A guide to preventing, spotting, and managing STIs
STIs are normal—let’s get over it.
Our society doesn’t do a great job teaching people about sexually transmitted infections. Sexual education classes, doctors, parents, and pretty much everyone who talks about sexual health tends to emphasize the importance of condoms, testing, and talking to your partners. But if you’ve ever had an STI, you know things can be more complicated than that.
No matter where you turn, it can be hard to find useful, accurate information about what you should be doing and how risky certain behavior is. Not only can the internet be a cacophony of confusing information, but social stigma can even make doctors feel awkward asking about their patients’ sex lives.
But the more empowered you feel to take the reins of your sexual health, the safer you and your partners will be.
STIs are mostly not a big deal
The first thing you need to understand is that the deeply ingrained notions that STIs are dangerous, will scar you for life, and only happen to “promiscuous people” are not statements based on scientific evidence. They’re unwarranted cultural fears. And they’re mostly wrong.
Chlamydia and gonorrhea, two of the most common STIs, can certainly cause serious irreversible damage if they go untreated or infect someone who’s pregnant. But if you seek medical care as soon as you notice symptoms, both of these bacterial infections are totally curable with medication.
[Related: The CDC needs the public’s help to reverse the upward trend in STIs]
Viral infections such as human papillomavirus (HPV), herpes (both oral and genital), and HIV are a little more complicated because there’s currently no cure for any of them. In the case of HPV and herpes, most patients are asymptomatic, and those who show symptoms may develop lesions that heal with treatment, and warts that are easily removable with cryotherapy.
“It might feel a bit scary at first because there’s so much stigma around STIs, but if you’re healthy, then you are not going to see too many outbreaks,” says Sofia Jawed-Wessel, co-director of the Midlands Sexual Health Research Collaborative at the University of Nebraska Omaha.
In the case of HIV, what was once known as a death sentence is now a disease that millions of people around the world manage day-to-day with antiretroviral therapy. This usually entails taking daily medication to reduce their viral load, which can shrink to a point where HIV cannot be detected in their blood.
Now, don’t take this as an excuse to stop trying to keep you and your partners away from STIs. You should always aim to take care of yourself and stay healthy, but it’s good to know that getting an STI is not the end of the world. As long as you seek timely medical treatment, you’ll be fine in no time, Jawed-Wessel says, and yes—you’ll be able to have sex again.
Get tested regularly
The cornerstone to good sexual health is to get tested for STIs regularly—Jawed-Wessel recommends every six to 12 months depending on your lifestyle and your sexual relationships. But it’s even more important to get tested between partners and take care of any potential issues before engaging in sexual activity with someone new, she says.
If STI testing is part of your yearly checkup with your primary care physician, keep in mind that you’re likely not getting tested for two of the most prevalent and well-known STIs: herpes, and HPV. That seems counterintuitive, but there’s a reason for that.
Herpes, for one, is diagnosed with visual confirmation of bumps and lesions, which doctors can swab to detect the virus. There is a blood (serology) test for herpes, but the Centers for Disease Control and Prevention—and most physicians—don’t recommend it.
“When someone’s not having an outbreak, we have to rely on serology, and those tests are not as reliable,” says Hillary Reno, medical consultant to the CDC’s STD prevention division, and medical director of the St. Louis County Sexual Health Clinic in Missouri. “You get false negatives and false positives, and both of those have consequences for people.”
When asymptomatic, there’s a 10 percent chance you’ll transmit herpes to a partner, but those odds decrease significantly when you use a barrier such as a condom or a dental dam. If you haven’t had any symptoms, the best way to take care of yourself and protect your partners is to watch for signs of an outbreak and seek medical attention as soon as anything seems off.
Testing for HPV is also complicated, as there’s no blood test for it, and the only way to diagnose the infection is by performing a pap smear on people with cervixes. But this STI can exist outside of the vulva and in penises and testicles, and there’s no way to know for sure if it’s there unless there’s an active outbreak. This, and the fact that 90 percent of HPV patients don’t have any symptoms, is what makes the virus so common.
“Most people who are sexually active have HPV already and don’t know,” says Jawed-Wessel.
Each time one of those asymptomatic people has sex, there’s a 70 percent chance they spread the virus. The good news is that 90 percent of all cases go away on their own within two years, and there’s an effective vaccine that can prevent infection. Only some of the 100 known types of HPV are associated with cervical and anal cancer, but Jawed-Wessel says you should not be alarmed, as those cancers grow slowly. Observant doctors should be able to catch them before they spread too far.
You probably know this one: use a condom or a dental dam, and use it appropriately. There are a lot of resources online that explain how to put on a condom correctly, and if you haven’t heard of dental dams, this is a great time to learn what they are and how to use them properly.
These kinds of barriers significantly lower your risk of contracting an STI, but they’re not completely effective.
“It’s not that the condom isn’t fully protective,” Jawed-Wessel explains. “It’s just that it doesn’t cover all the external genitalia where a wart might be present.”
This is especially true with HPV and herpes, which you can transmit via simple skin-to-skin contact. Additionally, herpes can easily go from the mouth to the genitals, and vice versa, when performing or receiving unprotected oral sex, which is what the majority of adolescents and young adults do in the US, according to a 2018 study in the Journal of Adolescent Health.
Talk to your partners
Every sexual encounter is a vulnerable experience, and talking to your partners about your STI status can be equally scary. Ideally, you’ll choose to have sex with people you know and feel safe discussing your sexual health history with. But life is not always ideal, so you may find yourself about to engage in sexual contact with people you don’t know that well, or at all.
Regardless of whether they’re a longtime partner, a sporadic fling, or a one-night stand, you should always have a conversation about your—and their—STI status. Having an STI doesn’t mean you’ll never be able to have sex again—it means you have a responsibility to provide your partners with all the information they need to make their own decisions about the risk they’re willing to take.
First, if you have an active outbreak and you’re starting out with a new partner, there’s no conversation to have—just don’t engage in sexual behavior until the outbreak disappears.
“Just don’t. It’s not ethical,” says Jawed-Wessel. ”Wait until you’re treated and the lesion has dissipated or the wart has been removed.”
If you discover you have an STI while in a monogamous relationship, tell your partner so they can get tested and treated if they need to. With more information and an updated STI status, you can make decisions about how to move forward—what risks you are willing to take, what activities are off-limits, and what precautions you’ll take to prevent future infections.
Starting with new partners is similar: before things get hot and heavy, take the time to hit pause and have a conversation. It doesn’t have to be serious and awkward. Remember—consent is sexy, and if you want to have a quick conversation about health without killing the mood, you certainly can.
Make sure that before there’s any skin-to-genital contact, you tell your partner about your STI status and ask them about theirs. Ideally, this conversation should happen in a neutral context, where no one is intoxicated or distracted by the heat of the moment, as that can prevent you from thinking clearly. But again, ideal scenarios don’t actually happen as often as we’d like, so just keep in mind that having the conversation at some point is what’s most important.
Finally, even though full disclosure is absolutely necessary, it’s crucial to understand that depending on who you are and who you’re having sex with, revealing that information can be more than awkward—it can be dangerous.
“We can say ‘Yes, disclose 100 percent of the time,’ but you can’t give that advice without respecting and honoring that it’s a different level of risk that people take just by giving that information,” says Jawed-Wessel. “A trans person or a trans person of color who is about to engage in a sexual activity is in a different threshold of risk than say, a white cis[gender] man.”
Talk to your doctor
When it comes to your health, a doctor may be the best source of information and the person we should go to with all your questions and concerns. Unfortunately, some physicians don’t provide all the answers or support we need regarding STIs and sexual health.
This is especially problematic when people use negative STI results as a “clean bill of health,” but don’t even know exactly what they were tested for.
“There’s so much stigma around [STIs] that people are afraid to talk to their clinicians about testing, and the clinicians are afraid to bring it up, too. That communication piece is missing,” says Reno.
She explains that the CDC offers health professionals comprehensive guidelines to treat and inform patients about their sexual health, and the agency updates those every few years to match the latest research. The problem is this information doesn’t reach all medical workers, and some don’t even know it exists. This is why people who get tested for STIs at their yearly checkups with their primary care physician might not have the best experience, and—not knowing what to ask—leave the office scared and confused.
Both Reno and Jawed-Wessel say it’s important to ask your doctor all the questions you have, be that during the visit or later through email or a phone call. If you still have questions or don’t know what to ask, Reno says asking for a referral to a specialist is a good idea, while Jawed-Wessel also suggests reaching out to specialists directly.
“Just because you didn’t get your test done at Planned Parenthood or another specialized health clinic doesn’t mean you can’t call them for a consultation, education, or treatment,” she says. “They’ll set you up with somebody who is informed and trained on how to have this conversation with you, and they’re going to do it right.”
Keep in mind that the information you need might not be health-related only, but more closely related to your lifestyle or sexual goals. This is why talking to a doctor may not even be necessary—sexual educators, nurses, and other trained specialists can also give you the answers you need.
Know your body
When a new coffee shop opens in your neighborhood, or the grocery store around the corner from your office suddenly becomes a restaurant, you notice. Intimate knowledge of a place helps you spot changes more easily—your body is no different.
“The more familiar you are with your body, the better,” says Jawed-Wessel. “Know how it looks, how it feels, how it smells.”
She recommends not only looking at your naked body in the mirror consistently but also touching it in any way you want so you know each and every one of your bumps.
“Not all bumps are warts or lesions! We have moles around our penises, vulvas, and testicles. Those exist. Know where they are. Being really familiar with your body is going to help you understand when something might not be right. And this goes beyond STIs,” she says.
Sex with another partner is also a good opportunity to take a closer look at them, as there are rarely other instances where you’ll be more up close and personal. You can help each other keep tabs on the changes in your bodies, as there are parts of your own body you simply cannot see as well as someone else can.
You can’t eliminate all risk
Anything worth doing involves some level of risk. You can try to eliminate it, but sooner or later you’ll find that’s usually impossible. So we do our best to manage and minimize it to a point where we feel safe and comfortable. The same can be said for sex.
“Everybody should assume that the person you’re having sex with has some form of STI, if not multiple forms. And if we haven’t been tested recently in between partners, then we should assume we also have an STI,” says Jawed-Wessel.
[Related: Stop being stupid about STIs]
Withdrawing from sexual contact until both you and your partner have been tested is the best thing you can do. But even then, sneakier viruses such as HPV and herpes may be a part of the equation without either of you knowing it.
So make sure you know the level of risk you’re willing to take. If you’re healthy, using protection, and don’t mind a potential 1-in-10 chance that you might get herpes from having sex with someone you really like, that’s great for you. If to the contrary, you don’t like those odds and would prefer to abstain, that’s your choice as well.
It may require some soul-searching to decide what you want, but knowing the facts and communicating with your partners openly and honestly is crucial to having a fulfilling, pleasurable, and healthy sex life.