Special situations

1 – Oro-genital relations without protection avoiding contact with sperm


D: I have recently met a partner, with whom I had only unprotected oral-genital intercourse, avoiding contact with sperm. He only revealed to me after a while that we were meeting that he is HIV-positive. He tried to reassure me by saying that he has such a low viral load that it is almost undetectable and that therefore there is no risk of transmission. Is it necessary for me to take a test? What should I do about the use of precautions?


R: The fact that the viral load is low or undetectable does not mean that the virus is completely absent in biological fluids; therefore also unprotected oral-genital relationships are potentially at risk. The possibility of transmitting other venereal diseases through this practice should not be overlooked. It is necessary to undergo an HIV test after 45 days (4th generation test) from the last report and, in any case, perform annual checks even if all reports are protected.


2 – Self-diagnosis or self-medication


D: A week after an occasional sexual intercourse I noticed the appearance of yellowish leakage from the penis and a burning sensation when urinating. I talked about it with a friend who advised me to take an antibiotic, which fortunately I had at home, because he also did the same symptoms in the past, so I avoided contacting the family doctor with whom I have no confidence . After an initial improvement, the disorders reappeared even if in a more attenuated form. Should I change the antibiotic?


R: In these cases it is necessary to contact the family doctor or a Sexually Transmitted Infection Service to ascertain the cause of these disorders by having the urethral secretion examined by a urethral swab. This is important to highlight the germ or germs responsible and undertake the most effective antibiotic treatment. In fact, inadequate therapy may not resolve the infection. Furthermore, the opinion of a physician is essential to establish whether it is appropriate to undergo blood sampling for a screening on STIs.


3 – HPV virus and warts


D: A few days ago I noticed the appearance of strange anal growths, which at first I thought were haemorrhoids. I turned to the family doctor who told me it could be condyloma; he asked me if I had had unprotected sex. In truth I had sexual intercourse, but protected in penetration, with people met in the sauna. Only the penile-surface surface contacts were not protected. What should I do now?


R: Condyloma are a disease caused by the HPV virus and manifest themselves in the form of warts, which can continue to grow over time. After the infectious sexual contact can occur even after several months (up to a year). It is necessary to undergo a dermatological and / or proctologic examination, the latter to exclude that they are not also present in the anal canal. The therapy involves the use of a cream to be applied on the warts, so that they disappear, or the surgical ablation or the laser. The course involves checks even after the disappearance of the lesions, since these can reappear in the following months. Therefore it is advisable to refrain from sexual intercourse until complete resolution of the infection.


4 – Symptoms that appear cyclically in the intimate parts of the body


D: About a year ago I suffer cyclically, especially in times of stress, of penile redness with the appearance of blisters that break, and that after a few days they heal on their own, despite having tried various remedies, especially ointments. I never went to the family doctor because I don’t have a good relationship with him and it embarrasses me to talk to him about these things. Who can I contact to talk freely and expose this problem?


R: In this case it is advisable to contact the dermatologist specialist, or a Sexually Transmitted Infection Service, where medical specialists can solve the problem. In any case, I do not recommend “do it yourself” therapy, because it could worsen the symptoms and delay a correct diagnosis.


5 – Asymptomatic syphilis


D: A friend told me that he had contracted syphilis despite having only unprotected oral-genital relationships with occasional partners. I would like to know if this is possible, since I also have occasional oro-genital relations, in which I avoid contact with sperm, and I have never done tests for syphilis.


R: Syphilis is a disease that is also transmitted by oro-genital contact, and does not always give symptoms. Therefore, in your case, it is necessary to undergo serology for syphilis, through blood sampling, at least 45 days after the occasional oral-genital contact. In case of positivity, the therapy is simple and effective, there is healing, but not immunity, so it is possible to be re-infected on other occasions. After completing the therapy, serology will remain positive as evidence of contact with the syphilis bacterium.


6 – Hepatitis A


D: A former partner phoned me a few days ago to let me know that he was admitted to the hospital for acute hepatitis A and that I should also take the exams. I wonder why, since we only had oral-anal intercourse, and then, is hepatitis A food-borne?


R: Hepatitis A is a disease that is usually contracted by eating raw seafood or contaminated vegetables because they are irrigated by infected waters. Since the virus is eliminated in the faeces, in the case of oral-anal relations with a person suffering from hepatitis A, even before the onset of symptoms, it is easy to contract the infection. You can perform the hepatitis A test as early as 50 days after the risky contact and possibly carry out the vaccination, in the event of a negative test.


7 – Hepatitis B


D: I recently attended a partner who told me that he is a healthy carrier of hepatitis B virus and that there are no problems. So far we have had protected penetrative relationships, but not the oro-genitals. Could there be a risk for me, and how should I behave in the future?


R: Being healthy carriers of the hepatitis B virus means not having an inflammation of the liver, so transaminases are normal. This does not exclude the transmission of the virus through sexual intercourse, since this is present in the body’s biological fluids (sperm, saliva, urine, faeces), so precautions must be taken in sexual contacts. However, there is the possibility of protecting yourself from contagion by resorting to vaccination against the B virus by contacting the vaccination centers of the Health Protection Agencies or your doctor.


8 – How and where to test for HIV


D: I would like to get tested for HIV and other sexually transmitted infections but I fear that if I go to my primary care physician then he will have “strange ideas about me”. I don’t know how much the tests cost and I would like to avoid going to a private lab. Where can I go?


R: In Italy there are centers for Sexually Transmitted Infections. In these public services the services are offered free of charge and with a guarantee of confidentiality, as neither the duty of the attending physician nor the health card is necessary and an identification document is not required. Some restrictions apply to children under the age of eighteen: in this case it is necessary for the child to be accompanied by a parent or parental authority. Before going to an MTS center, call to make sure that it is not necessary to make an appointment.


9 – How to prevent sexually transmitted infections (STIs)


D: I like to go out with friends a lot, I make new friends all the time and it can happen to have a casual relationship with a partner. Lately I’ve been a bit worried when I hear talk of ISTs becoming more and more insistent. Are there any vaccinations or “good practices” for prevention?


R: It is important to know the way in which infections are transmitted to avoid “risky behavior” (see below), this translates into the use of a condom from the beginning of all sexual relations with occasional partners or whose partners are unknown state of health, to reduce the risk of infection. It is important to remember the existence of appropriate condoms for anal sex (extra-strong) as well as the use of water-based lubricants, which drastically reduce the possibility of condom breakage: Vaseline, oily substances and saliva are not adequate lubricants. Flavored condoms are recommended for oral sex. It is important to carry out regular medical checkups for ITS to diagnose asymptomatic infections. Never trust the word of mouth or the advice of a friend. Better the opinion of a doctor or you can contact a center for Sexually Transmitted Infections, a specialized and free public service present in Italy. Finally it is advisable to carry out vaccinations against hepatitis A and hepatitis B.


Here is a list of the main risky sexual behaviors:

  • penis ratio – vagina
  • unprotected anal sex
  • unprotected oral sex to a man with and without ejaculation in the mouth
  • unprotected oro-anal contact (rimming)
  • unprotected manual-anal contact (fingering and fist-fucking)
  • sharing unprotected sexual objects.


10 – Communication of one’s state of health to the employer


D: If I was in the position of having to treat myself for a sexually transmitted infection, would I be required to communicate this condition to the employer?


R: No, the sick person has the right to privacy and anonymity at the workplace. In particular, the workers’ statute and Law 135/90 prohibits the employer from directly carrying out checks to ascertain the health status of the worker himself (specifically, the HIV test). For the inherent problems you can contact the major trade union organizations.


11 – Reliability of the HIV test


D: I recently took the HIV test and other STIs. I would like to know how reliable the test is and if I have to repeat it, as I haven’t talked about it with my doctor.


R: Taking the test at a Sexually Transmitted Infections center allows you to have a conversation with a doctor to assess the real risks you have run, perform the HIV test and other STIs and, if necessary and possible, make specialist visits. The necessary interval (window period) for the execution of the HIV test is 45 days (4th generation test) from the report at risk. However, the HIV test does not provide any information on health status. The test has no preventive value: whatever the outcome, the behaviors to be adopted are the same (safe sexual relations).


12 – The importance of early diagnosis


D: I have been suffering from redness in the penile area for about a month which also causes me an annoying itch. A friend of mine advised me to use a particular soap of intimate hygiene and to wait for any developments before I worry more than I should. The situation has not improved and I’m starting to think it’s something more serious. What do you recommend me to do?


R: Early diagnosis is an effective tool for prevention of complications and treatment. Delaying a diagnosis can make the situation worse for oneself and for others. So many minor infections are easily curable if correctly detected at their first manifestation. In any case, it is important to consult a doctor and do not choose self-therapy based on the advice of a friend, a magazine or a website.