Bare Facts: A Personal Exploration of the Risks in the Gay Sex Scene

[PozBearWI]

13 hours ago, BootmanLA said:

What I meant is that compared with, say, a single shot of an antibiotic, or a brief 7-day regimen of an oral antibiotic (which is standard treatment for many bacterially-caused STI's, and which ordinarily actually cures them), HSV is managed, not cured. And that management depends on where the infection is, and whether the prescriber is aiming to treat an outbreak or keep the virus suppressed. In the former case, the treatment is more like that of a bacterial infection, except it only knocks the virus back "this time". Any number of things can trigger another outbreak, and some people experience few while others have outbreaks on a recurring basis, sometimes multiple times in a year. That's typically how HSV-1, which has primarily been spread orally, has been treated, but now HSV-1 is spreading by oral-genital contact on an increasing basis.

In the case of HSV-2 (the kind normally spread by genital contact), suppression treatment is more common because the virus can shed even when there are no visible symptoms. One area of concern is whether (as is believed) HSV-1, when spread genitally, can shed without symptoms as well.

So treatment is much more complex (at least in terms of choices made by the prescribing provider), and as HSV-1 becomes more widespread through genital contact, we may see a substantial number of cases being shifted to "suppressive" treatment rather than the traditional treatment of outbreaks only. Those who are already on suppressive treatment, of course, won't see anything new.

And let's face it: adherence to daily medications is something an awful lot of people seem to have trouble with. 

Nodding as I write this @BootmanLA.  Yes for me thrice daily medication to keep HSV-2 under control.  And I definitely follow.  My hubby would be awful at following med schedule were it not for me counting it out and putting them in front of him.  

[LetsPOZBreed]

I love this post.  Thanks to the OP @Philip for starting this thread.

I came of gay-age in the mid 1990's.  HIV and AIDS were still the big elephant in the room regarding gay sex and dating.  There were fishbowls full of condoms at the gay bars, and they got properly used.  It was incredibly common to ask your sexual partner if they had any protection ahead of anything starting - and I remember walking away when there was an answer of "no".  Too many gay men knew too many others that succumbed to the disease, so the barebacking scene was underground and/or unspoken.

That prob started to change about 5 years in.  It started to become easier to find "recent" bareback porn videos to watch.  I always wondered what it would be like, but never really wanted to take the risk.  Sure, I had a couple early instances of getting fucked raw (one really good experience, and one really NOT good one).  Just didn't feel like taking that risk as there was still a huge stigma around poz guys.  I didn't really start barebacking regularly until I was nearly done with college around 2005.  It was with a regular fuckbuddy that used condoms previously - we didn't have one on a particular night and figured we'd just go for it.  Never looked back when playing with each other.  There was a risk, sure; we weren't exculusively playing with one another and had other playmates.  While I might have played wrapped with my others, I didn't really ask about his practices.  So, yeah...there was a risk, but thankfully nothing ended up happening.

When I first started barebacking full-time, I wasn't really being all that slutty.  At least not until I started attending regular bareback parties at this one guy's house.  There was a small stable of us "regulars" there with the occasional newbie.  Never really caught anything from them either; most guys there were UD or neg and would test regularly.  Still a risk, yeah, but we mitigated it as much as possible.

I didn't get super reckless until I started drug use.  And sure enough, that's when things went off the rails. I was being so indiscriminate about it that it was kinda crazy.  Wasn't really "chasing", but not really asking either (nor would I have probably cared either way).  Some months afterwards, I wound up with a case of syphillis and converted over to being poz.  Not the best experience, really...really bad night sweats, complete loss of appetite, etc.  I'm lucky in that was all I'd managed to contract, though.  

These days, despite my profile name on here, I try and be really careful about playing bareback.  A big part of that is just because my views on sex have changed the last couple years (I made a separate long post about this some months back); but also, I'm not really interested in taking chances with another guy that appears to be reckless about his own status - namely, the guys on the apps who have "not sure" or "don't care" in that box.  I have played, and yes there's still further risks involved, but I've managed to avoid any other nasty bugs over the years as a result.  If the last few years of COVID and MPX has made me realise anything, it's that I'm not willing to put my health in danger for an experience of potentially questionable quality that I'm going to regret.

[shyvers]

On 8/15/2023 at 8:34 PM, BootmanLA said:

The actual percentage of sexually active people with genital herpes - the kind you can transfer during actual sexual activity - is far, far lower than "almost everyone". It's more on the order of 15%

The number among active gay men is much higher than 15%. Probably above 50% but many don’t know it.  That’s why it’s not even tested regularly.
 

Also It doesn’t mean they are all contagious as you mention, but mainly if they have a break out.
 

And there is no “oral herpes”, “genital herpes” and “anal herpes”. It’s type 1 and type 2 herpes and they can be in your mouth or genitals depending where they first entered your body.  Most cases type one is oral because people get it by kissing, but many times like in my case as mostly a top both types are genital.   

I think people like some on this post stigmatize herpes more than they should and that is the problem of herpes. The stigma is the problem, not the illness, because you mostly feel bad the first time you have it and then it’s just mildly uncomfortable.  And totally controllable with Valtrax.  

[BootmanLA]

11 hours ago, shyvers said:

The number among active gay men is much higher than 15%. Probably above 50% but many don’t know it.  That’s why it’s not even tested regularly.
 

Also It doesn’t mean they are all contagious as you mention, but mainly if they have a break out.
 

And there is no “oral herpes”, “genital herpes” and “anal herpes”. It’s type 1 and type 2 herpes and they can be in your mouth or genitals depending where they first entered your body.  Most cases type one is oral because people get it by kissing, but many times like in my case as mostly a top both types are genital.   

I think people like some on this post stigmatize herpes more than they should and that is the problem of herpes. The stigma is the problem, not the illness, because you mostly feel bad the first time you have it and then it’s just mildly uncomfortable.  And totally controllable with Valtrax.  

You're right that the types are HSV-1 and HSV-2. That said, for a substantial period of time, HSV-1 was almost exclusively transmitted non-sexually, while HSV-2 was almost exclusively transmitted sexually. That's beginning to change, in particular with HSV-1 beginning to spread readily via sexual contact. 

If you have any actual published figures to support that "probably above 50%" number for sexually active gay men, I'd like to see them, but I can't find any reference to any number that high.

In any event, the original poster didn't say "among sexually active gay men"; he said "almost everyone who has been sexually active". "Has been" means someone who's had sex, ever - and "everyone" includes men and women, gay, bi, straight, pan, whatever. That's a sweepingly large percentage of adults in the US - his formulation of "almost everyone who has been sexually active" covers more than 99% of US adults. There's no way "almost everyone" in that group has HSV.

[viking8x6]

Numbers from the last couple of decades, for the adult population in the US:

Genital HSV-2, ca. 2020 approx. 12% (down from 18% ca. 2000). But genital HSV-1 is rising.

Total HSV-1 (oral and genital) approx. 54% and falling.

The drop in oral HSV-1 acquired in childhood is cited as a probable cause of the increase in genital HSV-1 in adulthood (because of the concomitant drop in acquired immunity).

https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm#ref4

https://pubmed.ncbi.nlm.nih.gov/24136792/

 

 

[muscmtl]

On 8/17/2023 at 11:17 AM, hntnhole said:

Actually, this is spot-on. 

Fortunately, most gay men, and particularly barebackers, are utterly promiscuous, which of course expands the chances of catching a bug occasionally.  A pair of (gay) lovers who are scrupulously monogamous would likely never encounter an std in the first place.  Since most of us here on BZ are the last thing from monogamous, PReP, regular testing, is the next best thing to living a full, enriching sexualy life. 

Stds: get them, get treated, get over them 

[Murmillo]

Perhaps the "needs discussion" talk prior to sex truly is to recommend.

[loolikaa]

That's cool I guess