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A birth control pill, a mosquito, an open mouth, a condom, and a bacteria or virus.

Illustrations by Marta Pucci

Sex

STIs: common questions and misconceptions

by Jen Bell, Writer
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Sexually transmitted infections (STIs) are common, but most of us don’t learn much about them at school. In the United States, STI rates continue to rise, with estimates of 20 million new STI cases developing each year, half of which are among young people (1). But young people aren’t the only ones affected: one UK study showed that STIs in people aged 45 and older doubled from 1996 to 2003 (2).

Can you get an STI from a toilet seat?
Can you get one the first time you have sex?
Does the pill protect against STIs?

Read on to get informed and learn how to protect yourself and your sexual partners.

Who gets STIs

Is it true that only people with a lot of sexual partners get STIs?

No. It doesn’t matter if you’ve had sex once or 100 times. STIs can be passed on through unprotected (without a condom) vaginal, anal, or oral sex, by genital contact and through sharing sex toys.

Do only gay men get HIV?

No. Human immunodeficiency virus (HIV) can be transmitted in various ways, including through sex. It doesn’t matter what sexual orientation or gender you are—anyone who is sexually active can be at risk of HIV. Studies show that men who have sex with men are disproportionately affected by HIV, but the virus can also be passed through heterosexual sex, and (rarely) through lesbian sex (3,4).

I’m a lesbian. Can I still get an STI?

Yes. If you have sex with anyone, no matter their gender or genitals, there’s a chance of passing on an STI.

If you’re touching your partner’s genitals, or they are touching yours, then there is a risk of transmitting some STIs (such as HPV, genital warts, chlamydia, herpes simplex virus (HSV) 1 and/or 2, syphilis). Infection risks increase when more fingers or a whole hand are inside the vagina or anus (sometimes called fisting), as this can cause small tears or trauma, which can increase STI transmission (5). To prevent STI transmission, latex or nitrile gloves can be used.

There is also a higher risk of infection if someone puts their fingers in their mouth or a partner’s mouth after touching the genitals or anus, or if there is any oral sex also involved (putting a partner’s genitals or anus in their mouth). For safer cunnilingus (oral sex on a vulva), you can use a dam or cut a condom open. If you’re sharing sex toys, then covering them with condoms is a good way to prevent the development of bacterial vaginosis (BV) or transmission of STIs. Remember to change the condom each time you change partners, or when you change from anal to vaginal use.

How STIs are transmitted

Can you get an STI from oral sex?

Yes. Sexually transmitted infections, including HIV, syphilis, herpes, gonorrhea, HPV, trichomoniasis, and chlamydia, can all be passed on during oral sex (6). Infections can be passed from mouth to genitals, or vice versa. To protect yourself while giving or receiving oral sex on the vulva (cunnilingus) or anus (anilingus), use a dam, or a condom cut lengthwise. For safer oral sex on a penis (blow job) cover the penis with a condom.

Do I need to use a condom for anal sex?

Yes, if you want to avoid STIs. A US study found that when condoms were used for anal sex with an HIV-positive partner, they were 70% effective in preventing transmission of the virus (7). Using a silicone or water-based lubricant can also make anal sex safer, by decreasing the chances of condom breakage. Having anal sex without lubricant, or using saliva or oil-based lubricants, increases the chances of condom breakage (8).

Do I need to use condoms during my period?

Yes, if you want to avoid pregnancy and STIs. It’s possible to get pregnant during your period, although the day-specific risk is variable and depends on your cycle, age, and health.

Clue’s 2018 study with the Kinsey Institute’s Condom Use Research Team found that condoms are used less often (15% less) during menstruation. It is important to use condoms or a barrier during period sex because many STIs (like HIV and hepatitis B and C) can be transmitted through blood. Using a condom for period sex can prevent pregnancy and protect against STI transmission.

Can you get herpes from a toilet seat?

No. Herpes simplex virus (HSV) is spread by direct contact of mucous membranes (the soft tissue located at your genitals and mouth) with a herpes sore, saliva, or genital secretions of a person with a herpes infection. Transmission of herpes usually occurs during kissing, or oral, anal, or vaginal sex.

People are most likely to spread herpes to a sex partner when they have blisters and open sores on their body, but it can also be spread when someone doesn’t have any symptoms. That’s because herpes can be present on the body without causing any symptoms.

Herpes transmission can be reduced by using condoms, and avoiding oral, anal and vaginal sex if there are any blisters or open sores in the genital area or around the mouth (9). There is no risk of becoming infected after exposure to environmental surfaces like door knobs, toilet seats, utensils, drinking glasses, lipsticks, towels, or bed sheets.

Can you get HIV from a tattoo or body piercing?

Yes. There can be a risk for HIV or another blood-borne infection (like hepatitis B or C) if the instruments used for piercing or tattooing either are not sterilized or disinfected between clients. Any instrument used to pierce or cut the skin should be used once and then disposed of safely. If you’re thinking to get tattooed or pierced, ask the staff to show you the precautions that they use. If you’ve have any doubts about the cleanliness of their tools, go elsewhere.

Can you get HIV from a mosquito bite?

No. According to the Centers for Disease Control and Prevention (CDC), HIV is not transmitted by mosquitoes or any other insects (10).

How can I protect myself from STIs?

Does the pill protect against STIs?

No. The pill doesn't protect you or your partner from STIs. External (male) and internal (female) condoms are the only methods of contraception that will help protect you from getting and passing on STIs when you have vaginal or anal sex. You can also use a dam to protect yourself if you have oral sex. If you forget to take a pill or have been vomiting for any reason (e.g. illness), the effectiveness of the pill is lower and you could still get pregnant. If you track taking your pill in Clue, the app will let you know what to do if you miss a dose, including when you need to use back-up protection—like condoms.

I’m in a monogamous relationship. Am I protected from STIs?

No. A monogamous relationship won’t automatically protect you from STIs (or pregnancy). Anyone can get a sexually transmitted infection, sometimes even without noticeable symptoms. Although some STIs produce discharge or other visible signs, it’s not always possible to tell by looking at someone if they have an STI. To be protected from STIs, get yourself and your partner screened for STIs before engaging in any sexual contact, and practice safer sex by always using condoms, dams or gloves.

Do condoms protect against all STIs?

It depends. They are most effective against STIs which are transmitted through bodily fluids.

Consistent and correct use of latex condoms or internal condoms is associated with a significant reduction in STI contraction and transmission (11-15). If you have penis-in-vagina sex with a condom, you are 80% less likely to contract HIV, compared to sex without a condom (16).

Some STIs like herpes, human papillomavirus (HPV), or genital ulcer diseases like syphilis and chancroid, are spread via skin-to-skin contact. If a condom does not cover the infected area, then a condom cannot offer protection from these STIs. However, if the infections are limited to areas where the condom covers, then the risk of spreading these diseases will be reduced (17). Find out here about how to correctly put on a condom.

Can I prevent pregnancy and STIs if I wash my genitals immediately after sex?

No. Many people believe that douching (flushing the vagina with water, soap, or antiseptic) is good hygiene, and prevents infection or pregnancy. Nearly half the women surveyed in one 2008–2010 US study had douched in the past month (18).

However, douching does not prevent pregnancy and can actually create a higher risk of STI infection (19, 20). Douching alters the vaginal flora and increases the likelihood of developing bacterial vaginosis (BV) (19). Douching is associated with ectopic pregnancy, low birth weight, preterm labor and preterm birth, and an increased risk of cervical cancer, pelvic inflammatory disease, and endometritis (19).

Are there any ways to be sexual that don’t have an STI risk?

Yes. There are lots of ways you can be sexual and stay safe. Solo masturbation, dry-humping (rubbing genitals with clothes on), sexy talk, massage (without touching genitals) and cuddling are just some of the things that you can do that won’t spread STIs.

STI symptoms, testing, and treatment

How can I tell if I have an STI?

Get tested! Often, STIs have no obvious symptoms. This means it’s not possible to tell if someone else has an STI or not, and often the person with the STI doesn’t know either—but they can still pass the infection to someone else. The only way to know is to get tested. This is why it’s important to have safer sex, if you want to prevent STIs being passed on.

If I have an unusual rash, pain, or discharge, does that mean I have an STI?

Maybe. Sometimes STIs do cause problems that you might notice. These symptoms don’t always mean you have an STI, they could indicate another health problem such as a yeast infection or UTI.

If you have any of these symptoms on or near your genitals, anus, or mouth, see your healthcare provider:

  • Pain
  • Swelling
  • Bumps, sores, or rashes
  • Itching and/or burning
  • Pain or burning when you urinate
  • Vaginal discharge that has a different smell, color, or texture
  • Bleeding from your genitals (that is not your period)

Is getting an STI test painful?

No. Tests for many STIs are as quick and easy as giving a urine sample, while some tests might also involve having blood taken. Your healthcare provider might also do a visual examination to look for signs of infection, or use a swab (like a small, soft cotton bud) on the genital or mouth area. In some places home testing kits are available, so you can get tested without leaving home. Look for a service that offers support and treatment in case that is needed after testing.

Do STIs go away on their own?

Not usually. It’s very unlikely that an STI will go away by itself, and if you delay seeking treatment there’s a risk that the infection could cause long-term problems. Even if you don’t have any symptoms, there’s also a risk of passing the infection on to partners.

If you think you might have an STI, see your healthcare provider and get it checked out. If STIs are left untreated, they can pose a long-term risk to your health and fertility, so it’s important to get tested regularly. Chlamydia and gonorrhea can both lead to pelvic inflammatory disease (PID) if they are not treated. This can result in long-term pelvic pain, blocked Fallopian tubes, infertility, and ectopic pregnancy.

Human papillomavirus (HPV) is a very common STI that is often transmitted during sexual intercourse. The majority of HPV infections clear up within two years, and do not cause any diseases or symptoms (21, 22). However, this is not always the case, as some type of HPV may have long term consequences. Two strands in particular, HPV 16 and HPV 18, are responsible for 7 in 10 cases of cervical cancers and precancerous changes (23,24). These strands of HPV have also been associated with cancers of the anogenital region and oropharynx (throat tissue) cancers (23,24). Other strands, such as HPV 6 and HPV 11, are responsible for genital warts (21).

Can all STIs be cured by antibiotics?

No. Many STIs can be cured if caught in the early stages, and the treatment may be as simple as being prescribed a course of antibiotics. But medicine cannot cure all STIs, so prevention through safer sex is the best option. For example, there is no cure for genital herpes. Antiviral medications can be used to prevent or shorten herpes outbreaks, but the disease cannot be eliminated from your body (25). There is also no cure for HIV, but there are antiretroviral medications that reduce the amount of virus present in the blood. This therapy slows down the progression of the disease and works to also reduce the chance of transmitting the disease to any future partners (26).

Are STIs something to be ashamed of?

No. STIs are illnesses, just like the common cold or the flu. STIs are passed on by unprotected sexual contact with someone who has an infection. Getting an STI has nothing to do with cleanliness or grooming, and getting an STI test is not a reflection on your behavior—it’s a responsible health choice. Get tested regularly, and don’t forget to talk to your partners about STIs and safer sex. We wrote a guide about how to do that.

If you’re looking for more information, check out our mythbusting articles about condoms and about how pregnancy happens.

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