Ask the Doc :: Barebacking?
Dear Doctor Jason,
Can you answer the barebacking question once and for all? A guy I was with wanted to do this, and told me that since he’s the bottom there’s really no risk for me. What’s true and what’s not?
Doctor Jason’s Response:
There’s always a risk, whether you’re the top or the bottom; it all depends on what we’re talking about the risk being related to.
As a barebacking top, the penis is being repeatedly exposed to the contents of the rectum, which is part of the intestinal tract. No matter how clean the bottom may be, there is still a risk of being exposed to the normal bacteria of the intestines. Some of these bacteria (notoriously E. coli) can travel up the urethra and cause a urinary tract infection. Chlamydia can be present in the rectum without causing any symptoms. Traditionally, gonorrhea is more often symptomatic when present, but this also can be transmitted to the top if there are no symptoms. Syphilis, especially in its early stages, does not cause symptoms and would not be noticed by either the top or the bottom if it is in the rectum. Anal warts, caused by Human Papilloma Virus (HPV), are often asymptomatic and are transferred by frictional contact.
With regards to HIV, there still is a risk to the barebacking top. No matter how lubed up you are (or how experienced the bottom), the act of anal intercourse is still traumatic and can cause minor breaks in the skin and mucosa. This leads to the presence of blood, and HIV is found in blood. If you’re uncut, the risk is even greater because the surface under the foreskin is thinner and makes it easier for HIV (and Syphilis) to break through. The presence of any sexually transmitted infection increases the risk of transmission of HIV, mainly due to inflammation of the area.
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