STD prevention

[Lukecool]

Hello doctor,
First of all, let me say thank you for your service.  I've learned a lot from your posts.

I am a male (asian) in late 20s.
Since I am single, I often have casual sex (hetrosexual) with my friends in the US and CSW in Bangkok.
Havinig sex is not a risk free activity like any other activity such as driving, I would like to set up a rule for myself to reduce the risk of getting STD (including HIV) as low as possible.

So here are the rules that I've set up.

Don't do list
1.  Do not give oral (only kissing around vargina is allowed)
2.  No french kissing (dry kissing on mouth is allowed)
3.  Don't have sexual contact with people from African ethnicity (I am not a racist, just heard that african ethnicity has higher STD infected population)
4.  No anal sex
5.  Only have sex with one partner at a time

Do list
1.  Always wear condom for both oral and vaginal sex
2.  Kissing is allowed areas other than vargina as long as there is no visual symptom of herpes like symptom
3.  Use ky.
4.  In Bangkok, only have sex with people 20-30 age range.  (heard that 20 years ago, std infected population was much higher than now, so I guess I need to stay in this range to reduce the chance of having sex with a person who is std infected.)
5.  Giving masterbation is allowed (do I need to wear condom on my finger to reduce STD infection?)

Base on these rules, I guess I am reducing the risk of getting STD as low as possible. like one in million?
Do you suggest anything more?

Thanks

[Edward W Hook, MD]

We do recommend HPV vaccination for men with multiple partners such as yourself.  The reason the the "official" recommendation is for persons under 27 to get the vaccine has to do with cost effectiveness considerations rather than the effectiveness of the vaccine.   Your circumstance places you at risk for HPV and thus if it is available, I would recommend it.  EWH

[Lukecool]

Dr. Hook,
One last question.
Would you recommend getting HPV vaccination?
I read it somewhere that you can be vaccinated if the person is under 27 and hpv negative.
Thanks

[Edward W Hook, MD]

It is difficult to put a precise numerical estimate on your lifetime risk.  Too many variables. If you do the things outlined above however, your risk for getting any STI will be far, far lower than most persons.  EWH

[Lukecool]

Thanks again for your help.
So if I follow the rules above, do you think the risk of getting sti (other than hsv-1) is less than 0.1 percent in my life time?

[Edward W Hook, MD]

Welcome back to the Forum and thanks for your thanks. We do our best to help our clients.  The steps you outline will certainly dramatically reduce your risk for all STIs, including HIV.  In fact there are a few things you mention that really are not necessary to do to prevent STI acquisition.  

As you indicate, the main thing is regular use of condoms with all casual or new partners.  Other steps will add to this.  However.

1. there are no STIs (other than oral HSV-1 which many [over 60% of the general population] people already have but do not know it) which are transmitted by kissing of any sort, including French kissing.  I would not let concerns about STIs keep me from kissing a partner.

2.  While persons of African ancestry do have higher rates of STIs, this is a result of limited access to health care, not anything else.  I would not feel there is an absolute need to not have sex with any partner on the basis of their ancestry alone.  

3.  for your information, STIs are not spread through masturbation even if you happen to get a partner's genital secretions on you during the activity  and there is no need to not take part in unprotected masturbation.

I hope my comments are helpful to you.  EWH