as HIV, then both the STI and HIV can be easier to pass on to your partners.

In people who are HIV-negative HIV can enter the body via STI sites more easily due to clustering of white blood cells at these areas.

Mucosal damage caused by STIs promotes both HIV transmission and acquisition.

When to have an STI test?

The more sex you have, the more frequently you should have a sexual health check-up to test for HIV and other STIs.

All men who have sex with men should have a full sexual health check at least once a year, even if you only have one regular partner.

More frequent testing, up to 4 times a year, is recommended for men who:

  • have episodes of unprotected anal sex
  • have more than 10 partners in the past six months
  • participate in group sex or use recreational drugs during sex

If you or your partner have casual sex outside of your relationship, both of you should get tested.

If you’re HIV positive, getting regular blood tests to monitor your HIV viral load doesn’t mean you are getting tests for other STIs. If you are sexually active, it is recommended that HIV positive men should have a syphilis test every 3 months as part of their routine HIV monitoring. You should also ask your doctor to test for the full range of STIs at the same time. It is also recommended that HIV-positive men should have a hepatitis C test once a year.

If you are in a new relationship, monogamous or otherwise, it is advisable for you both to get a check-up as either of you may have contracted an STI from a previous partner.

Indications (i.e. symptoms) that you may have an STI include:

  • An unusual discharge from your cock
  • Itching or stinging when you urinate
  • Sores, blisters or rashes in the genital or arse area

Even if you show no symptoms, it is possible to have an STI and pass on the infection – especially if the infection is in the rectum or throat. Testing is the only way to know.

You can register to receive free and confidential e-mail or SMS reminders to go for a sexual health check-up, using the Remind Me service on this website.

What happens in an STI test?

You can get a sexual health check from a GP or from a sexual health clinic. If your doctor doesn’t see many gay or bisexual men, or you don’t want them to know you have sex with men, try a different doctor or go to a sexual health clinic. Sexual health clinics offer confidential STI (including HIV) testing, treatment and information. Specialist medical, nursing, counselling and interpreter services are also available. Public sexual health clinics are free, you don’t need your Medicare card, and you can be anonymous if you wish. Free condoms and lube are also available, along with needle and syringe programs. There is a list of sexual health clinics listed on this website, listing both public and private sexual health clinics.

When you go for a sexual health check, your doctor will assess your risk by asking a series of questions about your sexual history. A full sexual health check-up should include all of the tests listed below.

If you don’t have any symptoms a routine check-up should involve a:

  • Blood test for HIV;
  • Blood test for syphilis and hepatitis A and B and, depending on your risk, for Hepatitis C (it is recommended HIV-positive men and men who inject drugs should get tested for Hepatitis C once a year);
  • Urine sample for chlamydia;
  • Anal swabs for gonorrhoea and chlamydia (even if you aren’t fucked, as STIs can be transmitted by activities like rimming and fingering);
  • Throat swab for gonorrhoea; and
  • Physical examination for genital herpes, genital warts, pubic lice and scabies.

You may need to ask specifically for some of these tests.

If you have symptoms you may be offered different tests.

An STI test can be done regardless of whether you have symptoms or not. For urethral tests (that is, testing for infection in the penis) the type of test you have is determined by the presence or absence of symptoms.

If you do not have any symptoms you will have a urine test. A urine sample is the 'first void urine', the first part of the urine stream.

For rectal or throat (pharyngeal) tests, or when you actually have symptoms from the penis such as discharge or an ulcer or sore, a swab will be taken with what looks like a long cotton bud. Swabs can be taken from the mouth, anus and cock. Swabs of the anus are important even if you aren’t fucked, as STIs can be transmitted by activities like rimming and fingering. Some practitioners will let you take your own anal swabs if this is more comfortable for you. If you are concerned or feel uncomfortable about having swabs taken perhaps go to a sexual health clinic as they do these tests every day.

For blood-borne viruses (BBV), such as HIV and hepatitis C, and bacterial diseases such as syphilis you will need to have a blood test. A small vial of blood will be taken for testing. Before taking blood for HIV and hepatitis C, it essential that the practitioner has discussed the test and possible outcomes with you, this is called the pre-test discussion or pre-test counselling.

With all testing it is important to specify what you want to be tested for, as health care workers cannot test for STIs and BBVs without your permission. Talk to your practitioner if you are unsure what to be tested for. Test results can take up to seven to ten days to come back and you may need to make another appointment to receive these results in person, particularly for tests such as HIV. Post-test counselling is available and should be provided if you are receiving results for HIV or hepatitis C.

Telling

If you have an STI, or had one recently, contact all the people you’ve had sex with recently and suggest they get tested. Sometimes this isn’t easy. You might find it hard to tell your sex partners you have an STI.

It is important to talk to your sex partners so they can get tested and treated too. Remember, if one partner is untreated, many STIs can be passed back and forth.

Sometimes a sexual health centre will anonymously contact sexual partners for you.

You can also notify your recent sexual partners anonymously through email or SMS by using the Let Him Know service on this website.

Below are the some of the most common sexually transmitted infections (STIs) experienced by gay men (HIV-positive or HIV-negative).

Chlamydia

What is it?

Chlamydia is the most common STI in Australia and is caused by bacteria (Chlamydia trachomatis). Chlamydia can cause infections of the urethra (the tube that runs through your cock), the throat or the arse.

How do you get it?

You can get chlamydia in your cock (urethra) or arse through giving or receiving anal sex, or in the throat through oral sex. Although uncommon, you can also get infected in your cock through oral sex and in your arse through fingering and fisting. It is possible to have chlamydia more than once.

What are the symptoms or signs?

Symptoms can include:

  • A watery, white or grey discharge from your cock which is most noticeable in the morning
  • Itching or pain in the opening of your cock which often fades after you piss
  • Irritation or soreness around the urethra
  • Pain in the testicles or arse
  • Pain when you cum

Symptoms usually appear between two and 14 days after being exposed, but may take as long as 21 days; however it is quite common to have no symptoms, or for the symptoms to go unnoticed, especially in the throat or arse.

Most men do not have any symptoms. Left untreated chlamydia can cause infertility.

Testing

A medical practitioner can diagnose chlamydia by swabbing the throat or arse. Testing for urethral infection is usually done through a urine test; however, if you have symptoms a urethral swab may be required.

How is it treated?

Chlamydia is treated with a course of antibiotics. If you had sex while you were infected with chlamydia your sexual partners may also need to be tested and possibly treated.

How can it be prevented?

Using condoms can reduce the risk of transmission if the infected area, for example cock or arse, is covered. However condoms may not always cover the infected area so there is a high chance of passing on chlamydia even when condoms are used.

HIV and Chlamydia

If you are HIV-positive, chlamydia greatly increases the viral load in semen. This means that it is easier to pass HIV on to other people while you have chlamydia.

Crabs

What is it?

Crabs (Phthirus pubis) are tiny mites that live on the skin at the base of pubic hair. Crabs lay eggs that are attached to the hairs and are usually seen in the pubic area. Crabs can also be found in beards, armpits, chest hair and eyelashes.

How do you get it?

Crabs are passed on through close skin-to-skin contact and sharing clothes, bed sheets or towels.

What are the symptoms or signs?

Crabs can cause an intense itching in the pubic regions. This may take between three days and several weeks to occur. Close examination of the pubic hair should find tiny brown lice and/or white eggs, called nits, attached to the pubic hair.

Testing

No test is required. You can usually identify crabs by self-examination.

How is it treated?

You can treat crabs yourself with appropriate genital lice shampoos and creams available at pharmacies. At the time of treatment wash all your bed linen, towels and clothing in warm, soapy water. Sexual partners and anyone in close physical contact should also be treated. It is advisable to repeat the treatment after seven days. Shaving pubic and other body hair is not necessary.

How can it be prevented?

There’s no way to prevent the initial outbreak of crabs. To prevent crabs from recurring after an outbreak, wash everything that may have come into contact with the lice in warm soapy water including bed linen, clothes, towels and underwear.

Genital & Anal Herpes

What is it?

Herpes is a sore or blister caused by the herpes simplex virus (HSV). There are two types of HSV. Type 1 is usually found around the mouth and is commonly known as cold sores. Type 2 is usually found around the cock or arse areas.

How do you get it?

Herpes is transmitted both sexually and non-sexually during skin-to-skin contact such as direct contact with a sore on the mouth, penis or arse.

The herpes virus is most easily passed on when there are sores or blisters present but can also be passed on when there are no obvious symptoms.

Once you have HSV it stays in your body for the rest of your life. Every now and then you may have a recurrence and this can happen when your immune system is lowered. Recurrences may not be as severe as the first infection because your body has produced antibodies to help fight the infection.

What are the symptoms or signs?

There may be no symptoms however herpes usually starts with tingling, itching, burning or pain followed by the appearance of painful red spots which then form blisters. These blisters then form scabs. However, blisters do not always occur. You may also experience flu-like symptoms. If symptoms occur they generally show up between two and seven days after you have been exposed to the virus, but it may take much longer.

Testing

If you have blisters or sores a medical practitioner can take a swab otherwise you will have blood test.

How is it treated?

There is no cure, but there are treatments that can reduce symptoms and speed up the recovery. The frequency of outbreaks varies from person to person, but outbreaks may become less frequent and in time may stop altogether.

How can it be prevented?

Condoms can reduce the risk of transmission but do not always cover the infected area. The virus may be present on the balls, arse area or thighs. Avoiding sexual contact if you or your partner has visible blisters or sores will prevent the transmission of herpes. Anti-viral medication can reduce the risk of transmission by reducing asymptomatic shedding and recurrences. Shedding is a term for the herpes virus being released from the surface of the skin. Asymptomatic shedding is when the virus is being released and there are no visible symptoms or signs.

If you are HIV-negative, an occurrence of herpes makes you more vulnerable to HIV infection.

Herpes (HSV) & HIV

If you are HIV-positive and you also have herpes you may experience recurrent genital HSV flare-ups that are more serious than in people not infected with HIV.

Herpes may also increase the replication of HIV and therefore raise viral load. If you are HIV-positive it is possible to control herpes effectively but the severity and frequency of outbreaks of anal and genital herpes may increase as the immune system is weakened.

Genital & Anal Warts

What is it?

Genital and anal warts are caused by certain types of HPV (human papillomavirus).

How do you get it?

HPV is transmitted by skin-to-skin contact, including oral and anal sex. HPV may be transmitted even when there are no visible warts present.

What are the symptoms or signs?

Visible warts are small growths, often rough or rubbery to the touch. These occur around the cock, balls and arse, and are often painless. Warts usually show up between two or three months after infection with HPV but may take much longer.

Testing

Diagnosis is usually by observation by a medical practitioner. Sub-clinical infection can be diagnosed through observation of cells on a biopsy.

How is it treated?

Visible warts are usually treated in several ways. These are:

Self-administered

  • imiquimod cream (this is not on the Pharmaceutical Benefits Scheme Schedule)
  • podophyllotoxin paint(a plant-based resin)

Provider-administered

  • freezing them (cryotherapy) with applications of liquid nitrogen or use of a nitrous oxide gun
  • application of a low-grade electrical current (electrocautery or diathermy)
  • laser surgery
  • surgical excision
  • Trichloroacetic acid (TCA)

HPV & Cancer

Some strains of this virus have been associated with abnormal cell changes on the penis or anus, as well as the mouth and throat, with a few strongly associated with cancer. These are the same strains of HPV that are associated with cervical cancer in women.

This association seems to increase with other factors, one of which is smoking.

Visible warts are less likely to lead to cell changes that precede cancer. The strains that are linked to abnormal changes usually cause infections without visible symptoms.

Men who have sex with men are much more likely to develop abnormal cell changes and cancer than other men, and it is even more likely for HIV-positive men.

There is currently no common screening for these types of cancers. However, some are recommending anal Pap screening as an option for screening for anal cancer and further research is being done for gay men in this area. Men can check themselves for any abnormalities in and around the anus by checking for things like lumps, unusual swelling or irritation.

Speak to your doctor about any changes or if you are concerned about anything.

How can it be prevented?

There is a vaccination available which protects against several strains of the human papillomavirus (HPV), two strains that cause genital and anal warts, and two strains commonly associated with these cancers.

This vaccine has been offered to women, and is now also indicated for men up to the age of 26. However, it is not currently available on the Pharmaceutical Benefits Scheme (PBS) to be offered at a subsidised price.

The vaccine was originally offered to girls as part of the government funded National Immunisation Program, but this has now been expanded to also include boys. This includes an ongoing program for boys 12-13 years of age, and a catch-up program over two years for boys in Year 9.

The vaccine is most effective if given prior to exposure, however, research has shown that even if you have had prior HPV exposure you may still benefit from vaccination.

If you already have one or more of the strains in the vaccine, you will benefit from the prevention of infection and disease from the strains you have not yet been exposed to.

In people with evidence of prior infection, vaccination can help protect from reacquisition or recurrence of infections leading to warts and other cell changes, including cancer. Research is confirming if this may also be the case for people who have undergone treatment for HPV related external genital lesions.

Speak to your doctor about your options for vaccination.

Most studies have shown no protective effect of condoms for HPV. However, even though condoms do not seem to provide effective protection against HPV infection, condoms do reduce the risk of the development of genital warts by 30 percent in women and about 40 percent in men, and reduce the risk of cancers associated with HPV.

HPV (genital and anal warts) & HIV

The rate of growth of genital warts increases as the immune system is compromised. Anal and genital warts may also respond more slowly to conventional topical treatment in people with HIV.

Damage to the immune system may also lead to an increase in the number of different HPV sub-types and the development of cell abnormalities. HIV treatment does not seem to reduce the prevalence of either cervical or anal HPV or the development of cell abnormalities.

Clearance of HPV appears to be slower or less likely among people who are HIV-positive.

Gonorrhoea

What is it?

This is an infection of your cock (urethra), arse (rectum), throat or eyes caused by the bacteria Neisseria gonorrhoeae.

How do you get it?

Gonorrhoea is passed on by giving or receiving anal sex, oral sex, and arse play such as fingering and fisting with an infected person. Touching an infected cock or arse and then touching your own cock, arse or eyes can also transmit gonorrhoea.

What are the symptoms or signs?

It is quite common to have no symptoms, especially if the infection is in your rectum or the throat. However symptoms can include a dry or sore throat, itchiness and pain during bowel movements (shitting), or a clear or yellow discharge from the cock and pain or burning when urinating. Throat infections may also cause discharge however this is less common. These usually take between two and 10 days to show up after being exposed.

Testing

Gonorrhoea is usually detected by a urine test as well as swabs collected from the arse and throat. It is preferable not to piss for at least one hour prior to having a urine test.

Can it be treated?

Gonorrhoea is easily cured with antibiotics. Sexual contact should be avoided for at least one week to ensure the infection has cleared after treatment.

How can it be prevented?

Using a condom for anal sex can reduce the risk of transmission if the infected area (for example cock or anus) is covered. Condoms may not always cover the infected area so there is a risk of passing on gonorrhoea. It can also be passed on through oral sex or by touching an infected area and then touching your own penis, anus or eyes.

Gonorrhoea & HIV

HIV infection may exacerbate some of the symptoms and complications of gonorrhoea. Also, some research has shown a link between gonorrhoea and faster HIV disease progression.

Cases of severe arthritis related to gonorrhoea have been reported in people with HIV. There are also reports of keratoconjunctivitis, a severe inflammation of the membrane which covers the eye.

Gonorrhoea infections also increase the amount of HIV in semen. This means that the chance of passing on HIV through unprotected anal sex is greater.

Gonorrhoea, particularly anal gonorrhoea, also causes inflammation, which can make an HIV-negative person more susceptible to being infected with HIV.

Hepatitis A

What is it?

Hepatitis A is a virus that causes inflammation of the liver.

How do you get it?

Hepatitis A is passed on when small particles of shit (faeces) enter a person's mouth through activities like arse play and rimming, or by not washing your hands after sex with an infected person. This is called oral-faecal transmission. It is also passed on through using eating and drinking utensils previously handled by an infected person, eating infected shellfish or by sharing a joint or bong.

What are the symptoms or signs?

Symptoms of hepatitis A infection may include mild flu-like symptoms, nausea and vomiting, abdominal pain, joint and muscle pain and jaundice (yellowing of the skin, eyes or urine). Symptoms can take 2 - 7 weeks to appear but the infection will usually clear within a month. On rare occasions people can be ill for several months.

Testing

Hepatitis A is diagnosed with a blood test. Once you have had hepatitis A, antibodies will be detected in your blood. Most people will become immune to hepatitis A once they have had it, meaning that it is unlikely that they will get it again.

Can it be treated?

There is no treatment for hepatitis A. Bed rest and plenty of fluids are recommended. In severe cases people will need to go to hospital.

How can it be prevented?

There is a vaccination course available for hepatitis A. Two doses of the vaccine are required, the second dose is given 6 to 12 months after the initial vaccination. There is also a hepatitis A and B combination vaccination available. Three doses of the vaccine are required; the second dose after 1 month and the third 6 months after the initial vaccination.

To prevent passing on hepatitis A wash your hands after using the toilet and before and after sex (especially arse play), and use dams for rimming.

Hepatitis A & HIV

If you are HIV-positive one of the consequences of also having hep A infection is often having to go off anti-HIV medication, and sometimes drugs for opportunistic infections as well. Many HIV drugs pass through the liver and so cannot be tolerated during acute hepatitis infection. Getting immunised is a sensible move (the vaccination is not a live one).

Hepatitis B

What is it?

Hepatitis B is a virus that causes inflammation of the liver and may result in liver disease.

How do you get it?

Hepatitis B can be passed on by infected blood or cum through activities like unprotected fucking and oral sex, sharing injecting equipment, toothbrushes or razors and tattooing and body piercing with un-sterile equipment.

What are the symptoms or signs?

Symptoms of hepatitis B infection may include mild flu-like symptoms, nausea and vomiting, abdominal pain, joint and muscle pain and jaundice (yellowing of the skin, eyes or urine). Symptoms can take 1 - 6 months to show up and some people may have no symptoms at all. Hepatitis B can become a chronic infection (more than 6 months in duration) however most adults will recover completely from hepatitis B. The few that do not clear the virus may be at risk of developing cirrhosis and liver cancer.

Testing

Hepatitis B is diagnosed with a blood test. Once you have had hepatitis B anti-bodies will be detectable in your blood. Most people will become immune to hepatitis B once they have had the disease, meaning that it is unlikely that they will get it again. For people who do not clear the virus hepatitis B infection is monitored with blood tests called liver function tests.

Can it be treated?

There is no cure for hepatitis B. However, people with chronic (long-lasting) hepatitis B should speak to their doctor about treatment options. For those people with liver damage, the doctor may suggest treatment. While for those people without liver damage it may be best to wait. Treatment does not cure hepatitis B, but it can change an aggressive infection into a mild one, helping stop the liver from being damaged. If the infection is considered mild, it may be considered better to monitor it and consider treatment later. People with chronic hepatitis B may be treated with anti-viral medication such as lamivudine, adefovir, entecavir, or pegylated interferon. These are specialised drugs so see your doctor and hepatitis specialist. There is no treatment for acute hepatitis B infection.

How can it be prevented?

There is a vaccination course available for hepatitis B. Three doses of the vaccination are required with an interval of 1 to 2 months between the first and the second dose with a third dose at 2 to 5 months after the second dose. There is also a hepatitis A and B combination vaccination available. (See hepatitis A prevention for details.)

For HIV-positive men, hepatitis B antibody level should be tested yearly to check for the need for a booster.

To reduce the risk of transmission of hepatitis B:

  • Use condoms and water-based lube when fucking or during oral sex, gloves and lube during fisting, and change these between partners.
  • Avoid sharing sex toys (or use condoms over toys and always change condoms between different partners).
  • Wash hands and sex toys during sex and between partners.
  • Avoid sharing injecting equipment, toothbrushes and razors and make sure body artists use sterile equipment for tattoos and piercings.
  • Avoid sharing injecting equipment including needles, syringes, swabs, spoons, filters, water and tourniquets.
  • Always use new injecting equipment.
  • Always wash your hands before and after injecting.
  • Avoid sharing personal items such as toothbrushes, razors and nail scissors / clippers.
  • Make sure body artists use new and sterile equipment for tattooing, body piercing and other body art.
  • Wear disposable gloves if you give someone first aid or are cleaning up blood or body fluids.

Hepatitis B & HIV

If you are HIV+ one of the consequences of also having hepatitis B infection is that it may necessitate having to temporarily stop taking certain kinds of anti-HIV medications and drugs for opportunistic illnesses.

Many HIV drugs are metabolised through the liver, and cannot be tolerated during acute hepatitis illness.

Studies have not reliably shown any link between hepatitis B and more rapid HIV disease progression though some have suggested such a link could exist.

Hepatitis C

What is it?

Hepatitis C is a virus that causes inflammation of the liver and may result in liver disease.

How do you get it?

Hepatitis C is passed on by blood-to-blood contact so infected blood from one person must enter another person's blood stream. A small amount of blood can carry enough of the virus to cause infection. Transmission can occur through sharing injecting equipment, toothbrushes and razors, unsterile tattoo and piercing equipment and needlestick and sharps injuries in occupational settings.

In the past, sexual activity was thought to be low risk for hepatitis C transmission. However, there is now an increasing number of cases occurring among gay men and other men who have sex with men (MSM), particularly among those men living with HIV. Although some of these cases relate to sharing of injecting equipment, it would appear that the majority of cases are related to sexual transmission.

Unprotected anal sex is the main risk for sexual transmission of hepatitis C. This risk is increased by any sex that further increases the risk of damage or injury to the lining of the anus, such as fisting, prolonged (long-lasting) sex sessions, rough sex, and unprotected anal sex—especially during party drug use and group sex. Sharing unwashed sex toys can also be a risk, Each of these situations involves potential exposure to blood, bleeding or broken skin, that may not be easily seen allowing entry into the bloodstream, and therefore, potential exposure to the hepatitis C virus.

Hepatitis C is also found in semen, though it is not clear if this adds to the risk of sexual transmission during unprotected anal sex.

What are the symptoms or signs?

Many people infected with hepatitis C do not experience any symptoms. Others may experience flu-like symptoms, nausea and abdominal pain in the early stages of infection. During the first 2 - 6 months some people are able to clear the virus naturally, for others they will go on to develop chronic infection. Chronic infection can lead to cirrhosis and liver cancer after many years in some people.

Testing

Hepatitis C is diagnosed with a blood test (HCV antibody test).

It is recommended that HIV-positive men should have a hepatitis C test at lease once a year, and every six months if they've:

  • had more than 10 partners in the past six months;
  • had unprotected anal sex;
  • used recreational drugs; and/or
  • had group sex.

Once you have or have had hepatitis C anti-bodies will be detectable in your blood. Unlike hepatitis A and B if your body clears the hepatitis C virus you can become infected again if you are exposed. You do not develop immunity to the hepatitis C virus. The hepatitis C virus can be detected with a PCR test. This test actually looks for the virus in your blood. Among people who do not clear the virus hepatitis C, it can be monitored with blood tests called liver function tests.

Can it be treated?

The current treatment for hep C is a combination of two drugs that aims to clear the virus from your body and to prevent the progression to cirrhosis (scarring of the liver), liver cancer or liver failure.

Some people with Hep C may not be suitable candidates for currently available treatments. This could be due to several things, such as how progressed hep C is, older age and other health issues. Treatment can have side effects ranging from mild to very severe. Some strains of hep C respond better to treatment than others. Not everyone clears the virus, even on treatment, but the sooner someone finds out they have hep C the better the outcomes they can have with treatments

There are also some promising upcoming developments in treating hep C.

Some people can manage their symptoms with complementary therapies and lifestyle changes.

For people with both HIV and hep C, treatment for both of these can be more complicated.

Talk to your doctor about your treatment options.

For people who do not clear hep C, it can be monitored with liver function tests.

How can it be prevented?

At present there is no vaccine available to prevent a person from being infected with hepatitis C.

To reduce the risk of transmission of hepatitis C:

  • Use condoms, gloves and water-based or silicon-based lube during anal sex and fisting or if there is blood or STIs present.
  • Avoid sharing sex toys (or use condoms over toys and always change condoms between different partnrs).
  • Wash hands and sex toys during sex and between partners.
  • Avoid sharing injecting equipment including needles, syringes, swabs, spoons, filters, water and tourniquets.
  • Always use new injecting equipment.
  • Always wash your hands before and after injecting.
  • Avoid sharing personal items such as toothbrushes, razors and nail scissors / clippers.
  • Make sure body artists use new and sterile equipment for tattooing, body piercing and other body art.
  • Wear disposable gloves if you give someone first aid or are cleaning up blood or body fluids.

If you are living with hepatitis C:

  • Wipe up any blood spills carefully with household bleach and disposable paper towels, wearing disposable gloves. Use cold water.
  • Keep cuts, wounds and abrasions covered with sterile waterproof dressing.
  • Place bloodstained tissues, sanitary towels or other bloodstained dressings in a plastic bag before disposal.
  • Blood stained clothing can be washed on a regular cycle in a washing machine once rinsed.
  • Use condoms and water-based lubricant during sex.

Hepatitis C & HIV

Studies have found a higher prevalence of hepatitis C in people who are also HIV-positive. This might be because a number of risk factors for HIV are also risks for hepatitis C. Hepatitis C in a person who is already HIV-positive can lead to a higher concentration of hepatitis C in bodily fluids than other people with hepatitis C.

However a high hepatitis C viral load does not necessarily mean a high HIV viral load, nor does it correlate to a low CD4 count.

Having HIV may lead to an increase in false-negative and indeterminate test results for hepatitis C. Evidence also shows that a person who is co-infected can have an increased HIV viral load. No relationship has been found between hepatitis C and the acceleration of HIV-related disease.

HIV and hepatitis C can be safely treated in people with both infections. However, HIV is usually the first priority, because untreated HIV may cause hepatitis C viral load to rise. Some people do need to be treated for both infections, especially if there are hepatitis C related liver problems.

Some anti-HIV drugs can cause liver inflammation and other problems, which can be life threatening. Starting treatment for both HIV and hepatitis C at the same time is not generally recommended, since it may increase the likelihood of side effects. Starting on combination HIV antivirals may cause brief symptomatic reactivation of hepatitis C.

There are a number of common drugs, many of them HIV treatments, which carry a risk of liver inflammation or damage. People with both HIV and hepatitis C are advised to regularly and carefully monitor their liver enzyme levels, and avoid HIV antivirals most strongly associated with liver problems.

LGV

What is it?

Lymphogranuloma venereum (LGV) is caused by certain types of the bacterium Chlamydia trachomatis. LGV is endemic in some tropical regions of the world. LGV has been rare outside these regions for several decades; however outbreaks of LGV among gay men started to be reported in late 2003 in the Netherlands and Germany and then in the rest of Western Europe. There have also been several outbreaks of LGV in Australia in recent years.

How do you get it?

LGV can be passed on through unprotected anal, vaginal or oral sex. Condoms reduce the likelihood of transmission. The use of latex gloves for fisting (and not using the same gloves with different partners) can also prevent transmission of LGV.

What are the symptoms or signs?

The clinical course of LGV is divided into three stages:

Primary stage
The initial symptom is usually a painless papule or shallow ulcer on the penis, urethra, vulva, vaginal wall or cervix, or in the rectum. This appears after an incubation period of 3-30 days. This lesion does not always appear or may pass unnoticed. In fact only 25-35 per cent of people report having had any lesions.

Secondary stage
A few weeks after the primary lesion there can be painful and swollen lymph glands in the groin. The secondary stage may also include proctitis - pain and inflammation in the anus and rectum (with more severe inflammation than non-LGV infections), rectal bleeding, anal discharge, constipation, cramping.

Tertiary stage
In the tertiary stage, lymphatic obstruction may cause extreme swelling (elephantitis) of the genitals of both men and women.

Testing

Diagnosis of LGV is by clinical findings in combination with a swab.

Can it be treated?

Treatment is a course of antibiotics for 21 days.

How can it be prevented?

Using condoms for anal sex can reduce the risk of passing on LGV. Wearing gloves for arse play or using a dam for rimming can also reduce the chance of transmission. You should wash your hands after handling used condoms or sex toys or after having sex involving arse play.

LGV & HIV

If you are HIV-positive, Proctitis can increase your viral load. This means that it is easier to pass HIV on to other people while you have Proctitis.

In people with HIV the lesions associated with LGV may be deeper, larger and more numerous.

Treatment for LGV does not differ according to HIV status. However the time to heal may be more prolonged in people with HIV.

Molluscum Contagiosum

What is it?

Molluscum Contagiosum is a common skin growth caused by a viral infection in the top layers of the skin.

How do you get it?

Molluscum Contagiosum is passed on by direct skin-to-skin contact with someone who has the infection. It can be transmitted through sexual contact and through non-sexual contact with infected areas.

What are the symptoms or signs?

The lesions look like waxy pimples that have a dimple in the middle. Lesions can appear in the genital area as well as other parts of the body and can be itchy. Scratching can spread the virus. Sexually transmitted lesions are usually found on the lower abdomen, pubic area and thighs. They usually show up between two and twelve weeks after exposure.

Testing

Diagnosis is made by observation by a medical practitioner.

Can it be treated?

The lesions can disappear by themselves however a medical practitioner can freeze off the lesions to reduce the risk of them spreading. Alternatively, the core of the lump, which contains the virus, can be extracted with a fine needle.

How can it be prevented?

Only the area covered by a condom, glove or dam is protected from the virus. Avoid close physical until the lesions have disappeared.

Molluscum Contagiosum & HIV

If you are HIV-positive you may be more susceptible to acquiring molluscum contagiosum, which is more persistent in people with a weakened immune system. The severity of molluscum infection is considerably reduced in some people with HIV who take anti-HIV medication.

NSU

What is it?

Non-specific urethritis (NSU) is inflammation of the urethra.

How do you get it?

NSU can be caused by an infection, which is passed on by sexual contact such as fucking without condoms or by oral sex. NSU can also be the result of damage to the urethra (which could be the result of extended or rigorous sexual activity).

What are the symptoms or signs?

When caused by an infection, symptoms include pain when you urinate or cum and a white or yellow discharge from you cock. The glands in your groin may also be inflamed or tender. Symptoms can take between one and three weeks to appear.

Testing

NSU is diagnosed by urine sample or a urethral swab, in conjunction with a genital examination by a medical practitioner.

Can it be treated?

NSU is treated with a course of antibiotics. Once you have finished the treatment you will need to be tested to check if you have been cured. If left untreated NSU can lead to inflammation of the prostate gland (prostatitis), inflammation of the balls and infertility.

How can it be prevented?

Using condoms and water-based lube can reduce the risk of transmitting the infections that cause NSU.

Scabies

What is it?

Scabies is an infestation of tiny mites (Sarcoptes scabiei), (smaller than crabs) which burrow under the skin.

How do you get it?

Scabies is passed on by close skin-to-skin contact, including sexual contact, and contact with towels, bed linen and underwear of an infected person.

What are the symptoms or signs?

Scabies are tiny and hard to see. The most common symptoms are a rash or itching caused by the mite burrowing under the skin to lay eggs. The mites prefer warm areas such as the armpits and groin but are also commonly found in the spaces between the fingers and the toes. Scabies usually gets noticed within four weeks. You may see silvery lines where the mite has burrowed.

Testing

You can usually identify scabies by self-examination.

Can it be treated?

Scabies can be treated with anti-scabies lotions available from pharmacies. At the time of treatment wash all your bed linen, towels and clothing in warm, soapy water and dry well. Partners and anyone in close physical contact should also be treated. It is advisable to repeat the treatment after seven days. The itch can last up to four weeks after successful treatment.

How can it be prevented?

It is difficult to prevent catching scabies because it is passed on by close physical contact. To prevent scabies from recurring after an outbreak, wash everything (including bed linen, clothes, towels and underwear) that may have come into contact with the mites in hot soapy water. All contacts, including people you live with, need to have treatment and it is advisable to repeat it after 7 to 10 days.

Shigella

What are they?

Shigella is a group of several bacteria that causes bowel infections. Other gut bugs cause amoebiasis, giardiasis and salmonellosis.

How do you get them?

Shigella is very infectious and therefore easily passed on. It is present in the shit of an infected person and can be transmitted when tiny particles of contaminated shit enter the mouth. This can happen in three ways:

  • through rimming
  • by getting shit onto your fingers and then touching your mouth
  • by putting contaminated objects like food, pens and cigarettes into your mouth

During sex, shit can get onto the hands while fucking, fingering and fisting and by handling things such as used condoms and sex toys. Once it is on your fingers it can easily get into the mouth. Gut infections can be passed on sexually or otherwise through food and water.

What are the symptoms or signs?

Symptoms include stomach cramps, diarrhoea (sometimes with blood and or mucous), fever and nausea. These can appear between twelve hours and four days after exposure. A person with shigella may experience no, mild or severe symptoms. In most cases recovery takes between four and seven days but may take longer. Giardia can cause cramps, swelling of your bowel and can make you shit frequently. Amoeba can cause diarrhoea, stomach pain, swelling of your colon and bleeding from your bowel.

Testing

Shigella and other gut infections can be diagnosed by taking a stool (shit) sample.

Can it be treated?

If you have diarrhoea, drink lots of fluids to avoid dehydration. Oral re-hydration solutions, available from pharmacies, can also be given to replace electrolytes and assist with re-hydration. Treatments which slow down the diarrhoea can be harmful but antibiotics may be used to treat the infection. In severe cases, especially for HIV-positive people, hospitalisation may be needed. Waiters and others involved in food handling are advised not to work while they have shigella and for 7 days after the symptoms stop. Avoid sex with anyone until seven days after the symptoms have ceased.

How can it be prevented?

Gut infections can be avoided by wearing gloves for arse play or by using a dam for rimming. You should wash your hands after handling used condoms or sex toys or after having sex involving arse play. Douching doesn’t help in limiting the spread of shigella as it brings bacteria to the surface of the arse.

Be aware of the ways that tiny particles of shit can enter your mouth. These include:

  • biting your nails
  • lighting up a cigarette
  • eating unwrapped lollies, nuts, fruit or other food
  • preparing food
  • sharing cups, bottles, cutlery, plates or other household equipment

Shigella (and other gut bugs) & HIV

If you are HIV-positive you are more likely to have severe symptoms, which may result in a prolonged illness and hospitalisation. Both HIV negative and HIV-positive people respond equally well to the standard treatment for Giardia, which is very effective.

Syphilis

Syphilis

Syphilis has been increasing among gay men.

Although syphilis is very easy to catch, it is more common among men with a high number of sexual partners (more than 10 in the last six months), men who are into group sex, sharing sex toys or fisting, and men who are HIV positive. If you fit any of these categories, you should get tested for syphilis every three to six months.

Please see below for more information about syphilis.

What is it?

Syphilis is an infection in your blood caused by a bacterium called Treponema pallidum.

How do you get it?

Giving or receiving anal or oral sex can transmit syphilis. It can also be passed on through arse play or direct contact with sores or lesions.

What are the symptoms or signs?

It is common for the symptoms of syphilis to go unnoticed however when they do appear they usually occur in 3 stages.

Stage 1:

A red sore (chancre)-which is usually but not always painless-will appear on your cock, balls, mouth, throat or arse that turns into a scab and then heals. It usually appears at the site of infection. This stage may show up 10-90 days after infection and may go unnoticed. If left untreated the sore will disappear after a few weeks, but the infection will progress to stage 2.

Stage 2:

A rash will appear on the palms of your hands, soles of your feet or other parts of your body. In addition to rashes, second stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle and joint aches, and tiredness. These symptoms can occur 2-6 months the after initial infection and last for 6 months or longer. Without treatment syphilis will progress to stage 3.

Stage 3:

If untreated, syphilis remains in your body and begins to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. In about one in 10 of untreated people, this internal damage shows up many years later in the late or tertiary stage of syphilis. This damage may be serious enough to cause death.

Although a person may show no visible signs of infection they are still able to pass on syphilis.

Testing

Diagnosis is through a blood test but swabs may also be taken if there are sores. If you're HIV positive, it is recommended to get tested for syphilis every 3 months when getting your regular blood tests to monitor your HIV.

Can it be treated?

Syphilis can be treated with a course of antibiotics. Syphilis can be cured particularly if it is diagnosed in the early stages and treated with penicillin. Other drugs may be used if a person is allergic to penicillin.

How can it be prevented?

Only areas covered by condoms, dams or gloves are protected from infection. Touching any sore or rash should be avoided.

Syphilis & HIV

Syphilis is more common in HIV-positive gay men. There can be significant differences in how syphilis disease progresses in people with HIV. There can be a rapid progression from early syphilis to nervous system involvement in a matter of months, rather than the years or decades it takes in HIV-negative people. The complications to the nervous system may also occur in the early stage of infection, not just in the later stages.

Co-infection with HIV and syphilis may also result in the more rapid onset of HIV disease and AIDS. It can decrease the CD4 count (therefore causing damage to the immune system) as well as increase the viral load of HIV-positive people. This is especially of concern for people with a low CD4 count.

There have also been cases of treatment failure in patients with secondary syphilis, all of whom were HIV-positive. People with HIV can also progress to neurosyphilis despite standard treatment. If you have syphilis (early or latent) careful monitoring is advised, so that any abnormality is treated immediately.

The diagnostic tests for syphilis may fail more frequently (producing false positives and negatives) in people with depleted immune systems. However, these failures are still believed to occur only rarely.