On this page
Condoms and lube
A condom is still 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. It reduces friction, and with it both condom failure and micro-tears in the lining.
No oil, cream or petroleum jelly with latex
Oils degrade latex. Use water- or silicone-based lubricant. Polyurethane condoms are the only ones with documented tolerance of oil-based products — 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 do not mix
Silicone lubricant degrades silicone toys. Use water-based with those.
Check the date, open with your hands
Not with teeth or a fingernail. Keep them away from heat, and not in a wallet for months.
Anal sex
The rectal lining is a single cell layer with a high density of the cells HIV targets beneath it. That is why receptive anal sex carries the highest risk of HIV transmission — not because it is “dirtier”, but because of how the tissue is built.
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 clinical guideline on “safe” douching: no recommended solution, no frequency, no pressure limit. That is not an omission on our part — no such guidance exists. What is known is that frequent, forceful douching damages the lining and is associated with higher infection risk. Less and gentler beats more.
Toys
Soap and water, and a fresh condom when switching person or orifice. No validated disinfection protocol has been published either — this is what health services recommend in its absence.
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 blood pressure to a life-threatening level. This is not a theoretical risk and not a “be a bit careful”. Do not combine them.
Poppers carry other risks too: eye damage with frequent inhalation, and methaemoglobinaemia if swallowed. Never swallow them.
Infections and testing
The most important thing to understand: a large share of throat and rectal infections produce no symptoms at all. A person feels completely well and is infectious at the same time. Regular testing is therefore not reassurance — it is the diagnosis.
What transmits, and how
How often
- Sexually active with more than one partner: every 3 months, per BASHH guidance for men who have sex with men.
- On PrEP this is already part of your regimen — three-monthly testing comes with the prescription.
- In a settled relationship with no new partners: once a year is a sensible baseline.
- Always with a new symptom, and after any contact you are worried about.
Insist on throat and rectal swabs
Urine-only testing misses a large share of infections, because gonorrhoea and chlamydia settle in the throat and rectum, where they most often cause no symptoms.
If you have had oral or anal sex, ask explicitly for a throat and a rectal swab. Not every lab offers them by default and not every doctor will suggest them.
If you are refused, that is a reason to change where you go, not a reason to give up.
HPV and the vaccine
HPV is the most common sexually transmitted infection and most people clear it without ever knowing. Some types, however, cause cancer — in men who have sex with men, chiefly anal and oropharyngeal (throat) 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 in Bulgaria stops at age 13.
- That places every adult gay and bisexual man entirely outside the programme. The UK, for instance, runs a separate programme for men who have sex with men up to 45. Bulgaria has no equivalent.
- That leaves paying privately. The prices we found in Bulgarian pharmacies differ sharply for what is described as the same pack, so we publish no figure — ask in several places.
Sex between women
This section is usually missing, or reduced to one sentence. That omission causes specific, documented harm rather than merely being incomplete.
Infections do transmit between women: HPV, herpes, trichomonas, bacterial vaginosis, syphilis. Bacterial vaginosis is particularly often shared between partners — 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 by skin-to-skin contact, including between women. UK research finds a substantial share of lesbian and bisexual women have been told exactly this by a clinician, and that this group is screened far less often than others. Screening is for every woman with a cervix.
“HIV does not transmit between women.”
The risk is low, but it is not zero. There are documented cases, including one confirmed by genetic analysis of the virus. Low does not mean impossible.
“Dental dams are proven protection.”
There is not a single study measuring their efficacy. That does not make them useless — a barrier is a barrier — but it does mean nobody can honestly tell you by how much they reduce risk. Gloves where there are cuts on the hands, and a condom on shared toys, are equally sensible.
Screening in Bulgaria
- The preventive smear covered by NZOK is for women aged between 30 and 40.
- At 25 or at 45 you are outside that and the test is paid for. This applies to all women, but it compounds the already lower screening rate among lesbian and bisexual women.
- The practical conclusion: if you are a woman with a cervix who has sex with women, go for screening on the same schedule as everyone else, and do not let anyone wave you off with “you don’t need it”.
Chemsex
We cover this because it happens and because silence helps nobody. We are not here to tell you what to do — only to keep you from being harmed.
GHB/GBL has a very narrow margin
The gap between a dose that works and a dose that puts someone unconscious is very small, and alcohol narrows it further. Measure, never eyeball, and never mix 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. Research shows the overwhelming majority of these episodes never reach a medical professional — which is precisely 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. If you are on treatment, check interactions.
If injecting
Never share needles, syringes, filters, water or spoons. Hepatitis C transmits this way.
Bulgaria has no dedicated service
We could not find a single 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.
On status: you cannot compel anyone to tell you, and you cannot tell by looking. Protection is therefore something you owe yourself — condoms, PrEP, regular testing. Someone on successful treatment cannot transmit HIV sexually; someone who has not tested recently does not know their status. The second is the more common case.
The Bulgarian Criminal Code refers to transmitting a “venereal disease” and nowhere mentions HIV or AIDS. We found no Bulgarian court decision interpreting it as covering HIV. For a specific situation ask a lawyer, not the internet.
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 in Bulgarian pharmacies differ by a factor of two for the same pack, so we give no figure.
Sources
Clinical statements here follow WHO, CDC, BASHH and NHS guidance. Bulgarian specifics were checked against official sources on 14 August 2026. Where evidence is absent, that is stated above rather than papered over.