The Ins and Outs of Gay Sex (12 page)

Penicillin was the mainstay of gonorrhea treatment, but the bacteria have become increasingly resistant.
Currently ceftriaxone, a cephalosporin type of antibiotic, given in a single injection is the drug of choice.
Another class of antibiotics called quinolones (ciprofloxacin) are also effective and taken orally.
Recently, however, reports have begun to
surface in the medical literature documenting a growing resistance to these antibiotics as well.
Close monitoring will tell if quinolones remain effective in the future.

Failure to treat gonorrhea is dangerous, because you continue to transmit infection to unsuspecting partners, and the bacteria can spread throughout your body.
Gonorrhea frequently targets the joints, skin, heart, and occasionally brain.
You’ll need higher doses of antibiotics over a longer period to cure these infections.

As with syphilis, your physician must check you for other STDs.
Gonorrhea is frequently associated with HIV, anal warts, herpes, and other forms of urethritis.
Disturbing evidence suggests that men with gonorrhea are at increased risk for catching and transmitting HIV.
Gonorrhea probably makes it easier for HIV to pass through inflamed mucous membranes into your blood.
As with all STDs, you must notify any sexual partners you placed at risk so that they can be tested.

Pediculosis pubis (more commonly called the crabs) is caused by an infestation of pubic lice (
Phthirius pubis
).
Lice are extremely contagious and easily passed between partners through close physical contact.
(Rubbing is more than enough.
) Even sharing a bed or towel with an infected man may be enough for you to catch lice.
A condom certainly won’t protect you no matter when you put it on.
Knowing this, you can easily understand how infestation occurs with just seemingly harmless touching.

Infestation occurs when a louse (bug, not guy) comes in contact with your pubic or perianal hair.
On hairier men, lice may spread to their upper thighs and lower abdomen.
Occasionally they can even be found in axillary hair (armpits), beard, or mustache.

The louse bites at the base of hair follicles and feasts almost continuously on blood.
Intense itching is the key symptom and results from the body’s allergic response to the bites.
If you have been infected before, your body is already sensitized and itching begins almost immediately.
If, however, you are one of the lucky ones and this is your first experience as a louse cafeteria, then it may take up to a week before you begin to scratch.
Bacterial skin infections develop from your scratching, not from the lice.

No microscope or fancy blood tests are needed to diagnose a lice infestation, only a look at your pubic area.
It is rare to actually see a louse (a rust-colored speck on your skin), because most infestations contain fewer than twenty adult lice.
Instead of actual bugs, look for dark-red specks of louse poop on your skin and underwear or nits (eggs) attached to your pubic hair.
The eggs laid by the female are cemented to your hair at skin level.
As the hair grows, the egg moves out with it.
Eggs appear as small white or dark specks on your pubic hair.
Although they can be mistaken for skin flakes or kinks in the hairs, the associated itching should give you a clue that something more serious is going on.

You can debug yourself at home with various over-the-counter medications.
Nix, RID, and Kwell are some of the more common preparations available in shampoo or lotion form.
Follow the directions on the box, being careful to shampoo or rub the lotion over all potential sites (pubic, scrotal, anal, and axillary hair), and leave it in place for the required time.
Some physicians believe lotions are more effective than shampoos, while most men prefer to shampoo.
Complete your treatment by running a fine “nit” comb through your pubic hair to remove any killed eggs.
Most medications are strong enough to kill adult lice and eggs with one application, and a second treatment is necessary one week later
only
if eggs persist.

Some men worry their treatment failed because itching persists.
This is a normal phenomenon, for the itch usually takes several days to disappear.
Be patient and stay calm.

The towel you dry off with and the clothes you put on after treatment must be fresh or you risk reinfestation.
Wash all your linens and clothes in hot water, then iron them or spin them in the dryer on high heat to kill any remaining lice.

As with any STD, you must notify any partners at risk for infection.
Remember, only close contact is necessary (even if you just shared a towel), not intercourse.
And last, it is easy for you to diagnose and treat crabs in the privacy of your home without seeing a physician.
I urge you, however, to notify your doctor and get tested for other STDs, because at least one-third of men have a concurrent STD.

Scabies are another sexually transmitted infestation.
A small mite called
Sarcoptes scabiei
burrows into your skin, builds a nest, and raises a family.
Not a pretty picture.
Your hands, particularly the web spaces between your fingers, are common sites, and so are your genitals, arms, and abdomen.
Intense itching that worsens at night is characteristic, and transmission occurs through direct contact or sharing a bed with an infected partner.
The diagnosis is made either by seeing the burrows the parasite makes into your skin or by skin biopsy.
Prescription creams such as lindane (Kwell) as well as a thorough washing of all linens and clothes kills the mite.
Remember to notify any of your partners at risk for infection and get tested for other STDs.

Unfortunately, as our attention focuses on HIV, doctors and patients alike are less aware of the other highly prevalent
yet curable infections.
Men go untreated because their problem is not diagnosed.

If you have one STD, get checked for others.


Notify all partners at risk so they can be tested and, if necessary, treated.


Even though a chancre will go away without treatment, you still have syphilis.


Gonorrhea in your anus and mouth is much harder to diagnose than in your penis.


Penetration or ejaculation is not required for the transmission of these infections—close sexual contact is enough.


Don’t forget to wash all clothes and linens in hot water after a case of crabs or scabies.

I
washed my hands and turned to face my patient.

“They’re hemorrhoids, right, Doc?”
he asked.

“No,” I said.
“They’re definitely not hemorrhoids.
You’ve got venereal warts.”