Condoms and lube
A condom is the only thing that protects against HIV and most other sexually transmitted infections at the same time. PrEP protects against HIV only.
Lubricant is not an extra — for anal sex it is part of the safety. Less friction means fewer broken condoms and fewer micro-tears.
No oil, cream or petroleum jelly with latex
Oils degrade latex — use water- or silicone-based. Tolerance of oils is documented only for polyurethane; treat polyisoprene as having the same limitation as latex.
More lubricant than you think
The rectum does not self-lubricate. Too little lube is the main cause of condom breakage during anal sex.
Silicone lube and silicone toys
It degrades them. Use water-based with those.
Check the date, open with your hands
Not with teeth or a fingernail. Away from heat, not in a wallet for months.
Anal sex
The rectal lining is a single cell layer, and beneath it sit exactly the cells HIV targets. That is why receptive anal sex carries the highest risk of HIV — because of how the tissue is built, not because it is “dirtier”.
It is also why PrEP makes particular sense here, and why lubricant is not a luxury.
If it hurts, stop
Pain is not something you push through. It means tension or not enough lubricant. Slow down, add more, pause.
On douching — honestly
There is no published guideline on “safe” douching: no solution, no frequency, no pressure limit. All that is known is that frequent, forceful douching damages the lining and is associated with higher infection risk. Less and gentler.
Toys
Soap and water; a fresh condom when switching person or orifice. No validated disinfection protocol has been published either — this is what health services recommend.
Poppers — the one thing that can kill you
Never together with Viagra or Cialis
Poppers (alkyl nitrites) dilate blood vessels and drop blood pressure. Erectile drugs — Viagra (sildenafil), Cialis (tadalafil) and their relatives — do the same.
Together they can drop it to a life-threatening level. Do not combine them.
They carry other risks too: eye damage with frequent inhalation, and methaemoglobinaemia if swallowed. Never swallow them.
Infections and testing
A large share of throat and rectal infections cause no symptoms — you feel well and are infectious. Testing is not reassurance; it is the diagnosis.
What transmits, and how
How often
- More than one partner: every 3 months (BASHH, for men who have sex with men).
- On PrEP: every 3 months, it comes with the prescription.
- Settled relationship, no new partners: once a year.
- Always with a new symptom or a contact you are worried about.
Insist on throat and rectal swabs
Urine-only testing misses a lot: gonorrhoea and chlamydia sit in the throat and rectum, where they stay silent.
After oral or anal sex, ask explicitly for a throat and a rectal swab — they are not done by default.
If you are refused — change where you go, do not give up.
HPV and the vaccine
HPV is the most common sexually transmitted infection; most people clear it without knowing. Some types cause cancer — in men who have sex with men, chiefly anal and throat (oropharyngeal) cancer.
The vaccine works and is most effective before sexual activity begins, but it still has value later. It does not treat an infection you already have — it protects against the types you do not.
The gap in Bulgaria
- Free vaccination for boys stops at age 13.
- Every adult gay and bisexual man is outside it. The UK runs a separate programme for men who have sex with men up to 45; Bulgaria has none.
- That leaves paying privately. Pharmacy prices differ sharply for the same pack — ask in several places.
Sex between women
This section is usually missing — and that causes documented harm.
HPV, herpes, trichomonas, bacterial vaginosis and syphilis all transmit between women. Vaginosis especially often: studies find a high degree of vaginal flora concordance in couples.
Three things repeated often that are not true
“Lesbians do not need cervical screening.”
False, and harmful. HPV transmits skin to skin, including between women. UK research finds a large share of lesbian and bisexual women have been told exactly this by a clinician, and that they are screened far less often. Screening is for every woman with a cervix.
“HIV does not transmit between women.”
Low risk, but not zero. There are documented cases, one confirmed by genetic analysis of the virus. Low does not mean impossible.
“Dental dams are proven protection.”
There is not a single study of their efficacy. A barrier is a barrier, but nobody can say by how much it protects. Gloves where there are cuts on the hands, and a condom on shared toys, are equally sensible.
Screening in Bulgaria
- The smear covered by NZOK is for women aged between 30 and 40.
- At 25 or at 45 you pay. That applies to everyone, but it compounds the already lower screening rate among lesbian and bisexual women.
- A woman with a cervix who has sex with women screens on the same schedule as everyone. Do not let anyone wave you off with “you don’t need it”.
Chemsex
We cover this because it happens. Not to tell you what to do — to keep you safe.
GHB/GBL has a very narrow margin
The gap between a dose that works and one that puts someone unconscious is very small, and alcohol narrows it. Measure, never eyeball, never with alcohol. Stay with whoever has taken it.
If someone goes under — call 112
Do not let them “sleep it off”. Put them in the recovery position and get help. The overwhelming majority of these episodes never reach a medical professional — that is what makes them dangerous.
HIV medication interacts
Ritonavir and cobicistat (boosters in some regimens) slow the breakdown of several recreational drugs and can multiply their blood levels. A fatal interaction between ritonavir and MDMA was reported in The Lancet in 1998. On treatment, check interactions.
If injecting
Never share needles, syringes, filters, water or spoons. Hepatitis C transmits this way.
Bulgaria has no dedicated service
There is no Bulgarian service working specifically on chemsex. The nearest are general addiction support and CheckPoint Sofia for sexual health.
Consent and talking
Consent runs throughout, not once at the start. It can be withdrawn at any point, including midway, including without explanation. Consent from someone very drunk or very high is not consent.
You cannot compel anyone to tell you their status, and you cannot tell by looking. So: condoms, PrEP, regular testing. Someone on successful treatment cannot transmit HIV sexually; someone who has not tested recently does not know their status — the more common case.
The Bulgarian Criminal Code refers to a “venereal disease” and nowhere mentions HIV or AIDS. We found no Bulgarian decision interpreting it as covering HIV. For a specific situation ask a lawyer.
For PrEP, PEP and “undetectable = untransmittable”, see the HIV centre
What we do not know and do not claim
- There is no published clinical guideline on safe rectal douching — no solution, no frequency.
- There is no study measuring how much dental dams reduce risk.
- There are no reliable per-act transmission figures for oral sex for any specific infection.
- We could not confirm whether mpox vaccination is available to an individual in Bulgaria today.
- HPV vaccine prices differ by a factor of two for the same pack, so we give no figure.
Sources
We follow WHO, CDC, BASHH and NHS guidance. Bulgarian specifics were checked against official sources on 14 August 2026. Where evidence is absent, we say so rather than paper over it.
Read next
- HIV & PrEPPrEP, testing, and what “undetectable” means
- OrganisationsWhere to get tested free and anonymously
- Mental healthThe shame around sex is its own subject