Dear Dr. Dick, his profile says he's negative...

Dear Dr Dick,

Like so many other gay and bisexual men in Seattle I spend a great deal of time online looking for hookups. It seems that is where all the HOT guys hang out. When I hookup with guys from websites I practice safe sex. However recently I met two guys online that I am considering barebacking with. That's cool if all parties involved are HIV negative right? Both of guys have posted the following statement in their online profiles: "HIV NEG as of November 20, 2008." [I'm guessing that you meant 2008??]

So here my question: is it safe to bareback with them?
Hooked on the Man Hunt

Dear Hooked on the Man Hunt,

Thank you for your question!

The short answer is, no, barebacking (intentional unprotected anal sex) is a very risky sexual practice. Barebacking can easily transmit HIV, along with several other sexually transmitted infections. These potential partners say they are HIV-negative but they were negative as of a year ago, so consider these facts:

In a recent large study of gay/bi men, on average about 2% became infected each year; but among those guys who engaged in the highest risk behavior the rates of new infection reach levels as high as 8% yearly. Other studies have shown that recently HIV-infected guys are the most infectious, because they have very high levels of virus in their blood and semen in the first few months after being infected, before their bodies have brought the infection under some control. So, if you happen to encounter a guy who enjoys high risk behaviors, there could be an 8% chance that he's acquired HIV in the past year, and he may be not just pretty but also pretty infectious.

Knowing your own and your partner's HIV status is an important part of maintaining one's overall health. However, because one advertises their year-old HIV status in an online profile or in person does not necessarily mean it is accurate and frankly it's a big risk to take for HIV, the worst of all sexually transmitted diseases.

Additionally, someone is HIV negative can have another sexually transmitted infection (STI) present. Anal and/or oral sex without condoms can still spread infections such as syphilis and gonorrhea.

Be sure to talk more about this with your partners and even your doctor to settle on a decision that works best for all parties.

Best,

Dr. Dick

Ohh no, a Wart!!

Dear Dr. Dick,

The other night I took home a date from the bar. He was giving me head when he felt a wart-like thing on my pole. I turned on the lights and there it was! It doesn't hurt, itch or ooze and it is pretty small - but it has wasn't there before - Dr. WHAT is it?

Thanks
Magnum

Dear Magnum,

Thanks for your question!

First things first, have a doctor take a look at it to be sure!
In the mean time, it sounds like you might have acquired Genital Human Papillomavirus Virus (HPV). HPV is the most common sexually transmitted virus in the United States. At least 50% of sexually active people will have genital HPV at some time in their lives, and often acquire HPV in the first few months/years of sexual activity, as it's easily spread. Most people who have genital HPV don't even know they have it. There are often no symptoms, and the warts which are an expression of HPV usually go away on their own--without causing any serious health problems.

HPV is passed on through genital contact (such as vagina, oral, and anal sex) and without even knowing it. There is no cure for the infection itself, HPV, but there are treatments for the health problems that some types of HPV can cause, like genital warts. The warts are usually painless and not a serious problem. They can be flat or raised, single or in groups, and small or large. And, they can be caused by many different kinds of HPV, only some of which are associated with more serious disease, like anal and cervical cancer and cancer of the throat.

Without treatment, the warts may grow in size and number, or (again) they may go away on their own. Since you possibly have acquired genital HPV infection and may have a wart, see your doctor about available tests for genital HPV. Although there is no treatment for that cures HPV itself, there are treatments for genital warts such as laser removal, burning, cutting, topical chemotherapy, or freezing them off. Even after genital warts are treated, the virus remains in the body. This means that you may still pass HPV to your sex partners, even when you don't see any warts.

So, Magnum go see a doctor (in-person) and have it looked at - that is the best way to know for sure. In the meantime, be sure to wear a condom if you do have sex with anyone else.
And, since HPV can be spread orally even without warts being present, a condom for oral sex would help protect your partner.

All the best,

Dr. Dick

Anal Fissure

Pride & My Ass

Dear Dr. Dick,

If this Pride season is anything like the last one - my ass is going to be very busy housing bursting buldges - literally! Last year, amidst all my safety tactics I still managed to get an anal fissure! While it has healed considerably since then, I am worried I might not be doing enough to have an exciting, safer and healthy pride season!

Thanks,
Robbie Rumpsworth!

Dear Robbie Rumpsworth,

I am glad to hear your anal fissure has healed considerably! For those readers who have not heard that term before, an anal fissure is a tear in the skin of anal canal. Most anal fissures are caused by severe stretching of the anal lining. Symptoms of an anal fissure include bright red bleeding from the anus, most noticeable on the toilet tissue or on the toilet.

Striking pain and/or consistent discomfort during anal sex should be a strong indication to inspect your ass hole. Or better yet, since someone has to be very flexible to really examine their own ass, go visit a doctor or knowledgeable health care provider and let them examine you carefully. If you plan on taking multiple dicks with lots of girth or even getting fisted -it is recommended that you do some anal prepping on your own. Get a butt plug or even use your own fingers and water-based lube to safely stretch your hole before the main event!

Given that a fissure is a tear in the anal skin, and that that provides ready access to your blood, you are at increased risk of acquiring infection by bacteria and/or virus' such as HIV, Syphilis, or Gonorrhea -if one of your partners is so infected, of course. And any partners who have direct access to your blood may more easily acquire a blood-borne infection, like HIV or hepatitis B or C, from you if you've already become infected.

Remember the old adage: Healthy pink parts contribute to a healthy sex life! So, stock up on water-based lube and condoms of all sizes, colors and feels for those bursting buldges! And, don't have too much fun, unless you're being very careful with yourself and with your partner(s).

Dr. Dick

***

Too Shy To Show

Dear Dr. Dick,

Too Shy To Show

Dear TSTS,

I'm not one for labels myself - whether you're straight, gay, bisexual, straight-curious, etc - you like who you like - and that's that! However, if you are going to express your sexual interest in someone (or something), SEXUAL SAFETY is the one thing I am sure to remind guys about. And, guys who have sex with guys are at considerably greater risk for sexually transmitted bugs than guys who only play with girls - 400 times greater risk, for example, for acquiring HIV, even if you're mostly a top.

HIV, STD or any sexual "bug" for that matter DOES NOT discriminate. Just because you may not identify as gay does not mean you're immune to acquiring HIV. But, some people do think that and word does get around as fast as syphilis or gonorrhea spreads around!

Gettin' it on with a guy or an occasional gal - you MUST get tested regularly. Whether it's oral or anal - STD risks are there. Get tested regularly every 3 months for the following:

HIV, Syphilis, Chlamydia, Gonorrhea AND Hepatitis

Especially if you have multiple partners!

Start with having conversations around your sexual safety guidelines as much as you talk about acting out your fantasies. And, tell your partners when you were last tested and your results, even if they were all negative. Saying "I was HIV negative as of last month" will help your partner disclose to you whether he/she has been tested and when the last test was. Also, it sounds odd to some people, but you might be surprised at how many folks are actually comfortable wearing condoms for sex, even blowjobs and such.

Online resources are definitely out there - but doctors and specialists are trained with years of education and practice to know what an STD looks, feels and smells like - so I encourage you to go in. There are a lot of weird and fake online resources out there - as much as there are online chat spammers.

If it feels uncomfortable seeing your doctor - there are other options locally. You can schedule an appointment at the following:

• Gay City Wellness Center - 511 E. Pike St - 206.860.6969
• Harborview STD Clinic - 325 9th Ave - 206.744.3590
• Or if you go to bathhouses and sex clubs, most of these locations offer free, confidential and anonymous testing.

For now - always clean underwear and buckle up - take care of yourself!

Dr. Dick

Scabies

Dear Dr. Dick,
With the sun comin' out - I thought I should get myself a new buddy: a new pet and a fuck buddy for the summer. I like walkin' the dog, and fuckin' my bud. Thought I was bein' safe - but now I have scabies! I don't know which bitch I got it from. What's an urban bunny to do?
Urban Bunny Princess

Dear Urban Bunny Princess, Dogs [and cats] are infected by different types of mites than those which infect humans. So, you got it from the other bitch, as you put it. Scabies is one of the more common infections, because it is easily passed on through skin contact between men [or person to person], not men and dogs [although men can be dogs!]. Most men, once they found out they are infected, treat themselves at home or their doctor treats them. The mites can't be seen.

Itching can be so mild that you don't realize you have scabies, it's good now that you know, so you can better take care of yourself.

Your fuck buddy could have given it to you either or both of these ways:

• through body contact during sex.
• through sharing clothes, towels and bedding (but this is unlikely).

Now that you know for sure that you have scabies: There's no way to stop infection but this will stop it from spreading to others:

• Get treated if you know you've had sex with or shared a bed, towels, clothing or bedding with someone with scabies.
• Any and all shared clothing, bedding and towels should be washed on a hot wash.
• And if you're into BDSM, leather clothing can be dry cleaned.

Here are some useful signs and symptoms that you may have scabies:

• For some people the itching can be intense, usually starting two to six weeks after infection.
• The mites burrowing under the skin can leave red lines, especially between fingers and around wrists.
• Mites can also be found on your feet, buttocks, stomach, ass, cock and balls.

Here are some more helpful hints to take care of yourself:

• Lotions are available for scabies through a pharmacy. Several lotions are available to treat scabies. Always follow the directions provided by your physician or the directions on the package insert.
• You spread the lotion over your whole body, including palms of your hands, soles of your feet and between fingers and toes - but not your face or head.
• You leave it on for 24 hours. Even when the treatment works you may still itch for several weeks.
• If after two weeks you still itch, call your doctor or pharmacist for advise .
• Only repeat the treatment if a doctor tells you to, as too much lotion can irritate your skin.

No one is immune to scabies. If you had them before you can get them again.

-Dr. Dick

MRSA

Dear Dr. Dick,
So, I've got MRSA - well at least my doc said so. I am just frantic and freaking out over it. People say you only get it at hospitals, but then I my friends say it's an STD! What's going on? Is this the new gay disease? I don't have time to deal with this.
Frantic & Freakin'

Dear F&F,
MRSA [Methicillin Resistant Staphylococcus Aureus] is an increasingly common cause of skin infection. These infections can affect ANYONE, gay, straight, and kids who haven't even begun having sex.

Although recent research shows that MRSA does affect MSM (men-who-have-sex-with-men) populations, it certainly still affects others. We don't know how specifically most men who have sex with men got it, but it can be pretty easily acquired by skin-to-skin contact, which would include sex, but would also include wrestling and totally safe sex, and use of someone's contaminated towels, or facecloth, or sleeping in someone's bed could also be ways to spread MRSA regardless of population.

These MRSA bacteria are resistant to some of the standard antibiotics, but they are nevertheless quite treatable. Treatment with the antibiotics used to treat the typical staph infections won't work, so providers must suspect a resistant strain of staph, get appropriate cultures, and start the right treatment. And you need to take the treatment just as prescribed, otherwise you're helping these bugs develop additional resistance.

MRSA is typically transmitted through skin-to-skin contact, which occurs during a variety of activities, including SEX. But [pun-intended] this does not mean MRSA is a sexually-transmitted disease or infection.

Early-on a MRSA infection often looks like an angry bite from a spider or some other insect, as the skin is raised, looks reddish, feels warm and may be tender to the touch; but instead of gradually fading like most
bites, it will keep getting bigger until it gets treated. Infections often start around hair follicles, particularly in warm, moist areas and around hair follicles, e.g., in the groin, and pockets of pus may develop. Any growing area like this, especially if associated with a fever or chills, needs immediate medical attention.

You can prevent spreading staph or MRSA skin infections to others
by following these CDC guidelines:

1. Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages. Follow your healthcare provider's instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping wounds covered will help prevent the spread to others. Bandages or tape can be discarded with
2. the regular trash.
3. Clean your hands thoroughly and frequently. You, your family, and others in close contact should wash their hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wounds. If you find yourself feeling the bandages, wounds, or scratching the area, wash you hands, before contaminating someone's skin or some other surface.
4. Do not share personal items. Avoid sharing personal items such as towels, washcloths,
5. razors, clothing, or uniforms that any that may have had contact with infected wounds or bandages. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
6. Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.

Hope this makes your more relaxed & informed, F&F!

-Dr. Dick

Itchy Rectum

Dear Dr. Dick,
I'm a bit embarrassed to ask you--thank heavens for email though--but, [pun intended] I started dating this guy I met online, you know--one of those free personal ad websites, and we met face to face after a week of chatting--had a nice date, coffee & chat, and went to my place for "dessert." We didn't have sex--well, at least not butt sex--and just made out...I gave him a nice blowjob, and he rimmed me. So, I'm gonna see him again. Thing is--about a couple days later [and I haven't seen anyone but him], my hole's been really itchy, and I can't really tell, but there might be some weird discharge, too. But, it's hard to tell when I poop and stuff--and it's been hurtin' lately! Should I tell the guy? What if it's not him? I don't want to embarrass myself further. Oh, what to do?
--Embarrassed Bung Hole

Dear EBH,
It can be embarrassing to tell some you just met about intimate details even though you've made out with him already. But, better safe than sorry... Let's start with you: it sounds like you "might" have symptoms of rectal gonorrhea, because your symptoms are compatible with that infection, even though it probably doesn't get transmitted to the anal area by rimming very often.

Symptoms usually develop 2 days to 10 days after catching the infection. These are the main symptoms from anal infection, shown from most common to less common:

• Discharge from the anus
• Painful bowel movements
• Anal itching
• Blood or mucus on the feces

Gonorrhea is generally transmitted through anal sex, and sometimes oral sex--such as rimming. Go to your doctor or nearest clinic, such as the STD Clinic at Harborview (HIV/STD Hotline: 206-205-STDS) to get tested & treated immediately. The infection may spread inside the body if it is not treated. There, it can cause epididymitis in men, a very serious illness. Rarely, the gonococcus can get into the blood and cause a kind of arthritis and other problems.

Gonorrhea usually is treated with a single dose of an antibiotic. Treatment usually can be given by mouth, but sometimes an injection is required. Because gonorrhea and Chlamydia often occur together, persons with gonorrhea usually are also treated with an antibiotic against Chlamydia.

*Important: Many common antibiotics do not work against gonorrhea. Never treat yourself with an antibiotic left over from another prescription.

People should not have sex for 7 days after treatment is completed. Recent sex partners must also be treated, since there is a high likelihood that they also have gonorrhea, and many people with gonorrhea have few or no symptoms, but could continue to be at risk for complications and spreading the infection to others. Sex partners must not have sex until both have completed treatment; otherwise they may re-infect one another.

Follow-up: Everyone with gonorrhea should be re-tested 3-4 months after treatment. Public Health routinely contacts patients or their health care providers after three months to remind them about repeat testing.

It would be wise to let him know of your situation, so he can get tested & treated right away, too. Who knows, this could be a really nice ice-breaker for you both and the start of a great relationship of honesty and caring. I hear autumn's going be pretty cold this year... better make reservations for a nice bear hug! And have a nice tasty & safe dessert!
Sweetly yours,
-Dr. Dick

Is Urine Okay?

Dear Dr. Dick,
Is urine okay?
--Arnold

Dear Arnold,
Safety-wise, urine is essentially sterile; it's not necessarily free of HIV, so it's not safer sex to drink someone else's urine. Also, urine contains mostly salts that your body is trying to eliminate, so drinking it again will strain your kidneys. If you're drinking urine, make sure to drink lots of water as well. -Dr. Dick

MDR HIV

Dear Dr. Dick,
It's all over the newsstands and TV, and friends from New York are talking about "MDR HIV." I'm freaking out!!! What gives?
--Freaked Out and Horny

Dear FOH,
I'm really glad you asked. It's ok to be freaked out, but if we keep ourselves well-informed we can better manage our choices. MDR HIV means "Multi-Drug Resistant HIV [Human Immunodeficiency Virus]." These forms of the 'HIV' are resistant to multiple classes of anti-HIV medications. There are 4 classes: protease inhibitors, nucleotide transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and fusion inhibitors (which includes just the one drug Fuseon, or T-20). These four cases were resistant to practically all of the PI and NNRTI drugs, and to some of the NRTI drugs, meaning that it may be hard to find a treatment that will work when these guys need treatment. I've asked my colleagues at Public Health here in Seattle to help me address this concern in a more consistent message.

What does "drug resistant" mean?
There are four classes of anti-HIV drugs (also called "antiretrovirals" or "ARVs"), with several drugs in three of the classes. When HIV meets an anti-HIV drug, it tries to survive by changing its genetic code. Over time, the HIV virus often changes enough to get around the drug and keep making copies of itself. When HIV can resist one drug, it can often resist other drugs in the same class. Sometimes HIV can be "drug-resistant" to several drugs across two or more classes. This kind of HIV is called "multi-drug resistant HIV" or "MDR-HIV." HIV treatment is very complex, and people with HIV must take medications on a very strict schedule. Resistance can build up if a person does not follow this schedule or if he/she is not on the correct treatment program.

How did Public Health find out about these cases?
Since around 2000, Public Health has been looking for cases of drug resistance among people newly-diagnosed with HIV. Two of the four cases were found during this routine lab testing. The last two cases were found by medical providers who then alerted Public Health.

Where did this MDR HIV come from?
There is no way to know for sure. We do not know where this strain started (i.e., who had it first) or how many people in this network came in contact with this strain through unprotected sex or sharing injection equipment.

Is this a new problem?
Drug resistance is not new. Since 2000, Public Health has identified 16 total cases of multiple class drug-resistant HIV in people recently diagnosed with HIV in King County. None of the past 12 cases looked as similar to each other as the current four. About 11% of people recently diagnosed with HIV who haven't started treatment have at least some high-level resistance to at least one of the ARV drugs used for HIV. 3% have shown high-level resistance to one or more drugs in two or more drug classes. These rates are similar to other urban areas and have not changed locally over time. However, the current 4 cases look very similar and share many of the same patterns of drug resistance. They are highly resistant to two ARV drug classes and somewhat resistant to a third. Tests on the 4th class are not back yet. These viruses are closely linked to each other and may still be in the community.

How do you know this MDR HIV is being spread?
Because the genetic make up of these four cases looks so similar, it is unlikely that each person developed the exact same resistance pattern on his own. Also, at least three of the four cases were recent infections. So this highly resistant strain does seem to be in the community, but we don't know how easily it spreads from person to person.

Why does Public Health track HIV drug resistance?
Public Health tracks HIV drug resistance among people who have not started HIV treatment. This helps Public Health learn what kind of HIV is being transmitted, how common drug resistance is, and which drugs might become less useful over time. This information helps medical providers prescribe HIV therapy more effectively.

Is there more drug resistance happening?
The longer people live with HIV, the longer they are taking HIV drugs. As more people use more HIV drugs, the chance of drug resistance increases. Over time, there will be a larger pool of people who might have HIV that is harder to treat and who may pass HIV to others. Also, regional testing for resistance is not comprehensive and has not been conducted steadily since 2000. There are likely to be more cases than the ones we have been found. We are likely to find more cases of resistance now that we are looking harder for them.

Does this mean that people with MDR HIV will not be able to get treatment?
No. Some antiretrovirals may still work against MDR HIV, but we don't know how well they might work. With MDR HIV, there are fewer drugs to choose from. These options may also be harder to use, cost more or cause more side effects.

Does MDR HIV progress faster to AIDS?
We do not know how quickly these virus strains will progress to AIDS. We have observed these four cases for only a short time, which is too short to tell how their disease may progress. At present, each of these cases is early in HIV infection and does not yet need treatment.

Can people who already have HIV get "re-infected" with MDR HIV?
Yes. People who already have one strain of HIV can get a different strain, usually within some months of the first infection. The second strain could be drug-resistant or not. Getting MDR HIV on top of existing HIV may cause current medications to stop working. It could also limit future treatment options and impact health.

What is happening with these individuals?
Public Health is working with these individuals and their medical providers to locate and test sexual and drug partners for HIV infection and drug resistance.

What Should I Do?

If you are a medical provider:

• Conduct genetic drug resistance testing in all patients with newly-identified HIV.
• Report all cases of multi-drug resistant HIV to Public Health.

If you are HIV-negative or have not tested in the last 6 months:

• Use condoms every time you have sex.
• Use your own drug injection equipment.
• Ask sex and drug partners about their HIV status. Find out your current
• status and share that with your partners.
• Get tested regularly for HIV. How often is that?: Every 3 months for gay and bisexually active men who:
  • Have had anal sex without a condom with a man who has HIV or whose
  • HIV status is unknown.
  • Have recently had a sexually transmitted disease (STD).
  • Use methamphetamine.
  • Once a year for other people at sexual or drug-related risk for HIV
  • (i.e., people who inject drugs, have STDs, or have multiple sex partners).

If you are living with HIV:

• Use condoms every time you have sex, even if your partner has HIV too!
• Use your own drug injection equipment.
• Share your HIV status with sex or drug partners. Ask them about their status.
• Find out if you have drug resistance before starting treatment or
• if your anti-HIV drugs don't seem to be working.
• Take your medications on schedule. If that's hard to do, talk to your doctor about options.

For more information about drug-resistant HIV or where to get tested for HIV, call the HIV/STD Hotline Monday-Friday, 9am-4pm:
(206) 205-6105 • 1-800-678-1595 • (206) 296-4843 TTY

Other useful websites:
www.hivdrugresistance.org

www.metrokc.gov/health/news/07020101.htm

What is MRSA?

Dear Dr. Dick,
I'd say I'm a fairly attractive guy in his early 30's. Sex is not an issue, especially when I'm out at the baths. I get tested for STD's every 3 months or so, but I've been hearing a lot about MRSA. What is it? I hear it's pretty scary.
--Fabulous And Gorgeous

Dear F.A.G.,
It's great to hear you are comfortable with your sexuality. Kudos to your regular STD testing! MRSA is an acronym. It stands for Methicillin-Resistant Staphylococcus Aureus.

Yes, I know BIG words for bacteria. Simply, it means it is a type of 'staph'(a bacteria commonly found on human skin and on lots of other surfaces that is resistant to a common antibiotic-- Methicillin, that in the past was quite effective in treating staph infections.

MRSA can still be treated with other antibiotics. It may just take longer and be more expensive and often it takes a while for your care provider to discover that it's MRSA that's causing the infection, which can delay selection of the best treatment. MRSA can be found inside the nose, armpit, groin and genital area.

Symptoms include:

• Redness, warmth, swelling, tenderness of the skin, and boils or blisters
• Sometimes its' appearance can be mistake for 'spider bites'
• Frequently fever and chills

MRSA is acquired by "close contact" with a MRSA-infected person. Close contact which has resulted in transmission of MRSA has included sex and even wrestling matches. You can also get it from "MRSA-contaminated objects and surfaces," like towels, soaps, sheets, clothes, benches in saunas or hot tubs and athletic equipment. Baths and gyms can sometimes be risky, and not just from sex.

Once MRSA is confirmed, it can be treated with proper wound and skin care and antibiotics, specifically active against MRSA. A healthcare provider can drain the pus from the infected area if necessary. This procedure is called I&D--incision and drainage. But some infections may require intravenous antibiotic administration and hospitalization.

If you think you may have MRSA-go to your health care provider right away. Appropriate treatment can help prevent it from getting worse. Follow your doctor's instructions carefully, and especially take your antibiotics for the full course, even when you start to feel better.

-Dr. Dick

Talking with your Doc: What to tell your doctor about your Crystal use.

Dear Dr. Dick,
I'm Poz. Should I tell my doc about my crystal use and how?
- Concerned Chris

Yes, always be honest about crystal use. There are a lot of health problems you can have as a result of crystal, HIV, or both. If your doctor doesn't know about your use of crystal, you might not get the right diagnosis or treatment. Also, some HIV meds don't mix well with crystal. And using crystal can increase your viral load. Especially, if you are skipping meds while high.

EASIER SAID THAN DONE, I KNOW!

Let's face it, crystal isn't healthy.

Doctors wish you wouldn't use it. But some doctors are more accepting than others. Most drug users are afraid of being judged or preached to. But give your doctor a try.

HERE ARE SOME GOOD TIPS FROM OTHER CRYSTAL USERS:

-Find a doctor by asking other users. If they like their doctor, you might too. & Start by asking, "Can I be honest with you about something?" This shows you are sincere and willing to talk. Even if you feel uncomfortable.

-TELL THE TRUTH, THE WHOLE TRUTH AND NOTHING BUT THE TRUTH. Why bring it up at all if you can't tell the whole story?

-If you don't want to be treated like a psycho tweaker or junkie, don't act like one!

• Don't focus too much on getting pills to fix your problems.
• Don't beg for 'painkillers' just to sell or trade for crystal.
• Show up for appointments on time.
• Be respectful and don't show attitude.
• Crystal can be a harmful drug. Don't pretend it isn't.

If your doctor doesn't return your respect and honesty, GET A NEW ONE! There are lots of really supportive, caring doctors out there, just like ME!

You love me, you really love me!
Dr. Dick

Enemas

Hey Doc!
Is it bad to give yourself enemas? I like to do several before I get fucked, so I'm doing them all the time. What is the negative impact of enema abuse?
- Clayton

A clean butt does add to the romance, doesn't it? But enemas, or anal douching, are NOT the way to go. Using enemas over time can cause severe constipation. In worst cases, men become so hooked on enemas that they cannot move their bowels without them.

Enemas can also increase your chance of HIV infection because they irritate the lining of your colon. And don't douche after sex. You may only push the semen, and HIV, further into your body.

If you feel you must wash out your rectum before sex, use an "ear syringe." (NOT your other syringe, please!) You can buy ear syringes in drug stores. Look for the ones with the long, tapered end. Put in warm water (water only), lubricate the tip, and then insert it into your butt. Gently squeeze the bulb a few times. Doing this one time is enough and milder than an enema. And you are more likely to get rid of the liquid and feces more fully.

Crystal slows down or even stops bowel movements when you're high. You can keep your colon happier by drinking more water--something all crystal users should do anyway! Eating more fruit or using fiber supplements like Metamucil can also help.

Until next time,
Dick

Dr. Dick on testicle health: Epididymitis

It's 10:00. Do you know where YOUR epididymis is?

Welcome to the second half of our talk about testicle health. Yes, each of you has an epididymis (ep-i-DID-i-mis) - in fact two! They are the coiled mass of tubes that drape over the back of each testicle. This is where young sperm grow and mature for several months before their Big Curtain Call!

When these tubes get infected, that's called epididymitis
(ep-i-did-i-MY-tis). It can easily spread down through your balls and turn your scrotum red. Sometimes, an abscess can even develop in your scrotum that needs to be surgically drained (YIKES!!).

What causes epididymitis?
For younger guys, the usual cause is an untreated STD, often chlamydia or gonorrhea. For older men, bladder or prostate infections are more common causes. (Although older guys can and do get STDs too). Epididymitis can also develop days to weeks after untreated urethritis (infection in your pee tube). And it's easy to have urethritis and not
even know it!

Symptoms of epididymitis include:

• Fever
• Swelling or discharge from your dick
• Tenderness, pain, or heaviness behind your balls

What can you do?

• Protect yourself against STDS. Condoms are handy like that!
• Get tested every 3-6 months for STDs, even if you don't see symptoms.
• Watch for signs of urethritis: pain when you pee or a yellow-green discharge from your penis. Get treated right away!

Call the doctor! Quick!
Warm soaks and pain medication may help ease your symptoms. But you still need to get rid of the infection. If you see your doctor early, oral antibiotics will usually be enough. Make sure you take your entire course of antibiotics-even if you think the problem has gone away! See your doctor early before you need more serious treatment or surgery!

Your epididymis needs your love, even if you can't pronounce it!

Until next time, Dick

Dr. Dick on testicle health

Your Testicles may be worth $1 Million...
But for most men, they're priceless! We love them and protect them at all costs! But most of my patients know very little about their balls.

Testicle injury, cancer, and other diseases are more common than you might think!

Pain is a typical symptom. It can mean many things:
Too much wear and tear from rougher, marathon crystal sex. Take the weekend off!

Torsion. Each testicle hangs on a tube that contains an artery, vein
and sperm duct. Sometimes during strenuous activity this tube can get twisted and cut off blood supply. Severe pain comes on quickly. If not treated right away, the testicle can die! Get to the emergency room ASAP!

"Blue Balls." Men often use this term to describe when their balls hurt during or after sex that didn't result in ejaculation. The pain is simply caused by blood backed up in your erect dick and balls. (They don't really turn blue.) For relief, let your erection go down a bit or cum.

Epididymitis is an infection of your-- you guessed it --epididymis (the mass of tiny tubes on the top and back of your testicles). You may feel pain, swelling, or sensitivity behind your balls. If ignored, the infection can spread to the whole testicle. A common cause of epididymitis is untreated STDs.

Testicular Cancer
This is the most common cancer in men ages 20-34. It starts as a painless, solid mass that grows slowly at first. But by the time you can feel a lump, it can grow rapidly. If caught early, cure rates are very high. So regular self-exams are critical.

Get to know your balls.
All men should do self-exams once a month. It's easy to do in the shower or before bed. Get familiar with what your balls normally feel like. That way you can notice anything out of the ordinary. Carefully hold each testicle between your thumb and forefinger. Then feel your
way from back to front and bottom to top. Nice that we have two, because we can compare one to the other! Show any hard lumps or irregularities to your doctor at once.

There are other testicle conditions that should be diagnosed by a doctor. Self-exams and regular doctor check-ups can help stop a problem
from becoming serious or even fatal.

Next issue: Dr. Dick asks: It's 10:00. Do you know where your
epididymis is?

Testicle Trivia:
Your balls produce sperm and testosterone.

The average testicle is the size of a walnut. Size has nothing to do with dick size, fertility, or "manliness."

Dr. Dick Circles your Anus: Some of the more common anal health problems among gay and bisexual guys.

Last issue, Dr. Dick answered a reader's question about anal pain. Now, Dr. Dick will take you on a guided galactic tour of anal health concerns.

Gonorrhea, Chlamydia, Herpes, and Syphilis.
These STDs are common among gay and bisexual men who have anal sex without condoms. These STDs don't always have symptoms. If you have anal sex without condoms, it's best to get tested regularly for all STDs every 3 to 6 months. (Call 206-205-7837 to get a test.)

To find out if you have an STD, the doctor or clinician may insert a finger or maybe a small scope to look around. Most likely, she or he will collect any pus or discharge on a tiny swab. The swab will then be dabbed on a "culture" plate or on a slide to see if any bacteria can be identified. If you've had unprotected anal sex recently, the doctor may prescribe antibiotics to get rid of any possible infections. Make sure to take all the medication your doctor prescribes - even if the symptoms clear up! That way you won't develop a "drug resistant" STD.

Sometimes gonorrhea and chlamydia symptoms go away on their own, but the infection will still be present. Syphilis generally causes no signs or symptoms in the rectum. You can have it without ever knowing it. Even if you don't have symptoms or if symptoms go away, untreated STDs can cause permanent damage to your body.

Anal Warts.
This STD is caused by human papilloma virus (HPV). Warts are small fleshy growths on the outside or just inside the butt. Not everyone who has the "wart virus" will develop warts. But even guys with HPV who don't have "visible" warts can pass the virus on to their sex partners. For example, a partner with HPV can pass the virus on to you if his genitals (penis, anus, and perineum) come into contact with your genitals. Using condoms will reduce your chances of getting warts. But
condoms won't eliminate all the risk because condoms don't cover all the areas where warts can be present.

Anal warts can be removed several ways. They can be frozen off with liquid nitrogen or burned off using "electrocautery." Topical medicines can also be used. But only trained medical staff should do these treatments. Don't try to treat yourself. And never use over-the-counter wart treatments on genital warts. If you are HIV positive or your immune system is compromised for other reasons, you may be more likely to develop anal or penile warts. HPV has also been linked to anal cancer among gay and bisexual men. Anal pap smears are being studied to see if they can detect early forms of cancer in the rectum. So, if you have anal sex, talk with your doctor. You can also call the STD Hotline (206) 205-7837 and ask about enrolling in clinical studies for the anal pap smear.

Anal & Rectal Fissures.
These are small tears or rips in the surface of the anus or rectum. The lining of your ass is moist tissue that can be damaged easily. Fucking, fingerplay, and using toys or dildos can cause small tears. You may notice a small amount of blood on the surface of your shit after a tear occurs, but many people don't feel any symptoms. Tears will generally heal by themselves, but can easily be reopened and enlarged. These tears can also become infected - after all, the ass isn't the cleanest part of your body! When an infection like this occurs, it can be really bad news. Sometimes a painful peri-rectal abscess may develop. Other times, the infection can spread into your body. If this occurs, a doctor will prescribe antibiotics and may need to hospitalize you. Usually, small anal tears will heal over time if you stop having anal sex for a while. Large anal fissures and extensive infections may require hospitalization & surgery to correct.

Hemorrhoids.
There are two kinds of people in the world: those who have hemorrhoids, and those who will get them. Hemorrhoids are enlarged veins. They can occur on the outside of the rectum or just inside the anus. These enlarged veins can be painful or just itchy. You will usually be able to feel an enlarged vein or lump with your finger either outside or just inside the anus. Hemorrhoids can become red and swollen if you strain when you take a shit. If this happens, try to push the hemorrhoid back up into your ass. Also, take a stool softener like Colace to limit further irritation. Hemorrhoids can become red and swollen during anal intercourse. This can also happen with other types of ass play like fingering, fisting, and using sex toys or dildos.

Most hemorrhoids are easily treated with creams, lotions and suppositories from your local pharmacy or grocery store. Sitting in hot water in the bathtub can also help. These treatments may decrease the itching, swelling and pain. For some individuals, over-the-counter medications may not be effective in reducing symptoms. If this is the case, a doctor or clinician may prescribe a stronger medication to assist in the healing process. Some guys will need to have hemorrhoids banded or removed surgically. Surgery is used for those with recurring problems and is a quick but somewhat painful procedure. Until hemorrhoids have had a chance to heal, it's a good idea to avoid anal sex.

So guys- for Dr. Dick's sake- Get your butt examined! And don't forget to wear your rubber space suit when exploring Uranus or other heavenly bodies!

Too Embarrassed: Anal Pain and Common STDs

Dear Dr. Dick,
Before I started getting high I would only let a guy screw me until I came, usually about 20 minutes or so. Since crystal has joined the party, I love to get screwed for hours.

Lately though, I've been having a lot of pain after I get topped. I've tried creams like Preparation H to help ease the pain but the only thing that really helps is to take it easy for a few days. The pain is slowly getting worse but I can't imagine giving up anal sex. I have a doctor that I like but I am way too embarrassed to talk with her about it. What should I do?
Too Embarrassed

Over the years, I have used humor to address the sensitive topics and questions sent in to AMPHETAZINE. This topic requires a different kind of bedside manner. Too often, feelings of shame and embarrassment make it difficult for guys to seek proper medical care for "sexually related pain." Feelings of shame are quite common.

As you know, it is difficult to ignore rectal pain. Many things can go wrong with your butt - it is important that you don't try to diagnose and treat problems on your own. A good rule of thumb is that if you have rectal pain that lasts for more than two days, you must speak with a doctor about it and get an exam! For many folks, having a doctor that you "like" is important. What is more important is that you have established an open line of communication with her or him. Find out early in your relationship if they are someone you can trust. If you can't talk openly with your doctor about your drug use and the sex you enjoy, you should find a different doctor.

Besides pain, other rectal signs and symptoms can include the presence of blood, mucus discharge, sores, incontinence (loss of shit when you aren't trying to take a crap), and cramping. If you have any of these, it's time to see your doctor.

As you pointed out, use of crystal (and other drugs) can lead to longer bouts of anal sex. Crystal can block the body's "pain" signals that normally limit the amount of anal sex you have. Also, some crystal users like to get fucked "harder." Having longer and harder screwing sessions will make it more likely that your butt will become damaged. It is important to recognize the limits of your body and your butt -- unfortunately crystal can make it difficult to recognize and stay within your limits. Learn to listen to your body -- if you've been having rectal pain it's telling you to "lay off".

Again, it is important to find a doctor or clinician that you feel comfortable with. Someone you can share your medically related "secrets" with. You should be able to discuss your drug use, sexual practices and any symptoms you are having in an open way. Before you go in to see your doctor, try writing down your symptoms on a piece of paper. That way, if you get nervous, you won't forget. If you're not comfortable going to your doctor, consider visiting the Harborview STD clinic (see insert) or call the HIV/STD hotline at (206)205-7837 for a referral.