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Tales from the Tail: STD Prevention in the Raw Era

June 13, 2018 by Dr. Evan Goldstein

The Tale

When someone asks me to sum up my year in one word it’s quite simple, fucked. Lots and lots of fucking. I go through phases, just like everyone else, and I am not proud to admit how many times I got treated this year for the myriad of sexually transmitted diseases. But I must say, I honestly don’t care. Actually, I lied, I partially care, but I am enjoying every minute of it, the sex that is (not the antibiotics). My craving for not only one, but a plethora of rock hard cocks in my ass, cannot even be described in words.

But what I can describe is me: I am 5’10”, 185lbs, and a slight muscular build with an 8″ cock. It’s one of those cocks that’s not too thick, but I do get my fair share of compliments. Now, the interesting thing is in this ridiculous gay world of ours, people look at me as this straight “bro-type” top, who is only down for a pump and dump. But looks can be deceiving, I assure you. I am into the submissive role and only seek to be on the receiving end. Actually, it can take me quite a lot to get off and most of the time my orgasm comes from you filling me up. Psychologically, I have always been this way, with partners of mine sometimes getting frustrated because of my lack of ejaculation.

Regardless, recently I have been seeking out dark dungeons for play in various locations around the city. Tied up in a small room, my hole becomes open for business. It’s such a contrast from my everyday life, one that consists of professional control and dominance. Jesus, it’s to the point where I don’t even care who is behind me – tall, short, older, twink, bear, I love it all. In my mind, the warmth of a cock, any cock, takes precedent.

Unfortunately, with this laissez-faire attitude, it clearly has led me down several interesting evenings, that’s for sure. But getting taken advantage of is part of the risk and the fun quite frankly (my partners always know where to draw the line). I am on PrEP and clearly love it raw, I wouldn’t have it any other way. But with all the action I’m getting, you name the STD and I’ve had it. Recently, I had my tenth visit in five months to my primary care doctor’s office because I was experiencing signs of an infection. It wasn’t a surprise that my STD results came back positive for Chlamydia and Syphilis, so he recommended I see Dr. Goldstein at Bespoke Surgical for a full evaluation, check, and planning.

My initial consultation went on for about an hour with Evan, he prefers going on a first name basis, by the way and we broke down everything I just discussed above, from my current desires, prior preparation steps, acts of engagement, and, finally, my recurrent bouts of infections. We also spoke of some new studies using a kind of a prophylactic approach to taking antibiotics after my sexcapades and we gave it a go. It hasn’t cured me of all infections, but for sure has cut down tremendously on their occurrences. It was just a great evaluation on risk assessing my behaviors in a completely non-judgmental manner. I can’t tell you how refreshing it was to be viewed in this light and it gave me a much broader vantage point on my actions and/or any of its repercussions.

Don’t worry! I am still taking cock in my ass like a champ and more than loving it. Fuck, just writing makes me want some. OK, I’m done. I’m going to get some!

My Discussion

Where to even begin! I think the best would be to first talk about the use of antibiotics after a high risk exposure or, in this case, the client’s routine weekend nights of “opening up”. Last year, a study was released that showed among men who have sex with men (MSM) who were using PrEP and had a median of ten partners every 2 months by taking Doxycycline within 24 hours after sex or up to 72 hours, one can reduce the incidence of contracting Chlamydia by 70% and Syphilis by 73%. Unfortunately, there was no drop in cases of Gonorrhea. Many naysayers are concerned with overprescribing of antibiotics and its effects on not only one’s digestive system, but also the development of a super-resistant bacteria. This approach is definitely not for everyone, but I do think in this client’s current situation, discussing it further was key. We did and he decided to start it. It just made sense for where he was in his desires.

Some other things to think about would be prophylactic use of Valtrex to decrease the development of Herpes Simplex virus or its recurrence. Also, making sure one has had the HPV vaccine, Gardasil, to decrease any new inoculation of specific strains of HPV or potentially any recurrence. The data in support of Gardasil even after the age of 26 continues to be in favor of receiving it. For this particular client, we also spoke of instead of the usual quarterly required PrEP/STD screening program, that we bump his up to every month. I’m a big proponent of being proactive instead of reactive.

Even though we didn’t have time during that initial visit, we did discuss the psychology of a potential sex addiction and what’s really behind him not only wanting it from behind, but specifically putting himself in extremely risky situations. Forget the STDs this was more about not getting killed. He was set up with a therapist who could help navigate safer encounters or, at the very least, how to decrease the risk of any adverse consequences.

Oh, and just a side note, I find it bullshit that we typecast those within our community and pigeon hole someone into sexual preferences simply based on their physical appearance. I am to blame, too, so don’t worry. I haven’t the slightest clue on how to rectify the preconceived judgements, but more to make notice of its occurrence and seek to find a way to prevent doing it in the future. The fluidity of sexuality, gender, and sexual desires is robust and constantly evolving and changing over time. So let’s just admit we do it and try to avoid these notions, making sure we all get our desires fulfilled.


What do you do if you find yourself in a similar situation? Talk to your physician with an understanding that everyone’s sexual acts are different. And that this dissimilarity should not be judged in any way, shape, or form, but rather assess it in a way to minimize any complications. Proactive, thoughtful sexcare is imperative for our community. I say it all the time if you’re not getting the proper care you deserve, then, by God, demand it.

More importantly, we as a community, must educate ourselves on not only the discourse of all of these previous client experiences, but also the treatment algorithms that followed. I feel like now would be a great time for the NBC “The More You Know” slogan. But the reality is, we at Bespoke Surgical are so thrilled to be spearheading the discussions for a better future for our community overall. Fuck on!

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About the Author

Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical. Dr. Goldstein has extensive experience educating and shedding light on health care issues relating to the gay community, and has been published in several national publications including The Advocate, OUT Magazine, Vice, Refinery 29, NY Mag and more.

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