If its optional to be gay in the game then it should also be optional to persecute gays in the game.
Why can't i hunt down all the gays in the game as an "optional" side quest? why can't i roleplay as a homophobic priest? why can't i report Hans to the Church for being gay? its all just "optional" right?
That's more applicable to modern faggotry, though. Antibiotics weren't really a thing in medieval or renaissance times.
I'm not sure what kind of STDs were common during that period in Europe. Definitely not AIDS, but perhaps something like syphillis, which was brought there from South America at the tail end of the fifteenth century. There were likely many other diseases as well, considering that even an ancient book like the Bible condemns sodomy.