It’s that time again—we’re here to talk about STIs and why you don’t want to catch them all. Recap: STIs (sexually transmitted infections) and STDs (sexually transmitted diseases) are essentially different terms for the same thing—the bacteria, viruses, parasites, and other organisms that can infect people through oral, vaginal, and anal sex. They’re spread through bodily fluids and skin-to-skin contact.
STIs are incredibly common among young people. According to HealthLink BC, almost half of all STIs occur in people under 25 years old. Rates of chlamydia are highest in people aged 20–24 and rates of gonorrhea are highest in women aged 15–19, according to 2013 data from the Public Health Agency of Canada. While that can feel a little scary to think about, the good news is that all STIs can either be cured or managed with treatment. The key is getting tested routinely and treated promptly. Plus, there are a bunch of things you can do to help reduce your risk of getting one or giving one to someone else.
“Think of STIs like other kinds of infections,” says Lizzy Appleby, Youth Program Manager at Angles, a sexual health, identity, and education clinic in Illinois. “You never want to get a cold, so there are some commonsense precautions you can take, like washing your hands or getting enough sleep. But sometimes, even if you do everything right, you still get sick. Then you want to make sure that you don’t make other people sick by covering your mouth when you cough or making sure to go to the doctor.” STIs function in a similar way in that taking precautions is vital to prevent passing them on to others.
Here are seven evidence-backed ways to reduce your risk of getting or transmitting an STI:
1. Get your condom skills on point—and use one every time
Condoms are easy to use, easy to find, and helpful at preventing many STIs and accidental pregnancy—both women and men can use them (one at a time, of course).
External (also known as male) condoms
How to put on a condom may seem like a no-brainer. It isn’t necessarily so. Most condom failures actually result from user error.
Here’s the evidence
- When people feel comfortable with their ability to use condoms correctly, they’re more likely to use them, studies show. So if you’ve never used one, practise putting one on yourself or your partner until you get it right.
- A study involving college men found the following common errors: putting on the condom after starting sex, taking it off before ejaculating, and not leaving a reservoir tip at the end—resulting in condom breakage and slippage (Journal of Sexually Transmitted Diseases, 2010).
- Oil-based lubricants can deteriorate latex condoms and make them more likely to break, according to Planned Parenthood. Stick with water-based or silicone-based lubricants whenever you’re using a latex condom.
Internal (also known as female) condoms
Another—though less well-known—option is the internal condom. These pouch-shaped condoms are made from a soft plastic material and contain a ring at each end. They can be used for vaginal sex or anal sex (you can remove the ring from the open end for the latter), and are a great option for minimizing STI risk and avoiding unintended pregnancy.
Some legit reasons to try internal condoms
- Trying new things is part of sexual experimentation and empowerment. Inserting the internal condom can be fun. Alternatively, it can be put in place up to eight hours before use.
- You or a female partner might get a pleasure boost. The internal condom has a wide, flexible plastic ring that can stimulate the clitoris during sex.
- They’re great for people with latex allergies because they don’t contain latex—they’re made from nitrile (synthetic rubber).
- They are pre-lubricated and can be used with any type of lubricant, including water-, silicone-, or oil-based.
There are three kinds of lubricants, all of which serve a different purpose.
- Silicone-based: Silicone-based lube is super slippery and safe to use with any type of condom, and you don’t need to reapply it as often as other types. It’s also hypoallergenic.
- Oil-based: Always avoid using oil-based lubricants (e.g., massage oil, baby oil, Vaseline) with a latex or polyisoprene condom—it makes them more likely to break. Most lubes are not oil-based, so you don’t have to worry too much when browsing the lube aisle.
- Water-based: Best if you have sensitive skin and generally the most recommended all-purpose lubrication, though it tends to dry up quicker, causing the need to reapply more often.
2. Use condoms and oral dams for oral sex
Consistently using condoms and oral dams considerably reduces your risk of contracting STIs.
Many sexually transmitted infections, such as human papillomavirus (HPV), herpes (HSV), gonorrhea, chlamydia, and HIV (though this is a less-likely means of transmission for HIV) can be transmitted through unprotected oral sex. This is why condoms and oral dams are important for oral sex too.
For oral sex involving a penis, you can use a dry, lubricated, or flavored condom. Putting lubrication inside the condom increases sensitivity for both partners and makes the condom easier to put on. Condoms are available on many campuses for free or at a low cost.
Oral dam option
An oral dam is a thin piece of latex placed over the vulva or anus for oral sex. Oral dams can also lower your risk of STIs (but not pregnancy). You can cut a condom, latex or plastic glove, or plastic wrap (e.g., non-microwavable saran wrap) into an oral dam. Oral dams are available on some campuses for free or at a low cost. They are also available in some health clinics; specialty stores, such as sex toy or condom stores; or online for about $1.50 each.
Good to know
While safer sex practices reduce your risk of STI infection, they do not entirely eliminate it. It’s similar to how washing your hands reduces your risk of catching a cold. It makes a significant difference, but you’re not 100 percent risk-free unless you choose to not engage in sexual contact with people.
3. Get tested for STIs
If you don’t know your STI status
Getting tested may help you subsequently take better care of yourself and others—for example, by curing or managing an infection. Get tested every six months and with every new sexual partner. “Perhaps introduce the idea of going together to get tested to ensure that both partners are being safe. That way, the request will not seem one-sided,” says Hope C.*, a fifth-year undergraduate at Mount Allison University in New Brunswick.
If you test negative for STIs
Remember that viruses (including HIV) can take several months to show up in your blood. For accurate results, repeat the test three months later. Herpes testing is most effective when symptoms are evident.
Here’s some of the evidence
- In a 2010 study involving teens, those who tested positive for an STI and knew their status reduced their number of sexual partners and became less likely to have unprotected sex (Journal of Adolescent Health).
- In a study by researchers at the Johns Hopkins Bloomberg School of Public Health, men who learned their HIV status subsequently reduced their risky sexual behaviours.
Getting tested for and treating STIs is often simple and painless
“The tests that we’re now using are much more sensitive and easier to do than earlier ones,” says Dr. Pierre-Paul Tellier, Family Physician at CLSC de Côte-des-Neiges at McGill University in Quebec. “If you’re concerned about pain, insert those earphones and concentrate on something else and it will be over soon enough.”
If you do test positive, many types of STIs that are common among young people are treatable with medication.
4. Treat current STI infections and avoid sex if you have a genital abrasion
Having genital abrasions (a cut or sore on or around your genital area) or another STI, with or without symptoms, can increase the risk of transmission and makes you a lot more vulnerable to additional infections, including HIV. If you have HIV, being infected with another STI makes you more likely to transmit HIV, research suggests. To lower your risk of HIV infection, treat the STI and avoid sex if you have a genital abrasion.
Lowering the risk of transmission if you have HIV
- If you have a co-occurring STI, treating the STI decreases the amount of HIV particles in your bodily fluids and makes you less likely to transmit HIV.
- Your risk of transmitting HIV is to a large extent determined by your viral load (the amount of HIV particles in your blood). A course of medication called Treatment as Prevention (TasP) can reduce your viral load to a low level, making you unlikely to transmit the infection to another person—including your sexual partners and your baby if you are pregnant or breastfeeding. There is still some risk of transmission, however, so you should continue to use condoms.
The herpes simplex virus (HSV) can also be spread to the genitals via oral herpes (cold sores) on or around the mouth.
The two herpes strains (HSV-1) and (HSV-2) can each cause symptoms and raise your risk of other STIs. If you have a cold sore or blisters on or around the mouth, avoid oral sex, as well as kissing and sharing drinks.
5. Try having fewer sexual partners—and talk to your partners about safer sex practices
The more sexual partners you have, the greater your potential exposure to STIs.
If you or your partner have multiple partners, do this
- Consistently use condoms and/or oral dams. “I always insist that partners use a condom. There’s so much pressure to not use condoms sometimes, but I’m always very clear. We either use a condom or don’t have sex. I’m sure you can imagine which option they choose,” says Mary P.*, a fourth-year undergraduate at Mount Royal University in Alberta.
- Get tested for STIs every six months and/or every time you have a new partner so you can treat or manage any infections early and minimize the risk of health consequences to yourself and others. “The frequency of doing this depends on the number of partners you or your partner has had. The more partners, the more frequent the testing,” says Dr. Tellier.
- Discuss sexual health and safer sex practices with every new partner. “When you first meet someone and decide—key word: decide—to have sex with them, first discuss each other’s sexual history and protection. It’s not the most romantic thing to discuss, but nonetheless, important,” says Dr. Tellier. If you need help getting used to talking about the topic, try practising these convos with your friends first.
Here’s why the risk is higher with multiple partners
- Even if you know a partner’s STI status from recent testing, you can’t know the status of that partner’s other partners.
- Viruses (including HIV) can take several months to show up in your blood; for accurate results, repeat the test three months later. Herpes testing is most useful if it is carried out when symptoms are present.
- You can’t know for certain whether each partner consistently practises safer sex.
6. If you have anal sex, use a condom and lubrication every time
Unprotected anal sex carries a higher risk for STI transmission. The anus does not naturally lubricate; it can tear easily, raising the risk of being infected with HIV, chlamydia, gonorrhea, and other STIs.
To reduce your risk
- Use a condom every time with every partner and plenty of lubrication to reduce microscopic tearing. Silicone-based lubricants tend to be best for anal sex, but water-based ones work well too.
- Use a condom even if you or your partner are on pre-exposure prophylaxis (PrEP) or Treatment as Prevention (TasP); these are daily medications that reduce but do not eliminate the risk of HIV transmission.
- Avoid ejaculating in or near the anus.
- Switch it up: You’re a lot less likely to get HIV via oral sex—although oral sex also carries a risk. Do not go from the anus to the mouth without washing the penis thoroughly in between.
- Do not have unprotected anal sex unless you are in a mutually monogamous relationship, are HIV-negative, and you and your partner are both getting regularly tested for STIs.
7. Men who have sex with men: Take daily preventive medication to reduce risk of HIV
Each of these risk-reduction strategies can provide around 90 percent protection (or more) from the specified danger, various studies suggest.
If you don’t have HIV
Pre-exposure prophylaxis (PrEP) is a course of daily medication for people at high risk of becoming infected with HIV, such as men who have sex with men or anyone who has had sex with an HIV-positive person or person who uses drugs intravenously. When taken as advised by health care providers, the medicine lowers the risk of becoming infected with HIV by up to 92 percent, according to the CDC. If PrEP is not taken consistently, it is much less effective. People taking PrEP should continue to use condoms and get tested for STIs every six months and/or with every new sex partner.
If you have HIV
Treatment as Prevention (TasP) is a course of medication for people who are already infected with HIV. The medicine reduces their “viral load”—the amount of HIV particles in their blood. When taken as advised by health care providers, TasP means you are up to 96 percent less likely to pass the HIV infection on to others, according to the New England Journal of Medicine (2011). People taking TasP should continue to use condoms and get tested for STIs every six months and/or with every new sex partner.
Since we’re talking about dramatically lowering risk, three other STIs can be prevented by vaccines: Hepatitis A, Hepatitis B, and some of the harmful strains of human papillomavirus (HPV). If you haven’t been vaccinated yet, talk to your health care provider about the options. Learn more about these vaccines.
Lizzy Appleby, MA, Youth Program Manager at Angles, a sexual health, identity, and education clinic, Northfield, Illinois.
Joleen Nevers, MA Ed, CHES, AASECT Certified Sexuality Education, Sexuality Educator, Health Education Coordinator, University of Connecticut.
Tara R. Schuster, MS, MCHES, Coordinator of Health Promotion, Rensselaer Polytechnic Institute, New York.
Pierre-Paul Tellier, MD, Family Physician, CLSC de Côte-des-Neiges, McGill University in Quebec.
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