Cases of sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), are rising. In 2021, an estimated 2.5 million cases of chlamydia, gonorrhea and syphilis — the three most common STIs — were reported in the U.S.1 Unfortunately, this spike is not new, as Americans reported record-high STI numbers every year from 2015 to 2019.2 On an international scale, the World Health Organization (WHO) estimates that over 1 million STIs are spread daily worldwide.3
In the battle against this rising endemic, improving STI awareness, safe sex practices and screening numbers are our greatest defense.
While the best protection from STIs is abstinence, which means not having sex of any kind, there are ways to protect oneself during sex, whether oral, vaginal or anal. Anyone sexually active should stay up to date on their STI status with the help of regular STI screening tests. Since most STIs can be asymptomatic, screening tests are not just necessary for those with symptoms.4 This awareness provides the opportunity to seek treatment for STIs before engaging in further sexual activity and unknowingly spreading it to others.
STI screening is easier than ever thanks to kits like imaware's at-home Complete STI Test. No clinic visit is necessary, as users collect their sample at home, mail it to one of imaware's certified labs, and receive fast digital results with optional telehealth support.
Generally, the CDC recommends a minimum testing frequency of 12 months for those who are sexually active.5 However, this recommendation changes depending on STI type, HIV status, and other personal and lifestyle criteria. Specific CDC testing recommendations include but are not limited to:6
- Individuals at higher risk, such as people with multiple, new or unknown partners, should be screened every 3 to 6 months.
- Sexually active women and men who have sex with men should be tested yearly for at least chlamydia and gonorrhea.
- Pregnant individuals should be screened for STIs early in the pregnancy and repeated as needed.
Testing frequency can vary over a lifetime as a person may find themselves with multiple new partners or entering into a long-term monogamous partnership. Whatever the arrangement, staying current and knowing how quickly one's STI status can change is vital.
Individuals with new partners are at higher risk because, even with protection, there is still the risk of transmission. To reduce this risk, ensure new partners have recently been tested.
Encouraging friends and loved ones to get tested is important too. Unfortunately, a high level of stigma and shame is associated with STIs, especially among young adults.7 Advise others to add STI screening to their regular health check-up routine — it will help protect them and their partners while working to destigmatize the testing process.
Once STI testing is complete, waiting for results can be stressful and uncomfortable. The estimated wait time for results will depend on the testing location, the STIs included in the screening and the screening method. For example, some urine and swab test results return in seven to ten days, while blood tests may take up to 14 days.8
Testing positive for an STI may feel overwhelming, but try to remember that STIs are common, there is nothing to be ashamed of and getting tested is the best thing to do. Move beyond the results with three key post-screening tasks:
- Treatment: A healthcare provider can walk through the treatment options. Many STIs are treatable with antibiotics prescribed by a healthcare professional,9 while others, like HSV-1 and HSV-2, are managed with antiviral medication.10
- Treatment is not just necessary to prevent transmission — untreated STIs can have serious long-term health consequences, like increasing the risk of developing human immunodeficiency virus (HIV).11 For those with a female reproductive system, STIs may cause pelvic inflammatory disease (PID), with side effects like chronic pelvic and abdominal pain, scarred fallopian tubes, infertility and risk of pregnancy complications.12 Other common conditions associated with untreated STIs include epididymitis, proctitis and more.131415
- Informing others: In addition to seeking treatment, it is essential to notify any past or current partners potentially affected by this diagnosis so that they may seek testing immediately.16
- Retesting: It is important to retest for certain STIs after treatment. Individuals who tested positive for chlamydia, gonorrhea or trichomoniasis, for example, should be rescreened three months after treatment.17
After treatment, no immunity develops, meaning it is still possible to contract the same STI in the future. For example, in three separate studies, chlamydia was found to have reinfection rates ranging from 10% to 26% within a year or two after the initial positive test.181920 Individuals who test positive should discuss preventing reinfections during and after treatment with their healthcare providers.
Practice safe sex
Practicing safe sex means using methods that reduce the risk of spreading STIs during sexual activities.21 In addition to regular screenings, practicing sex safe by using protection is integral to STI prevention.
Protection during sex is essential, though be aware that the different forms of protection available have varying purposes. Intrauterine contraception (IUDs), oral contraception (birth control pills) and other hormone-based protection methods, for example, help prevent unplanned pregnancy but do not protect from STIs as no physical barrier is involved.22 A diaphragm, another form of contraception, is a barrier placed inside the vagina to block off the cervix. However, since bodily fluids are still shared, diaphragms do not protect from STIs.23 Suitable forms of STI protection require more complete barriers like condoms or dental dams, which prevent partners from sharing bodily fluids.
One of the most recommended types of protection is the male (external) condom, which helps prevent pregnancy and STIs. In the 2021 Family Planning Report, 42% of male respondents say they use condoms as their primary method of protection24 — a concerning drop from the 65% reported in 2016.25 As the best method of protection from STIs, increasing condom use is integral to promoting safe sex.26
Male condoms provide a fitted single-use barrier, going on the tip of the penis and rolling down the length. They are made primarily with latex, a soft white substance found in rubber trees that is both stretchy and secure.27 Lambskin, polyurethane and polyisoprene condoms are non-latex alternatives for individuals with latex allergies or sensitivities.28 Lambskin condoms, made of sheep intestines, are ineffective against STIs due to porous holes in the material. Polyurethane condoms are more effective than lambskin, though they have a looser fit and high slippage and breakage rate. One study found that the breakage rate of non-latex condoms was eight times more frequent than latex condoms.29 Polyisoprene, a synthetic rubber, is likely the best non-latex option for STI prevention; however, latex condoms are still generally recommended over all alternatives.
To get optimal protection with condoms, users must abide by the following instructions:30
- Apply the condom carefully and correctly — detailed instructions are available.
- Use only one condom at a time as doubling up decreases rather than doubles the protection. This rule applies to internal condoms as well.31
- Apply the condom before sex and keep it on for the duration.
- Use each condom only once and dispose of the condom immediately after use.
- Do not use it if the condom appears damaged in any way.
- Do not use expired condoms, as the material breaks down over time and becomes less effective.
A less common form of condom is the female condom, or internal condom, which goes inside the vagina (or anus during anal sex) to create a barrier from the penis.32 When used correctly, following similar rules as the external condoms, the internal condom is about 95% effective at protecting against STIs.33
Oral sex, which means using the mouth to stimulate the genital or genital area of a partner, requires protection too. This is because STIs, like chlamydia, gonorrhea, syphilis, herpes, HPV and HIV, can spread through oral sex, infecting the mouth and throat as well as the genitals and rectum.34 In addition to condoms, dental dams are another form of protection usable during oral sex. Dental dams are single-use sheets of latex or polyurethane that act as barriers between the mouth and vaginal or anus.35
The term "safer sex" is often preferred over "safe sex" to clarify that many safe sex practices do not entirely reduce STI transmission risks.
Just as condoms are not 100% guaranteed to prevent pregnancy — they are about 98% effective when used correctly36 — there is still the risk of STI transmission. Condoms can also slip or break, particularly if mishandled or misused.37
Even if a condom effectively prevents sharing bodily fluids, certain STIs, like human papillomavirus (HPV), genital herpes, genital warts and syphilis, spread through skin-to-skin contact.38 That is not to say condoms are useless against these STIs as they still reduce the risk if the infected area is protected, but be aware they are not unfailing.39
Though kissing is considered lower risk than sex, it is possible to spread certain STIs this way. The STI most easily spread through kissing is herpes simplex virus 1 (HSV-1), also known as oral herpes. HSV-1 is a prevalent STI — the World Health Organization estimates that two-thirds of the world population under 50 already have it40 — and it can spread through saliva.41
When it comes to sexual contact, always examine the associated risks and consider how to mitigate them.
As cases continue to rise in the United States, implementing safe sex practices and regular testing procedures are vital. Correctly using condoms can help avoid transmission, though they are not infallible. As condoms are not guaranteed protection and since many STIs are asymptomatic, adding routine STI screenings is one of the best ways to prevent potential long-term health consequences. STI screening frequency may vary by person, but annual screenings are necessary for anyone who is sexually active and not in a long-term monogamous partnership. STI prevention is a lifelong practice that involves a combination of STI status awareness, safe sex precautions and retesting to stay up to date.