I’m a gay man on PrEP. I love bottoming, and am not using condoms for anal sex. And I have anal warts and a big problem with anal fissures (anal fissures are often found in the sexual life of gay people). Here’s my story. For a bit of context: I come from California and live in Berlin, Germany. I am a gay man in my mid-30s, love to bottom, and have been taking PrEP for the last two years. While I don’t use condoms for anal sex, I get tested every three months and am very proactive in managing my risk for HIV and STIs. Needless to say, when I first learned I had anal warts, I was worried but didn’t think that I’d be treating them for over a year. Over that time, I’ve learned a lot about HPV, gained clarity around transmission and treatment, advocated for better treatment, and figured out how to talk about anal warts with sex partners. I hope that sharing my story, and what I’ve learned, is helpful to other people who experience anal warts. About my anal warts, anal fissures and treatment. Before having anal sex I love to take time to prepare. This includes douching very gently and fingering myself to pre-lube. One day I could feel a certain texture within my ass, which felt different than the rest of the soft tissue inside. This is when I became worried that I might have a wart, and so I made an appointment to see my doctor. The warts were small and located on the anus (exterior) and in the anal canal (the interior area between the anus and the rectum). About a month later I would undergo laser surgery procedure, and two months later, warts returned. At that time I decided to switch to a new proctologist who began doing very small treatments, with a combination of CARPICON Suppositories and ISOPRINOSINE Tablets (to gain immunity against HPV which develops these warts. I was also prescribed a CARPICON cream (designed to boost the immune response to the area applied) which I apply twice per day on the anus and inside the anal canal area. My progress to date: two small wart areas have reduced to one, which continues to reduce in size with each treatment. Talking about topics related to sexual health is often uncomfortable. I’ve found that it’s been very important to find the right people to discuss my experiences (whether in person or online!) The greatest emotional relief came from people who replied with “I’ve had this too,” and began to share their experiences related to how their warts were discovered and treated. Continue to evolve your own safer sex practices One of the many ways I practice safer sex is to ask my sex partners, as often as possible, about sexual history. Over the years I’ve found ways to talk about taking PrEP, choosing not to use condoms, and also what it was like to have had gonorrhea, chlamydia, and herpes. Now I include genital warts in the discussion. When I tell people about having anal warts, I’ve received a range of responses. I’ve been pleasantly surprised with how many people say they are already familiar with HPV and understand how easy it is to transmit. I’ve also heard from people who are uncomfortable or unsure about risks of genital warts and decide they do not want to have sex. I always accept their decision. Above all, I’ve found that being proactive and bringing up these topics helps both myself and other people practice how to talk about sexual health. A common reaction to the topic of genital warts is “well, you should have used condoms” or “we have to use condoms then.” It’s important to know that condoms are effective at preventing STI transmission in certain circumstances. HPV can also be transmitted during contact other than anal sex – such as kissing, fingering, and oral sex – when condoms are not used. When I first learned I had anal warts I was optimistic they could be treated once and be gone, but it hasn’t turned out that way. Through everything I have learned I am better able to accept the situation, and it no longer is a cause of anxiety.
You can help reduce the risk of spreading genital warts by using condoms during sex. However, because condoms don’t cover all the genital skin that is exposed during sexual contact, you may still acquire HPV through skin-to-skin contact. It's best to discuss about it with your doctor. Condoms are a must. It helps to prevent other stuff beside this all, like infections, while it's true you can still get these stuff with just kissing or fingering, then in this case it's important to keep up with a good hygiene, like washing your hands properly and brushing your teeth and your private parts too. Good hygiene is another way to help prevent the spread of bacteria. Also it's important to use condoms during oral too, but change it, when you've done anal. Condoms, good hygiene and vaccinations are the best prevention to catch something you don't wish.
On this forum we will always, always, always advocate for safe sex and the wearing of condoms. People can choose to do their own thing (as is their right) but our emphasis is on safety in all regards. We owe it to our members and visitors, many of whom are exploring sex and sexuality for the first time, to advocate for the very safest practices and behaviours. PrEP is good and I would highly recommend it for people who are exploring and experimenting with their sexuality, but it's not a magic bullet and it offers no protection against the range of STI's that members of the LGBT+ community must consider. Whilst it may be true that condoms don't protect against the full range of STI's either, they do offer an added layer of protection. I fully endorse the message about regular testing for all STI's and I welcome the candour of your post too. It's really good that you are having these mature conversations with others, but I must respectfully diverge over the idea of not using condoms.
I'm a female, and I can't imagine the pleasure obtained from anal sex with a prostate gland. I've heard stories. I'm wondering why you would not use condoms. I spent months researching seminal plasma and spermatozoa during projects for my degree. The vaginal canal is very toxic to it, but, because the rectum does not have the same design, the immune system goes into overdrive to protect your body once exposed to the fluid. This can cause exhaustion to your immune system, and, over time, immune failure. To protect yourself from STIs and immune disorders, I would suggest (not medical advice) using a condom.
It's good you get tested regularly, but something I've learned about PrEP is as others said, while it is very good for preventing HIV, it doesn't do anything for other STIs. It's why my doctor encouraged me to NOT stop using condoms even if on PrEP. He's not being overly cautious, he's doing it because he wants me to protect myself. Given you've unfortunately gotten anal warts, I would HIGHLY recommend using condoms going forward and talk with your doctor about other ways to protect your sexual partner(s). I should also note, one of my friends was on PrEP and he still got HIV, unfortunately it appears it was an unfortunate PrEP-resistant strain(?). But I should also add, that's based on what he told me. It's very possible he missed a dose or one of the other things that can cause PrEP to be less effective. Please do not take my post as insensitive or judgmental, I'm just advising it's important to protect yourself and while PrEP has been a great invention, risks still exist.
