Dear Andre –
Settle a bet: I’m on prep and I’ve never tested positive for any STDs. Is there really a reason that I need to be wearing a condom for anal sex? If I don’t have anything, I can’t pass anything on, and I only top…
Before I answer your question directly, I just want to formally state that I am neither advocating for or against you using condoms. Your body, your choice! My goal here is to provide you with enough knowledge for you to make the most informed and appropriate safer sex decisions for yourself moving forward.
Now, let me break your question down for you:
“I’m on PrEP.”
Hooray! Good on you for seeking out that level of preventative care. For those who aren’t familiar, PrEP is short for “pre-exposure prophylaxis.” It’s a HIV prevention strategy in which HIV-negative people take an oral pill once a day before coming into contact with HIV to reduce their risk of HIV infection. PrEP must be taken for at least 7 days (rectal) or 20 days (vaginal) to reach optimal levels of protection against HIV. “Truvada” is the brand-name for PrEP. For more information about PrEP, check out prepfacts.org
“I’ve never tested positive for STDs.”
That’s great! However, the fact that you’ve never tested positive for a STD in the past does not make you immune to encountering one in the future. Please continue to get tested regularly - at the very least, after each new partner (yes, even if you’re using protection!).
“Is there really a reason that I need to be wearing a condom for anal sex?”
PrEP’s sole function is to prevent the transmission of HIV. Unfortunately HIV isn’t the only STD out there, and you’re just as susceptible to other STDs on PrEP as you’d be without it.
From the Center for Disease Control’s (CDC) website:
“In addition to HIV, a person can get other sexually transmitted diseases (STDs) like chlamydia and gonorrhea from anal sex without condoms. Even if a condom is used, some STDs can still be transmitted through skin-to-skin contact (like syphilis or herpes). One can also get hepatitis A, B, and C; parasites like Giardia and intestinal amoebas; and bacteria like Shigella, Salmonella, Campylobacter, and E. coli from anal sex without a condom because they’re transmitted through feces. Getting tested and treated for STDs reduces a person’s chances of getting or transmitting HIV through anal sex. If one has never had hepatitis A or B, there are vaccines to prevent them. A health care provider can make recommendations about vaccines.”
“I only top.”
Ehhhhhh you’re still at risk, though. Practicing responsible safer sex is all about [accurate, non-judgmental, non-assumptive] risk management and communication. Every time we engage intimately with someone there will be a certain level of health risk attached to that intimacy. It’s our responsibility to regularly engage our partner(s) in conversations about mitigating that risk, especially BEFORE we decide to fall into bed with them.
Unprotected anal sex is the riskiest kind of sex to engage in when it comes to STD transmission, and this is because of how delicate (and prone to tearing) the lining inside the anal cavity is. Should a disease or infection come in contact with even the most microscopic of tears, there’s a significant chance of it moving into the penetrated party’s bloodstream. That all being said, TOPS MUST BE CAREFUL, TOO! STDs may enter the penetrating partner’s body through the opening at the tip of the penis (or urethra) or through small cuts, scratches, or open sores on the penis.
So remember, while taking PrEP is hella responsible, it’s not the only safety method you should rely on!
If you have your own questions about sex, love, relationships, or any of the moving parts involved therein, drop Andre a line at firstname.lastname@example.org. Be sure to use the subject line "Ask Andre," so we know where to direct your thoughtful questions.