Ask the Doc: Sex, Coffee and STI Testing

In this installment of "Ask the Doc," Dr. Howard Scheiner lets readers know how often they need to be tested for Sexually Transmitted Illnesses (STI), even if they're on PrEP. Plus, can coffee make sex better?

How Often Should We Test for STIs?

Q: Dear Doc, My partner and I are having lots of sex recently, especially now that our summer Fire Island share has begun. We are into threesomes and groups and also play separately. I'm not concerned about catching HIV (he's positive) since I'm taking PrEP. But, my question is how often should we be getting tested for other sexual diseases?

A: General guidelines recommend getting tested yearly for HIV-infected patients who are sexually active and two to four times yearly for those with risky behavior. I would think the same frequency of testing should be recommended for someone with higher risk activity, who is negative and on PrEP.

CDC investigators examined the frequency of testing among sexually active patients using data from the nationwide Medical Monitoring Project. Investigators found a low testing frequency among not only sexually active HIV-infected patients but also among those at elevated sexual risk. Over a 12 month period only 55 percent had at least one syphilis test, 23 percent at least one gonorrhea test and 24 percent one chlamydia test.

It would seem that lots of people need to step up their testing frequency. Taking PrEP would not seem to alter the frequency of acquiring other sexually transmitted infections (STI's), based upon the results of the PROUD study (done in England and France).

With the high rates of syphilis and other bacterial STI's, documented among HIV positive individuals, I would choose every three months if you have higher risk behavior.

Of course, testing should always be done if you have developed symptoms, especially for pain or burning on urination, rectal pain or discomfort; discharge from the penis or rectum, sores, or rashes. So, as always, see your private physician or clinic if you have any questions or concerns about your sexual health.

Coffee, Tea or Me?

Q: My boyfriend has insisted that I start drinking more coffee to help erections ever since he heard a report on the news recently. So, is it true that drinking more coffee will help me be harder longer?

A: That's a maybe-yes answer as there is some truth to what he is saying. A study from the University of Texas Health Science Center at Houston, found that men who consumed more daily caffeine had a lower risk of erectile dysfunction (with the exception of men who had diabetes where caffeine didn't improve the odds).

About 3,700 men tracked by the U.S. National Health and Nutrition Examination Survey answered questions about their coffee intake and ED.

Men who reported consuming 8 to 170 milligrams of caffeine a day were 42 percent less likely to report ED than those reporting zero to 7 milligrams of caffeine a day.

Based upon this study drinking two to three cups of coffee a day might significantly reduce the risk of impotence. Drinking three to five cups a day reduces the risk of type 2 diabetes and heart disease per the U.S. Dietary Guidelines Advisory Committee.

This is not a prospective study with a control group, meaning that I wouldn't start drinking more coffee than I normally do based upon these findings. Also, this much coffee is not necessarily good for everyone. Individuals with acid reflux, heartburn, gastritis or ulcers will need to stay away. Again, check with your own physician to see what is best for you.