STIs

Chlamydia is one of the most common sexually transmitted infections. Although it affects people of all ages, most infections occur among under-25s.

How you get it:
Chlamydia is caused by bacteria and anyone who has sex is at risk of infection. It is mainly passed on by fucking without a condom but can also be passed on by sucking, being sucked or by rimming. Sometimes men are infected through docking (where you put your cock into another guy’s foreskin).

For Trans men: Chlamydia is caused by bacteria and anyone who has sex is at risk of infection. It is mainly passed on by frontal sex without a condom but can also be passed by oral sex or rimming. 

Symptoms:
There can be a white, cloudy or watery discharge from your cock, or more rarely from your throat or ass. You may also have pain when peeing or find yourself peeing more than usual. In some cases, you may also have pain in your testicles or ass.

If chlamydia remains untreated it can spread to other parts of the body, resulting in swelling of the testicles and prostate gland. In some cases, it can lead to infertility and arthritis.

For Trans Men: At first you may not experience any symptoms. However, trans men who still have periods may experience a number of symptoms. These include: 

• irregular periods or bleeding between periods 
• lower abdominal pain 
• inflammation of the cervix  
• if left untreated it can spread to the fallopian tubes causing pelvic inflammation disease (PID) 

Testing:
Testing for chlamydia is incredibly straightforward. In most clinics, you’ll be asked for a urine sample which is sent off for testing.

For Trans Men: In most clinics, you’ll be asked for a urine sample or a frontal hole swab which is sent off for testing. 

Treatment:
Chlamydia is simple to treat. You’ll either be prescribed a one-off dose or short course of antibiotic tablets. After treatment, you’ll be called back for a retest to make sure that you are all clear of infection.

Prevention
The best way to avoid becoming infected with chlamydia is to use a condom for oral and anal sex. Regular sexual health checks are also important and you should get checked out every 3-6 months.

For Trans Men: The best way to avoid becoming infected with chlamydia is to use a condom for oral, frontal and anal sex. 

Crabs (or pubic lice) are tiny parasitic insects that are found on body hair.  They can be found in the pubic hair around genitals and ass, as well as other areas such as underarms, legs and chest hair.

Sometimes they will be found in eyebrows and facial hair but not the hair on top of your head. They are most commonly transmitted by having sex, either anal, oral or front hole sex, and rarely by sharing bedding, towels or clothes. 

Crabs feed on your blood, but they can’t pass on HIV. They are the size of a pin-head when they are fully grown, and can live away from the body for about 24 hours.

How you get them:
They are spread through close bodily contact and surveys have found that 4% of men get crabs every year.

Symptoms
After getting crabs, it can take a few weeks for symptoms to start appearing. The most common symptom is itching in the affected areas, which is usually worse at night. You might also find small spots of blood on your skin caused by bites.

Testing:
Crabs are just insects that live on your hair, there’s no test for them. If you are getting symptoms, look for small black insects (they grow to about 2mm in length). They’re just big enough to see but often go unnoticed.

Treatment
Crabs are easily treated with a lotion that can be bought directly from a pharmacy. As they can live away from the body for about 24 hours, make sure you wash all towels, bedding and clothing when you start treatment.

Prevention
Sadly, condoms won’t provide any protection from crabs. However, given that they’re easily dealt with and pretty much harmless (other than being incredibly itchy), they’re not something to worry too much about.

Genital warts are small fleshy growths or bumps commonly found around the genital skin. They’re the result of a viral skin infection caused by the Human Papilloma Virus (HPV)

There are more than 200 different types of HPV. However, only a few of these strains commonly affect the genital area.

How you get them:
The HPV virus causing genital warts can be spread during anal sex, by sharing sex toys, through fingering while and by other skin to skin contact during sex.

HPV is very common, in fact, it’s so common that most people will get infected at some point in their life unless you have been vaccinated. Most men who have sex with men will get one or more HPV infections at some time during their lives.

Symptoms

People are often infected with HPV without knowing it as there are usually no symptoms and infections tend to go away on their own.

Most people who have an HPV infection will not develop any visible warts and, even if they do, it can take months, or even years, for them to develop.

Genital warts come in all shapes and sizes. They can be flat with stalks or rough cauliflower-like growths. Some people get them as single warts whereas in other people, they grow in clusters.

Genital warts will usually appear on your cock, often underneath the foreskin. They can also be found in the urethra and the area around your ass. Warts that grow flat are often invisible but sometimes cause slight itching or discomfort.

For Trans Men: Most people who have an HPV infection will not develop any visible warts and, even if they do, it can take months, or even years, for them to develop. Genital warts come in all shapes and sizes. They can be flat with stalks or rough cauliflower-like growths. Some people get them as single warts whereas in other people, they grow in clusters.

Genital warts will usually appear on your front hole. They can also be found in the urethra and the area around your arse. Warts that grow flat are often invisible but sometimes cause slight itching or discomfort. 

Testing:
If you suspect you’ve got genital warts, the best place to go for help is your local sexual health clinic to have it confirmed. 

There is no routine test for HPV infection – the diagnosis is made by examining the warts.

Treatment:
If you do have genital warts, there are a few options for treatment. This can involve either treating them with a cream or freezing them off. Treatment can be slightly uncomfortable, but it isn’t as unpleasant as it sounds!

Don’t be tempted to try and treat them yourself – over-the-counter wart treatments aren’t suitable for genital warts and you might end up with a nasty chemical burn.

Unfortunately, HPV does not always clear itself so you might find that even after treatment warts re-appear. However it is very unusual for warts to continue to re-appear over many years. The types of HPV that cause visible genital warts do not cause genital cancer, although, certain strains of HPV have been found to have strong links with cancer.

For Trans men: The types of HPV that cause visible genital warts do not cause genital cancer, although, certain strains of HPV have been found to have strong links with cancer such as cervical, vulva and front hole cancers. There is currently no evidence to suggest that testosterone increases your risk of developing certain cancers.  

Prevention

HPV is a common virus that will affect many people at some point in their life. As with other STIs, having multiple partners is a big risk factor, as is fucking without condoms. So the best way to protect yourself is by using a condom.

A vaccine is now available that prevents the four strains of HPV that can cause anal, throat and penile cancers, as well as genital warts. This vaccine is available in Scotland from sexual health and HIV clinics to men who have sex with men aged 45 or under.

Men who are at an increased risk of HPV are being encouraged to access the vaccine. This includes men who have multiple partners and those who are living with HIV. You may be eligible for vaccination even if you have already had genital warts.

More information on the HPV vaccine for men who have sex with men is available here.

Gonorrhoea is one of the most common STIs that gay and bisexual men catch. It’s caused by bacteria that live in moist parts of the body (your mouth, ass and urethra).

Although gonorrhoea is very easy to treat, a major concern is that it may become resistant to the antibiotics now available. It is important that you get the proper testing, treatment and follow up if you think you have gonorrhoea.

How you get it:
Gonorrhoea is mainly passed on through anal sex without a condom but can also be passed on through sucking, being sucked, or rimming. It can also be passed on by sharing sex toys.

For Trans Men: Gonorrhea is mainly passed on through sex without a condom but can also be passed on through sucking, being sucked, or rimming. It can also be passed on by sharing sex toys. 

Symptoms:
There can be a white/yellow discharge from your cock, or more rarely from your throat or arse. You may also have pain when taking a piss, or find yourself peeing more than usual. Other possible symptoms include a sore throat or a pain when having a shit. It is also common to have gonorrhoea without any symptoms, so it is worth getting tested even if you feel fine.

If gonorrhoea remains untreated it can spread to other parts of the body, resulting in damage to joints, heart valves, your testicles, and the prostate. Untreated gonorrhoea can also increase your chance of becoming infected with HIV.

For Trans Men: You may not experience any symptoms. For trans men you can experience a range of symptoms; the list below may include some that are not relevant to you (for example, if you no longer have periods, or if you have had a vaginectomy). Sometimes these symptoms may feel similar to those of a urinary tract infection. Symptoms can include:  

• white/yellow discharge from your front hole, or more rarely from your throat or arse 
• A strong, unpleasant smelling thick discharge from the front hole, that may appear green or yellow in colour,  
• pain or tenderness in the lower abdominal area, including a burning sensation when urinating  
• frequent need to urinate  
• irritation or discharge from the anus  
• bleeding between periods or heavier periods  

Testing:
Testing for gonorrhoea is incredibly straightforward. In most clinics you’ll be asked for a urine sample which is sent off for testing. You’ll also take swabs from your throat and your arse. 

If you have symptoms (such as discharge from your cock) you’ll need some extra swabs, taken by a clinician, to test if you have an antibiotic resistant form of gonorrhoea.

For Trans Men: If you have symptoms (such as discharge from your front hole) you’ll need some extra swabs, taken by a clinician, to test if you have an antibiotic resistant form of gonorrhea.

Treating:
Gonorrhoea is easy to treat, but it's very important that you get the correct treatment and tests afterwards to make sure the infection has gone. You’ll either be prescribed a one-off dose or short course of antibiotics, usually as an injection plus some tablets. After treatment you’ll be called back for a retest to make sure that you are all clear of infection. Some antibiotics offered by online chemists are not fully effective against gonorrhoea, so we recommend checking with a specialist clinic before using these.

Prevention.
The best way to protect yourself from becoming infected with gonorrhoea is to use a condom for sucking and fucking. Regular sexual health checks are also important and you should get checked out every 3-6 months.

Hepatitis B is a serious condition that can lead to inflammation of the liver, affecting its ability to work properly and potentially affecting your quality of life. In extreme cases the virus can lead to severe liver damage, liver cancer and sometimes it can be fatal. Fortunately it is very easy to get vaccinated against Hepatitis B and be protected against infection.

How you get it:
Hepatitis B is highly infectious. It can be found in all bodily fluids (blood cum, shit, sick). The virus can survive for up to a week outside the body.

Having sex is one of the most common ways to contract Hepatitis B. It can be spread through fucking, sucking, fisting, and scat. Because Hepatitis B is found in blood, there is a risk of spreading it by sharing common household items that could come into contact with blood, like razors and toothbrushes. It can also be spread through sharing needles.

Symptoms
Many people with Hepatitis B won’t experience any symptoms and may fight off the virus without ever realising they had it. Where symptoms do develop, it’s usually two or three months after infection.

Symptoms can include flu like illness, tiredness, loss of appetite and stomach pains. Your shit may look pale and pee become dark. Your skin and the whites of your eyes can also look yellow (jaundiced).

Symptoms can vary from person to person, and just because you have some of these symptoms doesn’t mean that you necessarily have Hepatitis B.

Testing:
The only way to tell if you have Hepatitis B is to have a blood test, either at your local sexual health clinic or your GP.

Treatment
In the vast majority of cases, people infected with Hepatitis B will clear the virus naturally with no medical treatment during the first six months. You’ll be advised to get plenty of rest (including no drugs or alcohol).

If you don’t clear the virus naturally you are said to have chronic Hepatitis B. Your doctor will discuss with you how best to manage your condition, including possible treatment. At present there is no cure for chronic Hepatitis B.

Prevention
There is a highly effective vaccine against Hepatitis B. The vaccination consists of a series of three or four injections over up to a year. The timing of vaccinations can be adjusted according to your risk and clinic appointments. This course may be adequate for lifelong protection, but a booster may be required after approximately five years. A small number of people don’t respond to the vaccine.

The other way to protect yourself (vital for non-responders) is to use a condom for fucking. You may also want to use a condom for sucking, a dental dam for rimming and gloves when fisting.

Hepatitis C is a serious condition that can lead to inflammation of the liver, affecting its ability to work properly and potentially affecting your quality of life. In extreme cases the virus can lead to severe liver damage, liver cancer and sometimes it can be fatal.

How you get it:
Hepatitis C is easily passed on through blood-to-blood contact, but not so easily through sex. The most common way Hepatitis C is passed on is through the sharing of drug injecting equipment and paraphernalia, or if sharing bank notes, etc for snorting coke. All these items can become contaminated by blood. In addition to this, a number of guys have become infected with Hepatitis C through ChemSex.

The virus can also be spread through tattoo or piercing equipment that hasn’t been properly sterilised. Legitimate tattoo parlours will follow strict hygiene guidelines to protect you but try to avoid tattoo parties and be careful if you’re getting a tattoo abroad.

Hepatitis C can be spread through unprotected anal sex where there is minor bleeding. Rough or prolonged sex (such as fisting or ChemSex) increases the chances of passing on Hep C.

People who are HIV positive are more likely to catch Hepatitis C and if you are an HIV-positive gay or bisexual man your clinic should test you for Hepatitis C at least annually along with your routine blood tests.

Because Hepatitis C is found in blood, there is a risk of spreading it by sharing common household items that could come into contact with blood, like razors and toothbrushes.

Symptoms
The best way to know if you have Hepatitis C is to get tested. This is because those with the virus often have very few symptoms.

Symptoms can include flu like illness, tiredness, loss of appetite and stomach pains. Your skin and the whites of your eyes can also look yellow (jaundiced).

Symptoms can vary from person to person, and just because you have some of these symptoms doesn’t mean that you necessarily have Hepatitis C.

Testing:
The only way to tell if you have Hepatitis C is to have a blood test, either at your local sexual health clinic or your GP. Testing for Hepatitis C is not part of a routine sexual health screen for gay and bisexual men, and other men who have sex with men, in many clinics in the UK, including Checkpoint and NHS Lothian clinics. Make sure you let the clinician know if you’ve been at risk of Hep C, or just ask for the test to be added to your other tests.

Treatment:
Around one in five people infected with Hepatitis C clear the virus naturally without medical treatment within the first six months.

For those that don’t clear the virus naturally, treatment is available that can cure the virus. Medications with fewer side effects and shorter treatment periods were launched in 2014. The treatment consists of taking drugs orally for a period of between 8 and 24 weeks and is effective in around 90% of cases. It is important to note that treatment varies depending on your circumstances and your medical team will discuss what treatment is best for you.

Prevention:
There is currently no vaccine to protect against hepatitis C. The best way to protect yourself against the virus is not to share drug injecting equipment and to use a condom when having sex.

Genital herpes is a common viral infection. There are two strains of the herpes virus, both of which can cause genital herpes and cold sores in the mouth area.

How you get it:
Herpes is transmitted by direct contact, including genital-to-genital, mouth-to-mouth and mouth-to-genital.

Herpes is most infectious during episodes, from the first signs of burning/tingling until the skin has completely returned to normal. Even when there are no symptoms, it is possible for someone to pass the condition on to a partner.

Symptoms:
Most people with a herpes infection won’t have any symptoms and may not even be aware they have the virus.

Where there are symptoms they usually include blisters and sore areas around the cock, anus and thighs.

The first time you have an episode, it can last two or three weeks without treatment and often feels like flu, with muscle aches, headaches, swollen glands and burning when you pee. If you get your first episode of herpes in the anal area, this can cause quite severe discomfort, diarrhoea and an anal discharge. If you think you have a first episode of herpes, go to a clinic or your GP – treatment can bring the symptoms to an end within a few days.

Once initial symptoms clear, the virus remains dormant and can lead to recurring episodes. These generally result in fewer blisters/sores which are much less painful and only take a few days to heal. Most people don’t need treatment for recurrences, but treatment can be given if they are severe or they happen frequently.

For Trans Men: You may also experience bleeding between periods or have irregular periods, and lower abdominal pain.

Testing:
At present, the only way of confirming that you have herpes is by taking a swab from a blister or sore in the lip or genital areas. This will confirm the diagnosis and indicate which type of herpes is causing the problem. You can get tested at a sexual health clinic or at your GP. A blood test for herpes in people who don't have symptoms is available but it is rarely needed and isn't part of a routine sexual health check.

Treatment:
While there is no cure for the herpes virus, there are antiviral treatments that can relieve the symptoms. Different treatments are available depending on whether it is your first episode or a recurrent episode.

There are also things you can do at home to ease symptoms. You should try to keep the affected area as cool and dry as possible. Bathe the area in tepid salty water or take a cool shower. Avoid tight clothing and, if it's practical, leave the sores exposed to dry out. If you have sores around the anus, make sure you keep your stools soft by either taking plenty of dietary fibre and fluids or using a stool softener such as lactulose. Protect the area with a little vaseline before going to the toilet - and wash afterwards.

Prevention:
If you have genital herpes and are experiencing an episode, you should avoid having sex from the first tingle or itch until any blisters or ulcers have cleared up.

Herpes episodes can be triggered when you are feeling run down or stressed. Irritation from clothing and using sunbeds can also trigger an episode. Try keeping a record of when you have herpes episodes, and you may begin to see a pattern. If you do, try to adjust your lifestyle to avoid them.

If the episodes are very frequent, or they are severe and are affecting your quality of life, go to a clinic or your GP to discuss whether taking treatment will help.

HIV is a virus that infects the body’s white blood cells and stops the immune system, which fights infection, from functioning properly.

How you get it:
The virus is present in blood and genital fluids, including cum, and, for gay and bisexual men, it’s primarily transmitted through fucking. There is also a low risk associated with oral sex.

If you’re unsure of the HIV risk associated with different types of sex, check out our ‘How risky is…?’ section. HIV cannot be transmitted through saliva so kissing is safe.

Without treatment, over a period of years, the immune system will weaken, leaving you open to opportunistic infections that might lead to and AIDS diagnosis. Today in Scotland, this is extremely rare and, with early diagnosis and treatment, people with HIV can live long and healthy lives.

Symptoms:
HIV symptoms vary from person to person and, because many other common illnesses share these symptoms, the only way to be certain that you have HIV is to get tested.

Some people will have flu-like symptoms, often within a couple of weeks of becoming infected. Typical symptoms include sore throat, a fever and a blotchy rash at the same time. Other possible symptoms include fatigue, aching joints and muscles, headaches, swollen glands, nausea and diarrhoea.

While these may be the signs of a bad cold or flu, if you have been at risk, it’s best to get it checked out. The only way to know if you have HIV is to get tested.

Testing:
Getting an HIV test is quick, easy and confidential, and can be accessed from GPs, sexual health clinics and home testing kits. SX's bi-weekly clinics can provide HIV test results while you wait.

Gay and bisexual men in Scotland are recommended to have an HIV test regularly. If you have lots of different sexual partners, we recommend that you do this as part of a routine every three months.

You can find out more information about testing, and what to expect when you test, here.

Treatment:
Although there is no cure for HIV, treatments have improved significantly in recent years and, with early diagnosis, people with HIV can live long and healthy lives. 

Antiretroviral Therapy (ARVs) 

The medications used to treat HIV are called anti-retrovirals and the earlier they are started, the better for your health. They are usually in the form of three drugs, each requiring you to take one to two daily tablets. Taken as prescribed, the medication helps reduce your viral load (amount of HIV in your blood) to the point where it is undetectable and the risk of passing on the virus is dramatically reduced. 

Having sex with someone who is HIV positive and has an undetectable viral load carries a very low risk of passing on HIV. If you are having, or thinking of having, sex with a guy who is HIV positive and you have any concerns about this, contact the SX team for more information. 

While there are side effects, as there are with any medication, in the majority of cases, the more severe impacts once associated with HIV medications are no longer a problem thanks to medical advances. Most people taking anti-retrovirals nowadays have no side effects, or very minor side effects that do not affect quality of life. Nevertheless, patients must work closely with their doctors to find the right combination of medications for them, as everyone responds slightly differently to the treatments. 

Injectable Treatment

Injectable treatments are newly available for people living with HIV in Scotland. Long-acting injections of Cabotegravir and Rilpivirine can be given once every two months (one injection in each hip) . as an alternative to ARVs. 

Not everyone is eligible for injectable treatment. You must already take ARVs and have had an undetectable viral load for at least six months. You must also be able to attend the clinic every two months, and have no resistance to NNRTs or INSTI tablets. Injectable treatments are not recommended during pregnancy. 

Currently, HIV clinics in Scotland are only offering injectable treatment to those with the greatest need. This includes people who have physical difficulty swallowing tablets, or who find taking a daily pill has a significant effect on their mental health and wellbeing. If you think that injectables might be an option for you, ask your clinician at your next appointment. 

It is important to know injectables will not work for everyone – this is called virological failure, and effects around 1 in 60 people after two years.  

More information on injectable treatments can be found on the BHIVA website. 

Prevention:
Condoms and lubricant are still the best way to protect yourself and your partner from HIV. Condoms and lubricant used correctly will reduce the risk significantly for both of you, especially when fucking.

If you’ve had sex and think you may have been exposed to HIV, you can access treatment known as PEP (Post-Exposure Prophylaxis) which vastly reduces your risk of infection. It’s important that you seek help as quickly as possible and you can find out more from our PEP page. Having sex with someone who is HIV positive and has an undetectable viral load carries a very low risk of passing on HIV, so we don't usually recommend taking PEP if you’ve had sex with a guy who is HIV positive and on treatment.

You may have also heard about PrEP (Pre-Exposure Prophylaxis). Similar to PEP, this medication can be taken before potential exposure to HIV. Currently PrEP is not routinely available, although some people are accessing it online. If you are buying PrEP online, or thinking of doing so, you can get advice and monitoring from sexual health clinics in Scotland. You can find out more about PrEP here.

LGV (lymphogranuloma venereum) is a form of the sexually transmitted infection, chlamydia.

How you get it:
It's mainly passed on by fucking without a condom, but can also be passed on through fisting, fingering, and sharing sex toys. Most men infected with LGV are also living with HIV

Symptoms

Some people will have no symptoms. If you do, Initially you may see a small sore on your cock, arse or mouth. An infection in your arse can lead to painful inflammation along with bleeding, constipation, ulcers and pus. An infection on the cock can result in swollen glands in the groin, a discharge and discomfort when having a piss. Infections in the throat are rare but can make the glands in your throat swell.

If left untreated, LGV can cause abscesses that burst through the skin leading to scarring and permanent damage. With anal infections, it may lead to an abnormal narrowing of the bowel/rectum, which requires corrective surgery.

Testing:
You can be tested for LGV at a sexual health clinic through providing a urine sample, or from a swab from your cock or arse. It’s the same as the test for chlamydia so, if you’re negative for chlamydia, you don’t have LGV. If you test positive for chlamydia and have LGV-like symptoms, further tests can confirm a diagnosis.

Treatment:
Provided it’s detected early enough, LGV can be treated with a 3-week course of antibiotics. After treatment you’ll be called back for a retest to make sure that you are all clear of infection.

Prevention:
The best way to protect you or your sexual partners from becoming infected with LGV is to use a condom for fucking and latex gloves for fisting. If several guys are being fucked or being fisted in the same sex session, then condoms and gloves should be changed with each man – or hands washed. Sex toys, like dildos, that are being used by more than one guy at a time should have a fresh condom put on them or be washed with warm soapy water between each guy. Douches and enema kits should not be shared.

NSU (non-specific urethritis) is basically an infection causing inflammation of the urethra (the tube that you piss out of). It can be caused by lots of different bacteria, and it’s thought that many cases can be attributed to STIs such as chlamydia and gonorrhoea.

How you get it:
You can get NSU through fucking, sucking and being sucked. There is also a risk associated with sounding (inserting objects down your penis) which may cause either an STI or a urinary tract infection. Particularly vigorous sex or masturbation has also been known to cause damage to the urethra and lead to NSU.

Symptoms:
Many men they will show only mild or no symptoms at all. Symptoms may include a white or cloudy discharge from your penis, pain while pissing or needing to go frequently, irritation at the tip of your cock and discomfort when having sex or cumming.

Testing:
If you think you have an NSU you can get tested for it either at your sexual health clinic or your GP. The test may involve taking a swab from the urethra, a urine sample and an examination of your cock and groin.

Treatment:
In most, NSU is treated by a simple course of antibiotics, either as a single dose or over a couple of weeks. If it keeps coming back then you may be given an additional course or a combination of antibiotics.

Prevention:
The best way to prevent NSU is to use a condom when having sex (including oral sex). If you are sounding, make sure the object is sterile and is able to fit in to your urethra. As with all forms of alternative sex, it is good to make sure you know what you’re doing first.

Syphilis is a sexually transmitted infection that remains a significant concern amongst the gay community and rates of infection among men who have sex with men keep on rising. The good news is that, if caught early, syphilis is easily treated.

If not treated it can lead to damage of the brain, heart, and liver. As well as causing long-term health problems, syphilis can also increase your risk of catching HIV. If you’re a sexually active gay man, getting a syphilis check every three months as part of a regular sexual health check is a good idea.

How you get it:
Syphilis is mainly passed on during anal or oral sex. Around half of new cases amongst gay men are linked to sucking cock.

For Trans Men: Syphilis can also be transmitted through frontal sex.

Symptoms
The most common sign of having syphilis is a sore or reddened patch on your cock, arse or mouth. These sores may not be painful. You may also notice that you have swollen glands around your groin or in your neck. Check yourself regularly and if you’re not circumcised (cut) check the inside of your foreskin as well.

A few weeks later you may find a rash appears, this is commonly found on the palm of your hands and on the soles of your feet but it can appear anywhere.

You may also experience flu like symptoms, including mild fever, fatigue, aching joints, sore throat and swollen lymph glands. It is also not uncommon to notice patchy hair loss. These symptoms may be mild and will disappear without treatment.

Testing:
The only way to know for sure if you have syphilis is to get tested, which involves a small blood sample. Syphilis testing is available from Checkpoint with results available while you wait. You can also get tested at your local sexual health clinic or GP.

Treatment:
If you get a positive syphilis test. Don’t panic. Syphilis is easy to treat with antibiotics. Once you’ve been treated it’s important to go back to the clinic for regular blood tests to make sure it has worked and you have not been infected again. During this period it’s best to use a condom or avoid sex until you get the all clear.

Prevention
The best way to prevent you becoming infected with syphilis is to use a condom when having sex. If you decide not to use a condom and have sex with different partners, then it is important that you have regular sexual health checks, ideally every three months.

Living with HIV?
People living with HIV are at a high risk of catching syphilis. If you are HIV positive, then catching syphilis may increase your viral load. Syphilis also makes it much easier for HIV positive people to pass on the virus to their sexual partners. 

How do you get it:

Trans guys can get trichomonas vaginalis from front hole sex and sharing sex toys. It’s spread by a tiny parasite found in the front hole and urethra.  

Prevention: 

Using condoms, both external and internal, can help prevent the spread of the Trichomonas Vaginalis. 

Symptoms:

Many infected people show no symptoms, but symptoms can appear between three and 21 days after infection.  

Symptoms include

• increased discharge from the front hole, that may change in colour and have a musty or fishy smell  
• itching, soreness and inflammation in and around the front hole 
• pain when passing urine or having sex  
• tenderness in the lower abdomen  

Treatment: 

Treatment for trichomonas vaginalis involves a single dose or short course of antibiotics, and a retest after a period of time.  

Shigella is a bacterial stomach infection that is often found in food products but can also be transmitted through sex between men, more often (but not exclusively) when men rim each other. Other sexual practices that pose a risk include anal sex, fisting, oral sex and group sex. People are exposed to Shigella through coming into contact with faeces (shit).

Symptoms:

The symptoms of Shigella include diarrhoea and stomach cramps, which can be severe. Some guys also experience sickness and a fever. If you have severe diarrhoea, which may contain blood (also in your anal mucus), this is sometimes referred to as dysentery.  Most people will get symptoms from 1 to 3 days after sex, but in some cases you can get symptoms after a week.

For some, symptoms may settle in a few days. However, if you continue to feel unwell and your symptoms do not improve, get worse or show signs of dysentery then it is important to contact your GP or sexual health service. You should let them know that you have had these symptoms after having sex and that it may be Shigella.

Being aware of these symptoms is important so you can take action if you are experiencing them, especially if you have recently had sex that may involve contact with your partner’s faeces. Shigella, with symptoms of dysentery, is serious and in severe cases may result you being admitted to hospital.

People with this bacterial infection can pass it on for up to a month after infection.

How you get it:

Shigella can be passed on when you have sex and come into contact with your partner’s faeces containing the infection.  This can happen when sex involves activities such as anal sex, using sex toys, fisting, handling a condom or touching / fingering your partner’s ass.  It only takes a small amount of the bacteria (entering your mouth from fingers or a sex toy, for example) to enter your body for you to become infected.

Testing: 

If you have suspected Shigella, a doctor will test a sample of your own faeces (shit) to find out if bacteria are present and confirm whether or not it is Shigella.  If it is Shigella then it is important that you follow the advice given by the health professional, and ask them when it is appropriate to go back to work or start having sex.

Treatment:

Treatment is by antibiotics prescribed by a doctor at your GP practice or sexual health clinic.  It is important to keep hydrated by drinking plenty of fluids and take your medication as directed. If you are struggling to keep fluids in your body you should mention this to your doctor.  It is also important to get plenty of rest to keep your energy up.

In addition to medical treatment there are some other things you should consider:

1. Wash your hands with antibacterial soap regularly.
2. Change your bedding and wash it at a high temperature.
3. Wash your clothing.
4. Avoid preparing food while you are feeling ill.
5. Clean surfaces, door handles and things you regularly touch in your house with antibacterial soap or wipes.
6. Keep your toilet, sink and shower areas clean.

It is very important that you don’t use public baths, saunas etc. when you are unwell as this may pass the bacteria on to other users.

Prevention:

The following simple steps are things you can do to reduce your risk of Shigella through sex:

1. Showering is the best way to clean yourself and remove the bacteria. It is a good idea to shower before and after sex to keep the bacteria at bay.
2. Wash your hands after you have had sex with your partner. This is especially important if you are touching your partner’s ass, including fingering or fisting.
3. After removing your condom, or after touching your cock after condomless anal sex, you should clean your hands immediately. 
4. Before rimming, you can cut a condom into a square and place it over your partner’s ass to use as a barrier.
5. When fisting, use rubber gloves but change or discard them before going on to do something else.
6. Don’t share toys. You can, however, cover the toy with a condom and change it between users.
7. The areas around your groin and between your balls and ass can also host the bacteria. It may be best to avoid these areas when licking or kissing your partner(s).

Urinary Tract Infections (UTIs) and Bacterial Vaginosis (BV) aren’t sexually transmitted infections, but can impact the sexual health of trans men. 

Both can be related to, or made worse by vaginal atrophy – a reduction in the strength of the tissue and the amount of natural lubrication in your front hole, which in turn can be linked to testosterone therapy. 

UTIs and BV are both very common, and treatment is straightforward. 

In Scotland, you can access treatment for a UTI at a pharmacy. If you do, you will need to explain you are a trans man to the pharmacist. You should be able to ask for a private conversation in a consultation room, so that this can be done discreetly.  

If you find that you are repeatedly getting UTIs, it may be worth it to do a course of topical estrogen for your front hole which is a local dose and won’t affect your testosterone therapy.  

Sometimes, you might need standing antibiotics (continuous, low-dose antibiotics) to prevent UTIs. 

BV (bacterial vaginosis) treatment is very straightforward—involving either a short course of pills or application of a cream. If BV keeps coming back, you might need a short course of topical estrogen for the front hole, which is a local dose and won’t affect your testosterone therapy.