QUESTION
My boyfriend and I have been together for two years and are 100% monogamous. Neither of us have HIV or any STDs. Is it safe for both of us to bareback since we're monogamous? We also want to try rimming. What do you think? Your advice is much appreciated.

ANSWER
Being free from HIV or STDs can be a tricky thing and would depend on what tests were done (syphilis, herpes, HIV, hepatitis B, etc.), at what anatomic sites (blood, throat, butt and urine) and when the tests were done (at least 4-6 weeks after possible exposure). Many men have chosen to forgo condoms after reviewing their STD and HIV testing history with their doctor but no one can guarantee that an STD was not missed or that one will be spread that was not tested for (like HPV, CMV, EBV).

Life and sex are about a balance between risk and pleasure. The most important thing is to be informed about what are your risks are and then decide how much pleasure you will have by taking some risk versus avoiding any risk. That is a decision only you and your partner can make.

No cases of HIV transmission have been reported from a rim job--most experts believe rimming is safer sexual activity in terms of HIV. Rimming or oral-anal sex can transmit other infections, however, like shigella, amebiasis, cryptosporidium, giardia, and hepatitis A. All of these illnesses are transmitted via contaminated fecal matter (stool). You can use a cut-up condom, household plastic wrap or a dental dam for rimming to lessen your risks. Also, have both partners wash thoroughly with soap and warm water before and after sex. Getting vaccinated for hepatitis A and B plus regular STD checkups are the best ways to stay healthy.

The trick in your situation is to be very sure both partners are truly monogamous. It's a good idea to keep communication open so you can both continue to be assured of your sexual health.

For more information on the risks associated with different sex practices and how to make your sex safer, visit our STD chart or call the San Francisco City Clinic at 415-487-5500.

To your health,
Dr. K