I was at a bathhouse a few days ago and gave blow jobs to a bunch of different guys. I did not have any anal sex. If I picked something up, how long will it take until I show symptoms? What STIs should I be worried about?

Giving head (i.e. performing oral sex, giving a blow job) can put you at risk for chlamydia, gonorrhea, herpes, syphilis and possibly HPV. Getting HIV from giving head is extremely rare. 

Is it possible to get HIV from oral sex?

Receiving oral sex (i.e. having your partner suck your penis or lick/kiss your vagina/clitoris), carries NO risk of HIV transmission.  Performing oral sex (i.e.  licking/kissing a vagina/clitoris or giving a blow job/sucking a penis) is extremely low risk in terms of HIV transmission.  There are a few case reports and individual experiences that support getting HIV from performing oral sex on a penis, but it’s extremely rare. As far as whether oral sex is riskier if you swallow semen, truthfully no one really knows.

I received a HPV vaccine shot a few years ago but never went back for the 2nd and 3rd shots. Should I start all over?

One of the most common questions we get asked is, “If I missed a dose of HPV vaccine, do I need to start all over again from the beginning of the series?”  No, with the HPV vaccine, you can just pick up right where you left off. You get credit for the first or second dose that you’ve already gotten.  If you're < 15, you only need 2 doses of the HPV vaccine.

I am a gay man and just got diagnosed with anal warts, does this mean I'm at risk for anal cancer? Should I get an anal pap smear?

While anal warts themselves are unlikely to develop into anal cancer, people who have had anal warts are more likely to get anal cancer. This is because people who are infected with HPV subtypes that cause anal and genital warts are also more likely to be infected with HPV subtypes that cause anal cancer.

Infection with HPV is common, and in most cases the body can clear the infection on its own, but in some people the infection doesn't go away and becomes chronic. Chronic infection, especially with high-risk HPV types, can cause certain cancers over time, including anal cancer.

My boyfriend has a history of genital warts (on his penis) but he doesn't have any now. If I give him a blow job, could I get HPV in my throat, and if so, what symptoms would it cause?

It is possible to spread HPV from the penis to the throat during oral sex, but it is rare.

As for ways to protect yourself, condoms can decrease the risk of HPV transmission. There is also an excellent vaccine that protects against 9 of the most common strains of HPV -including 4 high-risk strains and 5 strains that can cause warts. Its recommended that all men and women <26 receive this vaccine.

I am a gay man. Everyone I know is on PrEP. Its hard to find a hook-up because I'm not on PrEP. But I only have sex about 1-2 times a month, and don't want to take a pill everyday. I've heard that there may be another way to take PrEP. Is it safe?

PrEP is very safe and highly effective and is recommended for people at risk for acquiring HIV. Feel free to talk to staff at City Clinic or your health care provider about how to take PrEP. If you don't think you're high enough risk to take PrEP everyday, you can talk to your provider about just taking PrEP before and after you have sex.

I am a gay man and am exclusively a top. Most of my partners are HIV-negative and on PrEP. I don't think I'm at high enough risk to be on PrEP - seems like overkill. What do you think?

What a great question! PrEP is just one of several HIV prevention tools; deciding to take PrEP is a personal choice. As you say, people who only top statistically have a lower chance of acquiring HIV- according to the CDC, 0.1% as the top compared to 1% as the bottom (receptive anal sex).

I'm on PrEP and my boyfriend is HIV positive. We've been together for about a year and neither of us play around outside of the relationship. He's been undetectable for years. Would it be safe for me to stop my PrEP?

There is no universally correct answer for everyone in this situation; it depends on factors in your relationship, your comfort level, and the possibility of changes in your sex life. However, if your partner is taking HIV medications and maintains an undetectable viral load, and he is your only sexual partner, there is no risk of him sexually transmitting the virus to you. This concept is called U=U (Undetectable = Untransmittable).

I was diagnosed with HIV about a year ago. I started on meds right away and have been undetectable for the last 9 months. If I top someone without a condom, what are the chances of me transmitting HIV?

If you take HIV medications correctly and maintain an undetectable viral load (meaning, the amount of HIV in your blood is so low that it can’t be detected with tests) for at least six months there is no risk of sexually transmitting the virus to an HIV-negative partner. This concept is called U=U (Undetectable = Untransmittable). It is important that you continue to take the medications correctly, every day.
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