Ask the Doc :: Barebacking?

Question:
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?

Signed, Nervous

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.

Stay healthy,
Doctor Jason

Dr. Faulhaber is a graduate of Tulane University in Psychology and Cellular and Molecular Biology and received his medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School. He performed his residency training in Internal Medicine and Pediatrics at Saint Vincent's Hospital in Manhattan, where he then served as a Chief Resident in Internal Medicine. He completed his fellowship in Infectious Diseases at New York University, where he specialized in HIV/AIDS, Hepatitis, and fungal infections. Since fellowship, he has been working as an Internal Medicine/Infectious Diseases physician at Fenway Community Health in Boston. He is a Clinical Instructor in Medicine at Harvard Medical School, and he is affiliated with Beth Israel Deaconess Medical Center. He has been the lead author or co-author of several journal articles and textbook chapters on infections with HIV, other viruses, bacteria, and fungi. He is also accredited by the American Academy of HIV Medicine.

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