Anal Pleasure and Health: A Guide for Men, Women and Couples (39 page)

Some cases are sexually transmitted. Obviously, an effective means of making oral contact with infected feces-only a tiny amount is needed-is through oral-anal contact (called analingus or rimming). Thorough washing of the anal area, inside and out, greatly reduces the risks of HAV infection. Placing a piece of latex or plastic wrap between the mouth and anus during rimming virtually eliminates the risk. Especially in group sex settings, there are others ways besides rimming that contact with contaminated feces might occur-as, for example, when a finger explores someone's anus, then touches a penis which, in turn, may end up in someone's mouth.

Children under 6 rarely have symptoms from HAV. Most adults, however, show symptoms from 15-50 days following exposure. Symptoms may include fever, fatigue, nausea, abdominal distress, dark urine or jaundice (yellowing of eyes and skin). Most people recover and will then be immune to HAV.

A vaccine is now available for those who have not already been exposed. For those who work with children, as well as the sexually active, getting vaccinated makes sense. It's about 95% effective. The CDC now recommends that children between ages 1-2 be routinely vaccinated for HAV (www.cdc.gov/vaccines).

• Hepatitis B (HBV) can be much more serious than HAV. It is transmitted through direct contact with blood, semen, vaginal fluid, or saliva ( which contains much lower levels of the virus). Other body fluids such as tears, urine, feces, and breast milk are not associated with HBV transmission.

The most common routes for transmission involve intravenous drug users sharing infected needles, and/or unprotected vaginal or anal intercourse. Healthcare workers can be exposed through accidental needle pricks involving contaminated blood. HBV may also be transmitted during childbirth. On rare occasions, contaminated needles may be used for tattooing, body piercing, or even acupuncture. Responsible people who use needles always use the single-use, disposable kind, which pose no danger. There are a few cases of transmission via oral sex. HBV is not transmitted through food, water, or casual contacts such as kissing. However, bites from an infected person have caused transmission.

Being exposed to infected semen during unprotected anal intercourse is an especially effective means of transmission because microscopic breaks in rectal tissue offer the virus direct access to the bloodstream (similar to HIV). Since fisting (handballing) is even more likely than intercourse to cause rectal abrasions, it is also a high-risk activity for contracting hepatitis B, particularly when fisting is followed by unprotected anal intercourse.

About 95% of people with HBV recover completely within a month or two, but some remain ill for many months. Usually no treatment is required. In a small percentage of cases, the disease becomes chronic and can lead to cirrhosis (scarring) of the liver and a higher risk of liver cancer. These cases require treatment with various antiviral medications.

Once a person recovers from hepatitis B, he or she will develop immunity and won't get that form of the disease again. However, it is still possible to contract another form of hepatitis. As with HAV a vaccine is available for those who haven't already been exposed to hepatitis B. All sexually active, non-monogamous adults should discuss the vaccination with their physicians.

Since HBV is transmitted in virtually the same ways as HIV, following safer-sex guidelines is equally effective for HBV prevention. Especially important is the consistent use of condoms for anal or vaginal intercourse.

• Hepatitis C (HCV) has received much more attention since the 1990s, and rightly so. It is the most common, chronic blood-borne infection in the US. The CDC estimates that there are 30,000 new HCV cases each year. Many people recover from HCV, but more than half of HCV cases become chronic, resulting in mild to moderate liver disease. Sometimes liver damage will gradually become much more severe, which is why HCV is also the leading cause of liver transplants-very serious indeed. Between 1% and 5% percent of those with chronic liver disease will eventually die from it.

Hepatitis C is transmitted by blood-to-blood contact with an infected person, most commonly the result of sharing needles for injecting drugs. Occasionally, HCV is spread through unprotected vaginal or anal intercourse. Rough or abusive intercourse that causes injuries is much riskier. As with STDs in general, unprotected sex with multiple partners also increases the risk. There are no documented HCV transmissions from oral sex.

About 80% of those with HCV have no symptoms and don't realize they're infected unless routine blood tests show abnormal liver enzymes. Some have early, acute reactions such as flu-like symptoms or jaundice (yellow skin or eyes). Tests are available to detect antibodies to HCV. It's important to know if you have it so that the health of the liver can be monitored closely, and antiviral treatments initiated if necessary. An infected person can also take active steps to reduce the chances of liver damage, especially by quitting alcohol and other recreational drugs, and avoiding medications processed by the liver. In addition, recent research suggests that early treatment with interferon may lower the changes of developing a chronic form of the infection.

Consistent condom use for intercourse is presumed to lower the risk of infection, but there isn't enough data about how effective they might be. According to the CDC, people with chronic HCV infection are unlikely to transmit it to a long-term partner with whom they're monogamous.

INTESTINAL INFECTIONS

A VARIETY OF organisms make their home in the gastrointestinal (GI) tract and most cause no problems. However, some bacteria, protozoa (single-cell organisms), and helminthes (e.g., tapeworms, pinworms, and roundworms) can be troublesome if they enter your digestive system. Since adult helminthes can't multiply in our bodies, they're generally not transmitted sexually. Shigellosis, Salmonellosis, and Campylobacteriosis are bacterial infections. Amebiasis, Giardiasis, and Cryptosporidiosis ("Crypto") are parasitic infections caused by protozoa. When bacteria or parasites infect the digestive system, they're carried in feces. As a result, they can be transmitted from person-to-person through any oral-fecal contact, including analingus (rimming).

Intestinal infections are widespread in third-world countries, especially in tropical areas, where these organisms may contaminate the water supply. Some agricultural practices, such as using human waste as fertilizer, contribute to the problem. For Americans, international travel is a risk factor for infection.

Closer to home, Salmonella or Giardia may be found in beef, poultry, milk and eggs, and even vegetables can be contaminated during processing. People can also be exposed to Salmonella through contact with certain pets, especially reptiles (turtles, lizards, and snakes) or bird chicks. Public health agencies recommend that young children not be exposed to these animals.

Most bacterial infections are self-limiting because our own immune defenses are able to clear them from the body, typically within a week. Until that happens, symptoms may include diarrhea, fever, and abdominal cramps. Infants, the elderly, and those with impaired immunity may experience more severe illness and may even require hospitalization. About one per 1,000 cases of Campylobacter infection triggers "Guillain-Barre syndrome," an auto-immune disorder affecting the nervous system that may last for weeks, requiring intensive care. About 400 people in the U.S. die each year from acute bacterial infections of the intestines.

Giardiasis and Crypto are diarrhea-causing infections caused by microscopic parasites protected by an outer shell that allows them to survive, even outside the body, for months. Both are common water-borne diseases in every region of the U.S., and worldwide as well. Giardia is also found in animals such as cats, dogs, cattle, deer, and beavers. Humans can be exposed to Giardia or Crypto through raw or undercooked foods, bathroom surfaces, infant changing tables, toys, and contaminated water found in wells, rivers and lakes, pools, hot tubs, and even fountains-wherever tiny amounts of infected feces may lurk.

Sexual activities provide many opportunities for tiny amounts of contaminated feces to find their way into the mouth of a sexual partner. The most direct transmission route is oral-anal contact (analingus or rimming) without a barrier. But oral-genital contact with a penis that has recently had contact with infected feces can have the same effect. Such indirect contact can obviously occur if unprotected anal intercourse is followed by oral sex. An even more indirect avenue for exposure occurs when a finger is inserted anally, and then a penis or other areas are touched with the same finger, followed by oral contact with the same areas. A similar scenario can also lead to vaginal infections.

Much of the time, parasitic infections produce no symptoms at all, or ones too mild to notice. With or without symptoms, though, the person's feces are still infectious. When there are symptoms, they range from vague abdominal discomfort, bloating, gas, or loss of appetite, to severe cramping, nausea, intense diarrhea (sometimes containing blood and mucus), fever, malabsorption of nutrients, weight loss, and malaise. Fever and bloody diarrhea are more likely to be symptoms of bacterial rather than parasitic infections. Many symptoms, especially the intense diarrhea, are especially pronounced in HIV patients with weakened immune systems.

Diagnosis is made by examining stool samples in the laboratory. For greatest accuracy, multiple samples are usually necessary. Some infections, especially Giardia, may never show up in stool tests. In spite of the difficulties, accurate identification of the infecting organism is necessary for effective treatment. Medications that are effective against one organism may not be against another. Sometimes, inexperienced physicians treat suspected intestinal infections with general antibiotics that suppress some of the symptoms temporarily, but do not cure the underlying infection. Some diseases and situations-for example, Salmonella in generally healthy people-are best left untreated, since drugs may actually prolong the infection. Also, in generally healthy patients, most bacterial infections clear by themselves. Considering these complexities, it's important that diagnosis and treatment be directed by a physician who is experienced with intestinal infections.

Preventing intestinal infections is a matter of reducing the chances of oral-fecal contact. Consistent use of condoms for anal intercourse is a must for preventing most STDs among all but healthy and strictly monogamous partners. In gay male casual sex settings, condoms have the added benefit of keeping feces off of penises and, in turn, out of the mouths of oral sex givers. Rimming should be practiced only after thorough washing of the anal area and-if you want to completely eliminate risk-with a latex dental dam or piece of plastic wrap used as a barrier. Fortunately, safer sex guidelines for HIV prevention are also effective for preventing sexual transmission of intestinal infections.

You can find more detailed information about intestinal infections, whether bacterial or parasitic, online by searching www.cdc.gov.

OTHER DISEASES OF THE ANUS AND RECTUM

A VARIETY OF diseases can disrupt the health of the anus, rectum, and lower GI tract. Although some physicians believe that these diseases are more frequent among people who participate in anal sex (especially intercourse), there is no convincing evidence, other than anecdotes and opinions, that this is the case. It's undoubtedly true that reckless anal stimulation, like any other bodily mistreatment, can result in medical problems. In fact, virtually everyone I've talked to with anal problems caused or aggravated by anal stimulation had simply ignored the pain warning them to stop. Sensitive anal stimulation without pain is more likely to contribute to anal health by promoting relaxation, muscle control, and self-awareness.

One of the keys to analrectal wellness is having a basic knowledge of diseases and symptoms to which the area is vulnerable. This understanding increases your chances of recognizing problems before they become serious. Then selfhealing measures can be quickly undertaken and, if called for, professional attention sought.