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Sexually Transmitted Diseases/Risk Factors contributing to ill sexual health

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Question
hi there i was just wondering if you could describe for me how the risk for sexual health might increase when multiple (risk) factors interact.

Answer
Hello Alex!
Thanks for an interesting but difficult question. There are lots of risk factors (variables), and it is virtually impossible to assign risk to them all, and then try to determine their  interactions and subsequent risk. Part of the problem is assigning an arbitrary numerical value to a particular risk (yes or no might be assigned 1 or 2, or 1 and 10 depending on the actual risk involved.

For example, heavy alcohol or drug use might increase risk dreadfully, but which drugs create different risk. Some scientists have attempted to assign mathematical probabilities to risk activities associated with sex. Back in the late 1970s, I helped write a brochure called, "Guidelines and Recommendations for Healthful Gay Sexual Activity," based in part on previous work by the San Francisco Sisters of Perpetual Indulgence and the Bay Area Physicians for Human Rights. It was actually quite a seminal work, NOT BASED ON MATHEMATICAL PROBABILITIES like later work in the 1990s and 2000s, but on what we thought were the best advice experts could gather, since specific research was not available back then! But I digress...

Here are some variables to consider:
prevalence of different STDs (gonorrhea, chlamydia, herpes, HIV, HPV, hepatitis B, and a bunch more), virulence of each of the STDs (easy to "catch" or exactly how to spread), immunological competance of the host (strong immune system, or immunosuprressive medications, etc.), within certain aged people (adolescent, 20-somethings, 30-somethings, etc.) of differing sexes (male female), sexual orientations (gay bi straight), gender identity (transgender or not), cultural backgrounds (white, asian, latino, african american, middle eastern, thai, chinese, etc.), number of partners without protection, geographic areas (major city on the coasts, major non-coastal city, large or medium sized city, rural area), types of sexual activities practiced (vaginal penile oral anal frottage/hand jobs, top/bottom/versatile), condoms/no condoms, inebriated, or not. I think you get the idea!

Now scientists can get a good idea about any ONE of these variables. But how do they interact? That is impossible to determine, although some scientists have tried. Probably not the answer that you are looking for!

Good luck!
--mark  

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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