FAQs

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How long does it take for HIV to show up in a blood test?

This really depends on what type of HIV test is done. Most labs now use what's called a ""4th generation"" HIV test. This type of HIV test detects antibodies against HIV - which your body produces in response to the virus, as well as HIV antigens which are part of the virus itself. It usually turns positive about 3 weeks after infection, and should definitely be positive by about 6 weeks after infection. If you are worried about an exposure to HIV that occurred more recently than 3 weeks ago, ask for an HIV viral load test (also called an HIV RNA test). This test will usually turn positive around 10 days after infection. Using currently available tests, it is difficult to detect an HIV infection that occurred within the last 10 days. [link to HIV testing page].

If you think you may have been exposed to HIV in the last 3 days, then you may be eligible to take PEP to prevent HIV infection.

The last time I had unsafe sex was 8 months ago, I just had an HIV test and it was negative. Do I have to worry?
There is a period of time (commonly referred to as a “window period”) between infection and a positive HIV test, but with the type of HIV tests used today, this period is generally only about 3 weeks (and no more than 6 weeks). If you have not had any possible exposures in the last 8 months (i.e you either used a condom, were protected by PrEP, or your partner was undetectable), than you can be extremely confident that you are HIV negative. We recommend that sexually active gay men and other men who have sex with men get tested for HIV and STIs every 3 months. If you're concerned about your risk for HIV, talk with your provider about whether PrEP is right for you.
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). Some things to consider in deciding if PrEP is right for you: -Is your sex partner truly HIV negative, are they taking PrEP correctly, do you want control over HIV prevention by taking PrEP, are you ok with the small risk associated with getting HIV as a top if not on PrEP and not using condoms?

Overall 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. This is called 2-1-1 PrEP and is a good option for some men. Talk to your provider to learn more about it and to make sure you understand how to use 2-1-1 PrEP correctly.

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. This is called 2-1-1 PrEP and is a good option for some men.  In 2-1-1 PrEP, you take 2 pills of Truvada 2-24 hours before sex and then if you have sex, you take another pill 24 hours and 48 hours after the double dose.   Talk to your provider to learn more about it and to make sure you understand how to use 2-1-1 PrEP correctly.
I had sex without a condom and I'm worried I might have HIV, what should I do?
The only sure way to know your status is to get an HIV test. You can buy an HIV home test kit at a pharmacy, go see your regular medical provider, or drop into a local HIV testing site: https://gettested.cdc.gov/ HIV antibody tests take 3-6 weeks to turn positive after someone gets infected with HIV. If the sex without a condom was less than 3-6 weeks ago, you can talk to your provider about getting an HIV RNA test instead of an HIV antibody test. The HIV RNA test becomes positive 10-14 days after someone gets infected with HIV. If the sex without a condom was within the last 3 days, you should talk to a provider right away to see if you should start PEP. Your risk of getting HIV depends on your gender and sexual practices. Some sexual practices are much lower risk for getting HIV than others. You can talk to your provider or call the City Clinic PEP line if you have questions about whether you need PEP.
I'm a top. I was wondering if I can get HIV from barebacking. I know it's risky for the bottom who is receiving cum, but what about the top who is giving it?
Yes, you can get HIV from topping (putting your penis in someone else's butt) without a condom. While the risk of getting HIV from topping is about 10 times less than from bottoming, there is still a significant risk. The risk of getting HIV from topping is higher if you are uncircumcised (uncut). If you are not using condoms 100% of the time, PrEP is a great way to protect yourself from HIV. In addition, if you're living with HIV, taking medications for treatment and keeping your HIV viral load undetectable will prevent you from transmitting HIV.
I just began a new relationship. We got tested for HIV together and are both negative. We want to be able to have sex without a condom. What else should be we be getting tested for?

Kudos for being so responsible and prepared. What tests you need really depends on your gender (that is, are you a man, woman, trans man, trans woman or something else?), the gender of your sex partner and what type of sex you're having. A medical provider can help you figure out what tests you need. Also if you are in a heterosexual relationship, you should talk with your partner and medical provider about pregnancy prevention (contraception). Many people are nervous about talking to their provider about sex. Here are some strategies:

Any tips for how to use a condom?
Pinch the air out of the tip, unroll the condom to the base of the penis and use plenty of lube (reduced friction = less likely to break or tear the condom). Remove the condom after ejaculation while the penis is still erect. To ensure the condom does not come off too early, hold the condom at the base of your penis when pulling out of your partner. The addition of a good quality, water based lube will of course mean less risk of the condom breaking. Always be sure to check the expiration date on the condom. Don't use any that have worn or torn wrappers. The extreme heat or cold can affect the quality of the latex - so don't store them in the car, sun, or your pockets for long periods of time. You can find more detailed instructions and information about the FC2 (internal) condom here.
Are polyurethane condoms any better than latex? Are they more effective in stopping the transmission of HIV? I would prefer to use polyurethane because I can use oil-based lubricants with them.
Both version of today's marketed condoms are extremely effective when used consistently and correctly. Fortunately, there are increasing condom choices including new sizes and textures. In addition to latex and polyurethane condoms, the FC2 condom is a great option for women whose partners don't want to or can't wear a condom, and for bottoms who want to protect themselves during receptive anal intercourse (that is having someone else's penis in your butt). Check out our condom page for information on how to use a condom correctly or speak to your medical provider about using them. If you're not using condoms 100% of the time, are having trouble finding a condom that's right for you or if you just want an extra layer of protection against HIV, talk with your provider about PrEP.
Lately I've been having problems getting an erection while wearing a condom. I'm on PrEP, so I'm not too worried about HIV, but I've had chlamydia and syphilis a few times and want to protect myself against STIs. What should I do?
There a lot of different reasons why you might be having a hard time getting an erection. Sometimes when we're mentally stressed or depressed, our dicks work (or don’t work) differently.  One idea is to practice jacking off with a condom to make it easier to get hard when you're wearing a condom with a partner. You may also want to see a doctor to talk about other things that could be making it difficult to get hard, such as medications or medical problems like diabetes.  Its great that you're on PrEP, but as you shared in your question - PrEP prevents HIV but not other STIs. Therefore we recommend you get tested for both HIV and STIs every 3 months.
What type of lube is best for anal sex?
While water-based lubricants (for example, astroglide) are the most commonly recommended type of lubrication, many people like silicone-based lubricants (for example, Wet). Silicone-based lube lasts longer, is still effective in water and you need less of it. In addition, there are some data that silicone-based lubricants are less irritating to the rectal mucosa (i.e. the butt), and that people who use silicone-based lube are less likely to get rectal STIs than those who use water-based lube. Oil-based lubricants (e.g. petroleum jelly) are not safe to use with latex condoms, as they cause the condom to break. If you are having sex with a condom and want to use an oil-based lubricant, you should use a polyurethrane condom.
I had sex for the first time recently and the condom got stuck in me and my boyfriend pulled it out. Is there any way I could get pregnant?
Yes, there is a chance of pregnancy any time a condom comes off or breaks during sex. If this happened within the last 5 days, you can come in to get emergency contraception (the morning after pill) [link to emergency contraception page]. Please come in as soon as possible so we can help you get this medicine. If you are not able to come to the clinic, one kind of emergency contraception (Plan B) is available without a prescription at most pharmacies. If this happened more than 5 days ago, then emergency contraception is no longer recommended but you can take a pregnancy test. To get an accurate result, you will want to take the test 10 to 14 days after sex. You can buy an over-the-counter test at a drugstore or visit City Clinic or another medical provider. Planned Parenthood is also a good source for confidential help. To find a Planned Parenthood center near you, visit http://www.plannedparenthood.org/findCenterProcess.asp
I missed two days of my BC pill and had unprotected sex with my boyfriend. What are the chances of getting pregnant? Are there hormones left in my system that will cover me for the days I missed? What should I do?
Yes, it's true, you may be at risk for pregnancy if you had condomless sex after missing some birth control pills. Your exact risk depends on a few things, like which week of your pill pack that you missed your pills. For example, missing two pills at the very beginning of a new pill pack puts you at high risk for pregnancy. Missing two pills in the last week (where the pills don’t have hormones, they are just reminder pills) does not increase your risk for pregnancy. Depending on what week you were in when you missed your pills, you may need to use a back-up method of birth control (such as condoms) for 7 days until your pills are effective against pregnancy again. There is a very handy chart that you can check to see how to restart your pills and whether you need a back-up birth control for the next week. If you had sex within the last 5 days, you can come in to get emergency contraception (the morning after pill). Please come in as soon as possible so we can help you get this medicine. If you are not able to come to the clinic, one kind of emergency contraception (Plan B) is available without a prescription at most pharmacies.
I have Hepatitis B. I was diagnosed six weeks ago. Can I give Hep B to my partner by kissing? How about giving or receiving oral sex? We haven't had anal sex yet, but I assume a condom will protect both the top and the bottom?

Hepatitis B virus is found in blood, semen, and vaginal fluid. The virus can be passed from person to person when one of these fluids has contact with cuts or punctures in the skin or with the moist skin (mucosa) around the genitals or anus. Although hepatitis B virus can be found in saliva, it is not believed to be transmitted through kissing. Giving and receiving oral sex does put your partner at risk, particularly if you receive.

Condoms will protect both partners during anal sex. Remember to use lots of lube so the condom doesn't break. However, the best way for your partner to protect himself from hepatitis B is to get vaccinated right away. He should reach out to his medical provider, or to his local public health department, as soon as possible to figure out where he can get the vaccine. If you have anal or oral sex without a condom before he gets the vaccine, he should talk to his provider about PEP (post-exposure prevention) for hepatitis B right away.

Transmission of hepatitis B can also occur through sharing toothbrushes, razors, sex toys or injection drug equipment.

I received a hepatitis B vaccine shot a few years ago but never went back for the 2nd and 3rd shots. Should I start all over?
No. Regardless of when you received your first hepatitis B shot, you do not need to start over. You should go ahead and get your second shot as soon as possible and then get the third shot two months later. You can also ask your provider to order a blood test to see if your body has responded to the vaccine by making antibodies.
I don't have insurance but I really need an STI and HIV check-up. What should I do?
If you're in San Francisco, we offer STI and HIV testing at SF City Clinic whether or not you have insurance.  If you're not in San Francisco, you can click here to find a clinic near you: https://gettested.cdc.gov/. HIV tests are available over the counter at pharmacies, if you are able to pay. Visit our About You page to find out which STI tests you might need.
I lost my job and my insurance. Is it possible to get PrEP if you're uninsured?

Yes! There are many ways to access PrEP if you're uninsured. Visit PleasePrEPMe.org to find a provider near you. There are also patient assistance programs to help you cover the cost of the medication. If you're in San Francisco, walk-in to SF City Clinic or call us at 415-437-5537 for more info on our PrEP program clinic.

Is it possible for a person to clear their body of Chlamydia without treatment?

Yes, over time the immune system in some people can clear chlamydia infection, but most people need to take antibiotic medication to get rid of it. Untreated chlaymdia infection can cause serious health issues —such as sterility, pain, and pregnancy outside the womb. In addition, if you have chlaymdia, you can pass it on to your sex partners even if you don't have any symptoms. Getting re-infected with chlamydia after treatment is common, so be sure that your partners know about the infection and get treated too. Here's a great resource on how to talk to your partner about STIs: https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/get-tested/how-do-i-talk-my-partner-about-std-testing.

We recommend that everyone diagnosed with chlamydia get a test 3 months after treatment to make sure you were not re-infected.

I've been treated for Chlamydia but it keeps coming back. Why is this happening?
Chlamydia is usually curable with the correct treatment. Most persons who get repeat infections get them from untreated partners so its really important to make sure your partners are treated. Occasionally, the treatment for chlamydia is unsuccessful. If you test positive for chlamydia more than 21 days after you've been treated, and have not had sexual contact with anyone since treatment, talk to your provider about trying a different antibiotic treatment. Here's a great resource on how to talk to your partner about STIs: https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/get-tested/how-do-i-talk-my-partner-about-std-testing 
My doctor told me I have Chlamydia, but I don't feel sick or have any symptoms. What's up with that?
Chlamydia infections are often asymptomatic, which means the infection is present but you feel fine. This is especially common for Chlamydia infection involving the rectum (butt), pharynx (throat) and cervix. Chlamydia can still cause problems, even when you feel ok. In women, it can cause inflammation in the reproductive tract that can lead to infertility and increase the risk for an ectopic (tubal) pregnancy. Chlamydia infections can increase the risk of getting or transmitting HIV, especially when additional HIV prevention strategies (like PrEP for people who are HIV negative and treatment for people who are HIV positive) are not used.