In an ideal universe, people are aware, accountable, honest, and open. In long-term relationships they do not secretly cheat on each other. Those who spontaneously find themselves in the same bed exchange fresh, genuine certificates of the absence of STIs and always remember about contraception in a timely manner for all types of interactions. Condoms never tear or fly off. Latex wipes are at hand on time. If suddenly you have an unprotected one-night stand, it is not found out after the fact that your partner has HIV or STIs. The trajectory of the flight of the semen can be calculated with the same accuracy with which the landing of the plane. Nobody hopes for the chance. After sex, no one goes crazy with anxiety and guilt: “How could I be so imprudent?” and “Now what to do with it ?!”.
I would like to live in this ideal universe. However, I live in reality, where... well, let's be honest, everything happens. Even with the most responsible and sex-positive people.
That rare case when I propose to leave out the entire emotional component (who is right, who is wrong, how to cope with the feeling of anxiety, how to get answers fr om a partner “with words through the mouth”). And I will concentrate only on what you can and should do personally to you in a given situation.
I desperately want you to bookmark this text for yourself, send it to friends, and distribute it. Because in this way, many will have a sound and medical justified algorithm of the minimum necessary actions. This algorithm will help you protect yourself and minimize negative consequences in the event of different emergencies.
Situation number 1
You had unprotected sex with a person whose STI status you do not have reliable information about (a new partner with whom the passion seized you and “turned off the head”; a constant partner who, as it turned out, was unfaithful to you; action at a sex party, when you have not kept track of the number of participants, etc.).
The first is to forget about all the “folk methods” such as douching with “Miramistin”, potassium permanganate or alcohol solutions. All of this does NOT work! Bacteria and viruses are transmitted directly during intercourse as people exchange body fluids. And the infectious agents are so small that they penetrate the mucous membranes and end up under (!) the mucous membrane or in the cells of the mucous membrane itself. So, you will not neutralize them by any washing. But you can make it worse.
Washing the vagina with antiseptics increases the risk of developing bacterial vaginosis and vulvovaginal candidiasis, which just creates favorable conditions for faster penetration of infections.
A sufficient minimum, it is also a maximum: the hygiene of the external (!) organs. That is, thoroughly rinse everything with plain water. You can also drink plenty of water to pee. All this will help us to reduce the risks of postcoital bacterial cystitis. This is not an STI, but it is also an unpleasant thing and can occur after unprotected sex.
About taking tests: how and when to take if there are no symptoms? (If there is, we run immediately to the doctor as soon as they appeared.)
Blood for HIV, syphilis, hepatitis B and C plus a smear for chlamydia, mycoplasmosis (mycoplasma genitalia), trichomoniasis, gonorrhea – the same kit for which we take tests in any situation when there is a possibility that you are infected (for example, if it became known about the betrayal of a partner).
Chlamydia, mycoplasmosis, trichomoniasis, gonorrhea live in the lower genital tract (cervix, vagina / urethra). And if the infection has occurred, then we can determine the DNA of these organisms quickly enough. It is optimal to go to take a smear for these infections a week after unprotected contact.
HIV, syphilis, hepatitis B and C are blood-borne (i.e., blood-borne) STIs. What does sex have to do with it? And besides, there is a component of blood plasma in the fluids that we exchange during sex, which means that infectious agents can get into it fr om the blood.
We have blood tested for HIV, syphilis, hepatitis B and C, and we do it several times: the first test in 2-3 months, the second in 6 months.
Yes, this is such a slow and troublesome way. And only with this approach can we be sure that the results are really, really, 100% negative. The fact is that tests for HIV, syphilis, hepatitis B and C do not determine the presence of the infectious agents themselves, but the presence of antibodies, i.e. the body's response to these infectious agents. And each of these diseases has a “silent period” (the so-called “seronegative window”), when antibodies have not yet developed, but the person is already infected. By engaging in unprotected sex, such a partner will unknowingly infect other people.
Post-exposure prophylaxis (PEP) is not the same as “emergency contraceptive” pills, which can be bought freely at any pharmacy and taken after sex to avoid pregnancy. The only common thing is that it is advisable to start taking medications as soon as possible: within 48 hours, maximum – 72 hours. It makes no sense later.
Here you can hardly do without going to the doctor. Firstly, the medicines are quite specific, and in practice it is difficult / impossible to find them on the free market in a regular pharmacy. Basically, HIV postexposure prophylaxis is taking antiretroviral therapy, the same medicines used to treat HIV.
Secondly, the medicines are taken in a course according to a certain scheme for 30 days. The doctor determines what kind of scheme it will be, prescribes the necessary examinations (it will definitely be necessary to pass an analysis for HIV, hepatitis B, do a pregnancy test, discuss existing chronic diseases). It then decides whether it is really advisable to prescribe therapy based on an assessment of the risks of HIV infection.
The risk of infection is different for different types of sexual intercourse. Oral sex – regardless of the sex of the partners, the receiving or giving role – is not considered significant in terms of HIV transmission. With MF sex, if we are talking about vaginal penetration, the risk for a woman to become infected is greater than for a man. The highest risk is the AU, and for the receiving partner. All this is important to discuss with the doctor, as well as whether the contact was partially or even without a condom.
Which doctor should I run to? In theory, any doctor can recommend and prescribe medicines. But in practice, it is better to go to specialized medical institutions – AIDS centers, which are available in all large cities, or to specialized “HIV prevention rooms”. Here, doctors have exactly all the necessary information (unlike, for example, ordinary gynecologists, who may not be sufficiently knowledgeable). You can also get medicines for free only in specialized medical organizations.
How often can you take post-exposure prophylaxis medicines? Taking into account the fact that HIV-positive people take these medicines for life, then in our stalemate situation there is no lim it on the number of doses. On the other hand, if a person constantly has some kind of risky situations, then it makes sense to talk not about post-exposure prophylaxis, but about pre-exposure prophylaxis (PrEP). It is easier to take, and there are fewer medicines.
Against hepatitis B, by the way, there is also an emergency post-exposure prophylaxis option. In this case, in order to assess the risks of infection and receive therapy, you also need to consult a doctor (gynecologist or even a therapist) within 7 days after a possible infection.
Situation number 2
The condom flew off / tore.
When we talk about emergency (postcoital) contraception, as a rule, we mean pills such as “Escapel”, “Postinor”, “Zhenale”, which are taken after unprotected sex and prevent pregnancy. In terms of efficiency, they are all practically the same, so be guided by the price and what will be on sale.
Sold without a prescription at the pharmacy. The principle of their use is the same: the drug must be taken as soon as possible, no later than 72 hours after intercourse.
As for the permissible frequency of use... Fr om the pedagogical point of view, it would probably be correct to say that they should not be taken more often than a few times a month / year. But objectively, there is no indication of an acceptable “limit” in any international manual or manual. There is no official figure after which it is impossible. The medicines are safe for women. You will not cause fatal harm to health and the reproductive system. However, you have to be prepared for side effects in the form of menstrual irregularities and bloody discharge.
Another question is that if you rush to the pharmacy three times a month for some “Postinor”, it is wiser to choose a method of permanent contraception (COC, spiral, implant, etc.), which will save you from such hassles.
As for pregnancy tests, they are recommended to be done 3 weeks after the intercourse. Hypersensitive tests can be done on the 1st day of the expected period. Among the patients themselves, there is an inner conviction that electronic tests are more reliable than regular urinary tests (those with “stripes”). But from a medical point of view, it is definitely more reliable to donate blood for hCG. It makes sense to do this analysis starting from the 1st day of the expected menstruation.
Situation number 3
You and your new partner protected yourself from unwanted pregnancy with a condom, but oral sex took place without protection.
It does not matter who was the host of oral sex (i.e. it was a blowjob, cunnilingus, anilingus; in the format of MF or MM), the risks are actually the same as with the contact “genitals-genitals”. Accordingly, we hand over a smear for all the same 4 infections: chlamydia, mycoplasmosis (genital mycoplasma), trichomoniasis, gonorrhea.
The throat area is most often affected by chlamydia and gonococcus. Mycoplasma genitalia and trichomoniasis – less common, but also happens. Syphilis is also possible, but this is generally an extremely rare story. The likelihood of HIV transmission through oral sex is not exactly zero, but close to that. Very, very unlikely.
You can take a smear at the same time from several locations: pharynx, anus, genitals. Sometimes doctors “cheat in favor of the patient”: examining all three loci, they collect the material in one test tube so that a person pays for only one analysis, not three. Because if, for example, chlamydia is found in any one zone (for example, if there is in the pharynx, but not in the anus and vagina), the treatment will be the same, because in fact we do not care wh ere they live.
Situation number 4
You and your new partner protected yourself from unwanted pregnancy with a condom, but the fingering took place without protection.
Fingering is the safest of all interaction options in terms of transmission of infections. But on condition that it was purely contact of only “the hands of one partner / the genitals of the second partner”. If you first touched your partner's genitals, then yours, then again his / her genitals – or other options in which your fingers came into contact with vaginal secretions / pre-ejaculatory fluid – then infection is possible. And in this way, chlamydia, mycoplasmosis, trichomoniasis, gonorrhea can be transmitted.
HIV, syphilis, hepatitis B and C (blood-borne infections) – can be transmitted if there are open bleeding wounds on the hands and mucous membranes. The risk depends on the size of the skin defect and the infectious dose. It is not as great as when penetrating, but it is also there.
Situation number 5
An interrupted PA has occurred, which cannot be considered interrupted in a timely manner.
The efficiency of PPA itself is low – 40-60%. And there are no “scientific” or “objective” criteria by which it can be assumed that this intercourse was interrupted in a timely manner, and there is absolutely nothing to worry about, but this one is not, so take a pregnancy test / use emergency contraception at a run.
The method of interrupted intercourse was invented by people themselves, and not by the medical community, so there are no uniquely effective algorithms (relatively speaking, “the partner leaves, then makes at least 5 more hand movements, and only then finishes the partner no lower than on the chest, – and in this situation there is definitely no risk”).
The essence of the method is simple – do not cum in a partner.
But! Situations are different. A man is not always able to control this process as well as he thinks. For example, ejaculation can happen at the moment when he leaves the partner, i.e. some of the seed will be on the outside, but some will remain on the inside. You can never tell by eye.
Pre-ejaculatory fluid – the fluid that comes out against the background of arousal, some time before ejaculation – can also be unsafe. In order for the semen to be liquid, the prostate produces a special fluid secretion, which, roughly speaking, dilutes the semen. And this secret is called the pre-ejaculatory fluid. And yes, it may contain a certain amount of sperm. How much, whether it will be enough for fertilization, is all very individual. The risk of getting pregnant, of course, is less than if ejaculation occurs inside a woman, but it is still present.
The same goes for situations wh ere ejaculate ends up on the partner's body. If a man ends up on the external genitals of his partner, the risk is much less, but it also exists: if the sperm hypothetically can drain down and enter the vagina, then pregnancy can occur. Or take the situation when a man finished on his palm, and then with the same hand – without going into the shower, without wiping it on the sheet – decided to touch the partner's genitals.
What other situations are there?
For example, if ejaculation occurred on a sheet, and the partner, after some time, sat down on this not yet completely dried spot. Here I can please you: sperm cannot jump, so they cannot jump into the vagina from the tissue. Plus, to survive, they need a certain environment, temperature and the kind of liquid in which they usually find themselves. Moisture (the same secretory fluid) is absorbed into the fabric of the linen or evaporates, therefore, the sperm cells themselves either die or lose the ability to move. In other words, there is no chance of getting pregnant, as they say, “from the sheet”.
The final parting word: the PPA itself is unreliable, look for other methods. And if the PPA came out quite risky (that is, part of the sperm got into the vagina), it is definitely emergency contraception.
– Anastasia Belova, obstetrician-gynecologist, Fomin’s Clinic;
– Anastasia Pokrovskaya, Ph.D., senior researcher, infectious disease physician, FNMTS PB AIDS;
– Tatiana Rumyantseva, Ph.D., obstetrician-gynecologist, medical director of the Fomin’s Clinic.