They said researchers had assumed the human immunodeficiency virus, or HIV, sought out beaks in the skin, such as a herpes sore, in order to gain access to immune system cells deeper in the tissue.

Some had even thought the normal lining of the vaginal tract offered a barrier to invasion by the virus during sexual intercourse.

Read the full article at Reuters.

Between men, gonorrhea is transmitted primarily through unprotected anal intercourse and giving oral sex. Gonorrhea can be found in the penis, the rectum and the throat. The Rise in gonorrhea rates among gay men indicates an increase in high-risk sexual behavior. Because of the close link between infection with gonorrhea and HIV, the increase in gonorrhea rates may lead to a subsequent increase in HIV rates and other STDs as well, unless immediate public-health intervention takes place.

Genital/anal warts

Genital and anal warts are caused by infection with the human papilloma virus (HPV). Genital warts on the penis are common in both heterosexual and gay men. However, anal warts in males tend to occur more frequently in gay men. Anal warts are primarily a result of unprotected anal intercourse and direct penis-to-rectum contact during sex.

Hepatitis A

Hepatitis A is transmitted through the oral-fecal route. Sexually, this infection is transmitted by oral-anal sex (rimming). Sexually transmitted hepatitis A tends to occur more commonly among gay men. Outbreaks of hepatitis A among gay men are a recurring problem in many large cities in Western nations. There is now a very effective vaccine to prevent infection with hepatitis A. Unfortunately, despite the higher rates of hepatitis A infection among gay men, most members of the gay community are unaware of this vaccine. Most gay men who are at risk for this infection have never been vaccinated, despite the availability of the vaccine.

In addition to the risks of hepatitis A, rimming may also pose a risk for certain bacterial and parasitic infections, due to potential exposure to feces while rimming is taking place.

Hepatitis B

Hepatitis B is transmitted the same way as HIV, but is much more infectious than HIV. Between men, the infection is most commonly transmitted through unprotected anal intercourse and giving oral sex. Some gay men have been infected through sharing drug needles as well. In Western nations, sexually transmitted hepatitis B tends to occur more commonly among gay men. There is now a very effective vaccine to prevent infection with hepatitis B. Unfortunately, despite the higher rates of hepatitis B infection among gay men, most members of the gay community are unaware of this vaccine. Most gay men who are at risk of this infection have never been vaccinated, despite the availability of the vaccine. A strong effort needs to be made to increase hepatitis B vaccination rates among gay men.

HIV/AIDS

Worldwide, most of the people with HIV and AIDS are heterosexuals. But in North America, Western Europe and other developed nations, most cases continue to be transmitted sexually between men. In the United States, according to a recent report, most cases of recent HIV infection continue to be among gay men. This information also indicates that the rate of new HIV infections is relatively stable (it is not going down). We can therefore assume that the rate of infection among gay men is remaining relatively stable as well. Most cases of HIV transmission among gay men continue to occur through unprotected anal intercourse and, to a lesser extent, through giving oral sex (especially with ejaculation). Some gay men are also becoming infected through sharing drug needles. Based on all available data, the rate of HIV infection among gay men is not going down.

Cancer and the risks of smoking

Gay men may be at increased risk for certain forms of cancer, and illnesses linked to cigarette smoking.

Some cancers are more commonly seen in persons with HIV infection. For example, Kaposi’s sarcoma and certain types of lymphomas are more common in people with HIV. Since HIV is found in higher rates among gay men in Western nations, cancers associated with HIV infection are more common among gay men in these parts of the world.

Some strains of HPV — the virus that causes genital and anal warts (see above) — are linked to certain forms of cancer. When this virus causes cancer in men, it most often causes anal cancer. Anal HPV infection primarily occurs through unprotected anal intercourse, and direct penis-to-rectum contact during sex. Anal cancer occurs more frequently in men with damaged immune systems (including those with HIV). Smoking may increase the risk of cancer as well. HPV on the penis can also cause penile cancers, but this quite rare.

Gay men may also be at increased risk for liver cancer. As stated above, gay men are considered at increased risk for hepatitis B infection, which has been linked to liver cancer and other forms of liver disease (including cirrhosis of the liver).

In addition to anal and liver cancers, gay men may also be at increased risk for lung cancer and other cancers linked to cigarette smoking. It has been suggested that smoking rates among gay men may be higher than the general population. Of course, smoking also has many other health risks, including an increased risk for emphysema and heart disease.

Alcoholism and drug abuse

It has been suggested that alcohol use (and abuse) may be higher among gay men. This may, in part, be related to many gay men meeting in gay bars, where alcohol use is common. Alcoholism is itself a health-care problem since alcohol abuse can also lead to liver disease. In addition, alcohol use (and abuse) can also increase the risk for HIV and other STDs. While under the influence of alcohol, people tend to have sex more often, are less likely to use condoms or are less likely to use condoms correctly.

It has also been suggested that drug abuse may be a significant problem among gay men. Recreational drug use (and abuse) includes the use of poppers, cocaine, speed, crank, marijuana and other drugs. Like alcohol abuse, drug abuse leads to various health problems, including an increased risk for HIV and STDs, due to changes in judgment, while a person is under the influence of these drugs.

Gay bashing and gay domestic violence

These are often not viewed as health concerns, but they should be. Physical violence can lead to bodily harm, trauma, hospitalization, etc. Many gay “hate crimes” never get reported, due to the victims’ fear of further discrimination, shame, intimidation by police and similar concerns. On a related matter, gay domestic violence can also lead to significant bodily harm, and is also very rarely reported, due to victims’ fears of discrimination, intimidation by police, lack of services for male victims of domestic violence, etc. Due to the lack of reporting of these crimes, the rates of gay bashing and gay domestic violence are most likely much higher than statistics indicate.

Mental-health issues

Mental-health issues cannot be ignored. Many gay men suffer from depression and low self-esteem. Gay men live in a world where they are often told they are “bad.” Some gay men are abandoned by their families. Discrimination against gays is all too common. The way that society often treats gay men can lower their self-esteem and lead to depression. For example, suicide rates among gay youth are higher than heterosexual youth. When a person has low self-esteem, they tend to value their life (and their health) less seriously. They are therefore less likely to protect themselves against HIV and other STDs, and other health problems.

Safe sex, as it applies to HIV, is any type of sex which does not let one person’s blood, semen, vaginal fluid, or breast milk get inside another person’s body. Below is a useful set of guidelines produced by the San Francisco AIDS Foundation. These guidelines are useful in preventing transmission of other STDs as well.

• Wet Kissing: is safe unless either of you has a cut or sore in your mouth, or bleeding gums. (After you brush or floss your teeth, wait at least 1/2 hour before kissing.) Blood, not saliva, contains the virus.
• Touching your lover’s breasts is safe. You can lick, suck, kiss and bite them as long as there’s no blood or breast milk. Massage, dry kissing, masturbation (touching yourself), and body-to-body rubbing are all safe.
• Putting your fingers inside her can be risky. To be safe, wear latex gloves. If you use a lubricant, be sure it is water-based. (Oil-based lubricants like Vaseline and hand lotion will damage the latex.)
• Sores or cuts on your fingers, mouth or vagina-or hers- increase the risk. They can provide a way for the virus to get inside you. If you touch her vagina and then touch your own (or vice-versa,) you could spread the virus. Be sure to use gloves!
• Contact with menstrual blood is very risky. If she is infected, her menstrual blood (like other blood) will have a lot of virus in it.
• Oral sex on a woman is risky, especially when she has her period. To make it safe, cover her vulva (genital area) with a piece of plastic wrap. This will keep her fluids out of your mouth. Latex dams-also called “dental dams” – are safe to use for oral sex too.
• Sex toys are safe by themselves, but it is risky to share them. If you share dildoes or vibrators, cover them with a condom and put on a fresh one every time it is used by a different person.
• Getting pregnant can be risky. If you have sex with a man or have a man donate sperm to you, make sure he tests HIV negative at least 6 months after his last possible risk. (All licensed sperm banks test their donors carefully.)
• SM activities are safe if there is no blood involved. If you are piercing each other, clean the needle with bleach between users. Use different razors if you shave each other. Don’t let urine or feces of another person get inside your body.

Source: lesbianSTD.com
Reprinted with permission on 5/16/2006

Health Care

Health care is vitally important to everyone. As a transgender person, it is important that you find a physician that is knowledgeable of transitions and of your needs. Be warned (but not disheartened) that some providers may deny treatment because of their religious background, lack of knowledge or even fear. Do not let this deter you from seeking health care. It is important that you establish a relationship with a doctor that can understand your health-related needs and is willing to work with you to ensure optimized health. You should never be afraid to visit a doctor if you are in need of treatment or examination; your health and livelihood are more important than your own fears or the fears of others.

Health History

Be up front and honest about your health history, especially your transition. Doctors need a clear history of your health to better diagnose, treat, or understand your particular situation.

Hormones

Cross-gender hormone therapy gives desirable physical effects but it is not without risk.

Potential hormone risks include:

• Estrogen has the potential to increase the risk of blood clotting, high blood pressure, elevated blood sugar and water retention.
• Anti-androgens such as spironolactone can produce dehydration, low blood pressure, and electrolyte disturbances.
• Testosterone, especially when given orally or in high doses, carries the risk of liver damage.

Monitoring of hormone therapies and use should be done regularly by doctor and patient. Unsupervised hormones can produce undesired consequences. You should obtain hormones for cross-gender treatment through a licensed physician.

Heart Health

As with any human, trans people are at risk for cardiovascular disease and stroke. Conditions that may increase this risk include smoking, obesity, high blood pressure and even hormone treatments.

Cancer

Hormone-related cancer should be included in your health checkups. Breast cancer and liver cancer are especially but not rarely possible in trans women and trans men face risks of liver cancer from hormones. Cancer may also develop in reproductive organs. FTM may still develop cancer of the uterus, ovaries and breasts. MTF are at a low risk for cancer of the prostate.

STDs and Safe Sex

Safe sex should be practiced by all people including transgender persons. Please follow standard safe sex guidelines to ensure your safety.

Alcohol and Tobacco

Depression (commonly found in LGBT people due to reject and societal pressures) often lead to smoking and alcohol use. As a result, liver, lung and heart disease, as well as cancer, are all risks associated with alcohol and tobacco. Hormone use can actually increase risks of liver damage when used with alcohol. All risks are increased when combined with tobacco use.

Depression/Anxiety

Due to social pressures and family pressures, transgender people may face a higher level of depression and/or anxiety than most people. Post-transition, the risks of being exposed, criticized, and/or ostracized certainly can take their toll. Unchecked depression can also lead to depression before, during and after transition. If for any reason you are feeling anxious or depressed, consult a therapist or your physician immediately.

“Pumping” or Injecting Silicone

Pumping or injecting silicone is very risky and can lead to disfigurement, migration of the silicone, hepatitis and/or HIV/AIDS through use of contaminated needles, and also toxic poisoning due to low-grade, non-medical silicone. Hormones or plastic surgery are the safest options for feminizing the body.

• Allergic Vaginitis
• Bacterial Vaginosis (BV)
• Chlamydia
• Gonorrhea
• Hepatitis
• Herpes (genital)
• HIV/AIDS
• Human Papillomavirus (HPV)/Genital Warts
• Pelvic Inflammatory Disease (PID)
• Pubic Lice
• Scabies
• Syphilis
• Trich
• Yeast Infections (Candidiasis)

Allergic Vaginitis

Sometimes referred to as ‘chemical vaginitis,’ this condition is a great mimicker. Because it often affects not only the vagina itself but external tissues (the vulva), it is often mistaken for a yeast infection, or even new onset genital herpes. It’s due to genital contact with an irritant, the most common offending agents being latex or components of spermicides, lubricants, a new detergent/soap/bath gel, silicone sex toys, or ‘feminine’ deodorants. Anything that can cause an allergic skin reaction (like a rash) can cause a similar reaction on mucous membranes, including genital tissues.

• Symptoms: red, painful or irritated or itching vulva; increased vaginal discharge. The vulva may have whitish or grayish striations or hue, along with some scaly skin.
• Treatment: if you can figure out the offending substance, discontinue use. Antihistamines (Benadryl for example) may help relieve symptoms. Low-dose (0.5%) cortisone cream is also effective, but consult your health care provider before applying any steroid cream to the genital area.

Bacterial Vaginosis (BV)

BV is basically an imbalance of the normal bacteria that live in the vagina, most specifically in association with loss of the normal protective lactobacilli that normally live there in abundance. It is not clear what precisely causes BV; some researchers think women sex partners may actually transmit some undefined factor that causes it. Research continues on this question. We do know douching is a risk factor for BV (and douching is a bad idea in general). Join our BV study and help us find out what is up with this common condition!

• Symptoms: gray to yellowish homogenous discharge, sometimes with a fishy odor, sometimes causing vulvar &/or vaginal irritation.
• Transmission WTW: not clear. While one research article called BV a “STD among lesbians,” this has yet to be proven, and research is underway to look at this more closely. Whether or not partners should be evaluated or treated is not yet known.
  Join our new BV study! See Research for more information.
• Treatment: antibiotic vaginal cream or oral medication (metronidazole or clindamycin). Over the counter lactobacilli supplements do not contain the specific kind of bacteria needed to replenish the vagina’s natural balance.

Chlamydia

This STD is caused by bacteria transmitted to the vagina or rectum by contact with infected genital fluids. Chlamydia can infect the cervix, rectum or urethra (the passage through which urine exits the body) in women.

• Symptoms: usually none. Sometimes slightly increased vaginal discharge, spotting, burning with urination, abnormal bleeding (especially after penetration).
• Transmission WTW: theoretically possible but not yet studied.
• Treatment: oral antibiotics.(Azithromycin, Doxycycline. Pregnant women: Amoxicillin or erythromycin) All partners should be treated.

Gonorrhea

This STD is caused by bacteria transmitted to the vagina, throat or rectum by exchanging infected genital fluids during sex.

• Symptoms: often none. Occasionally, vaginal discharge—often yellow or yellow-green—and painful urination can occur, as can abnormal bleeding, especially after penetration.
• Transmission WTW: theoretically possible but not yet studied.
• Treatment: Antibiotics (oral:Cefixime, Ciprofloxacin, or Ofloxacin OR Ceftriaxone injection) Persons infected with gonorrhea are also treated for chlamydia. All partners should be treated.

Hepatitis

Inflammation of the liver. Many potential causes, including drugs, toxins and viruses. Hepatitis A, B, & C are the three major viruses that cause hepatitis.

• Symptoms: Often none. If symptoms do occur may include yellowing of skin & eyes, loss of appetite, nausea, stomach pain, extreme tiredness.
• WTW transmission: Hepatitis A is transmitted by fecal matter either in contaminated food or by oral-anal contact. Transmission between female partners has been reported.
  Hepatitis B is transmitted by exchanging blood or body fluids. Touching an infected person’s open sore or cut if you yourself have any skin breaks, or sharing a razor, toothbrush or nail clipper, can permit transmission. Even small amounts of blood or other body fluids can spread the virus if direct contact occurs. *Hepatitis A is preventable by vaccination: ask your health provider!
  Hepatitis B is not spread by food, water or casual contact. Transmission between female partners has not been studied, but has occurred. *Hepatitis B is preventable by vaccination: ask your health provider!*
  Hepatitis C is transmitted primarily through contact with infected blood. Sexual transmission between men and women is relatively uncommon; WTW has not been studied.
• Treatment: A complex issue. See our links for more information. .

Herpes (genital)

These infections are caused by the herpes simplex viruses (HSV-2 and HSV-1). Transmission can occur even when lesions are not present (in fact, probably most transmission actually occurs in the absence of skin ulcers or breakdown, which is why 90% of persons infected with HSV-2 don’t know they’re infected). See our Links for several excellent resources on this common infection.

• Symptoms: small blisters on the vulva, often painful, are classic, but at least 90% of people infected with HSV-2, which causes the majority of genital herpes, do not know they are infected. Itching is a common symptom. In the initial episode of HSV, symptoms can include painful/difficult urination, fever, swollen lymph nodes, and flu-like symptoms.
• Treatment: three antiviral medications (acyclovir, famciclovir, valacyclovir) are now available & all work equally well. Antivirals are also recommended for recurrences and suppression when there are more than 6 recurrences a year. Antivirals help the symptoms of HSV and speed healing; they do not cure the virus. They also reduce the likelihood that HSV is shed in the absence of outbreaks.
• Transmission WTW: very likely occurs, but data on specific prevalence and risks is very limited. In particular, oral-genital contact (oral sex) can transmit HSV-1 from the mouth to the genital area, especially when one partner has a cold sore.
• Precautions: because transmission can occur even when no lesions are present, any genital-genital contact should involve latex barriers 100% of the time; couples should abstain from sex during outbreaks, until the skin is fully healed.

HIV / AIDS

AIDS is caused by the HIV virus. It is spread through direct contact with blood, semen, vaginal fluids, or breast milk, usually during sex, birth, or sharing needles. The HIV virus slowly attacks white blood cells which constitute a major part of the body’s immune system. White blood cells fight infections. When the immune system is weak, harmful germs & infections take over, and AIDS (acquired immunodeficiency syndrome) becomes evident.

• Transmission WTW: while there is little research or documentation on this topic, the medical literature does have case reports of WTW sexual transmission of HIV. The most likely sources for transmission are menstrual blood, vaginal discharge when there is vaginitis (there are more white blood cells containing HIV present then), and traumatic sex practices. However, more research is urgently needed in this area; none of these mechanisms, or their relative risk, have been directly studied yet.
• Prevention: Please see Practices section.
• Treatment: There are numerous drug therapies to help the immune system and fight the HIV virus, though at this time there is no cure. Treatments are constantly changing so for the most up to date information we suggest visiting the San Francisco AIDS Foundation website and The Body website.

Human Papillomavirus (HPV)

HPV is probably the most common STD (some estimates say ~70% of all adults have evidence of previous infection), with most infected people never evidencing its two major effects: genital warts, and cervical neoplasia (pre cancerous or cancerous changes, detected as an abnormal Pap smear). It is an STD caused by skin or mucous membrane contact with an infected person. Different strains of HPV cause genital warts and cervical cancer.

• Transmission WTW: very likely occurs, probably through direct contact of genital skin, or contamination of hands/fingers. The role of insertive sex toys is not known for sure, but it’s possible that HPV could be transmitted on shared toys not thoroughly cleansed between use in one (infected) partner and the next.
• Treatment: if warts are present, the most common treatment is freezing using liquid nitrogen; more than one treatment may be required. There is no cure for the virus itself. Pap smears can detect HPV and cervical changes ; yearly exams are essential for all sexually active women, regardless of the gender of partners. Our research and others has shown that lesbians may be less likely to get Pap smears as frequently as they should. Get routine screening (every 1-2 years, depending on your Pap smear history) regardless of whether you have sex with men!

Pelvic Inflammatory Disease (PID)

An infection of the uterus, fallopian tubes and ovaries. Caused by many kinds of bacteria, but chlamydia and gonorrhea are the most common causes. It can also occur after childbirth, abortion, or surgery on the female organs. The infection usually starts 2 to 21 days after having sex with an infected person, but some infections do not start until several months later. PID can cause scar tissue that can block fallopian tubes causing infertility (after 1 PID infection 10% of women become infertile; 75% are infertile after 3 infections), tubal pregnancies (a woman is 7 times more likely to have a tubal pregnancy after PID), and abcesses. Some women continue to have lower abdominal pain for several months after PID.

• Symptoms: Mild to severe abdominal pain, back pain, may have fever, nausea, bleeding between periods, pain with sex, vaginal discharge. Some women have no symptoms.
• WTW Transmission: Transmission of the bacteria that cause PID is theoretically possible though not studied. A recent report did discuss PID occurring in two lesbians, in whom the diagnosis was initially missed because they were thought to be at ‘low risk’ for STD.
• Treatment: Mild PID is treated with a shot of antibiotics in addition to oral antibiotics. Severe PID is treated in the hospital with IV antibiotics. Routine treatment of sex partners.

Public Lice / “Crabs”

“Crabs” There are 3 kinds of lice that can live on humans: head lice, body lice, and pubic or crab lice. Lice move relatively slowly and cannot survive more than 24 hrs. without human contact.

• WTW Transmission: Absolutely! Any close contact w/ an infected person or their clothes or bed linens can allow for contact, so sex partners are at very high risk. However, you might be relieved to know that lice cannot hop or fly.
• Symptoms: Itching, finding nits or lice.
• Treatment: Special shampoos, cream rinses & lotions (obtained by prescription). All partners for the last 30 days must be treated. For washable clothing and bedding use HOT cycle of washer and dryer. Dry cleaning or keeping items isolated from body for 10 days will also kill lice and eggs.

Scabies

A skin infestation by mites (tiny bugs). Mites likes to burrow in warm moist places like between fingers/toes, the wrist, armpits, breasts, skin folds, and waist. The female mite gives off a chemical as it burrows under the skin. This chemical, not bites, is what causes the itching.

• Symptoms: Itching, especially at night. The first time a person gets scabies it takes 2-6 weeks for the itching to start. The second time a person gets scabies the itching starts in 1-2 days. Scabies can mimic other skin rashes and look differently on different people. Test for scabies is a small skin scraping for microscopic examination.
• WTW Transmission: Yes. Primarily by close contact, including sex, with an infected person. Mites can live a couple of days in fabric and dust. An infected person can transmit scabies even if they have no symptoms.
• Treatment: 5% permethrin cream (not the 1% used for lice). Be sure to put some lotion under finger and toe nails. All sex partners, close contacts, and anyone else living with you within the last month should be tested and treated. You may have to be treated more than once. Itching may continue for a few days even if the mites are dead, though it should lessen. For washable clothing, bedding, towels, rugs and toys use the HOT cycle of washer & dryer or dry clean. Things that can’t be washed in hot water can be placed in plastic bags and sealed for 3-4 weeks.

Syphilis

An STD caused by a spirochete that is usually detected with a blood test. Some of its most devastating effects occur when it is transmitted from a pregnant woman to her fetus.

• Transmission WTW: unknown, but theoretically possible. Contact with the sores or rash of an infected person during sex is the main mode of transmission.
• Symptoms: 10-90 days after sex a painless single sore appears in the area where contact was made. The sore “chancre” usually feels hard at the edges. It does not hurt. It can look like herpes, warts, scabies or hemorrhoids. The sore is very contagious. After 2-6 weeks the chancre goes away. If untreated, 6-8 weeks later, the second stage begins in about 30% of persons. Symptoms can last from 2 weeks to 6 months and include swollen lymph nodes, rashes, or a flu-like feeling. There may be different genital sores that look like flat grayish warts. Like other syphilis sores, these are highly infectious and can spread the disease. Symptoms start to go away in 2 weeks. Infection untreated beyond this point can eventually cause serious damage to the heart, nervous system, kidneys, eyes, and brain.
• Treatment: Penicillin injection, routine treatment of sex partners.

“Trich”, a tiny protozoa, can present like BV but in contrast is definitely an STD. It lives in the moist areas of the genitals of infected people (e.g. vaginal fluid, genital glands).

• Symptoms: Often causes foamy discharge with foul odor, but symptoms may be absent. Painful urination, itching or irritation are sometimes present. If symptoms occur, they usually occur 4-20 days after infection but can begin much later.
• Transmission WTW: clearly documented, and probably underestimated. Partners should absolutely be evaluated and treated. Both partners should abstain from sexual activity until treated.
• Treatment: metronidazole in a single dose. Partners should be treated.

Yeast Infection

This infection, also known as candidiasis, is caused by a yeast overgrowth which disrupts normal vaginal flora. Certain yeast (candida) normally live in the vagina in relatively low numbers without causing a problem.

• Symptoms: burning &/or itching of the vulva, vagina; thick white discharge with cottage cheese appearance; possible yeasty odor.
• Transmission WTW: unknown, but not considered an STD in heterosexual couples.
• Treatment: anti-fungal creams, suppositories, or oral anti-fungals (tablets).
• Note: While recurrent or difficult-to-treat yeast vaginitis usually occurs in completely healthy women, occasionally it may be indicative of diabetes (undiagnosed or uncontrolled), HIV infection, or genital herpes, and should be fully evaluated — consult your healthcare provider.