What advice would you give to a person who is just becoming sexually active and wants to avoid getting an STD?
In truth, there is no simple one-size-fits-all strategy for avoiding STDs. The best approach is probably to start by understanding the factors that determine your risk of acquiring an STD and then to think about the precautions you might take to lower it. As far as the first point, the basic principle is this: The more sexual partners you have, the more likely you are to acquire a sexually transmitted infection. Herpes is a good example. Among people who so far have had only one sexual partner 10% are infected. Among those with five to nine partners, 26% are infected, and among those with 10 to 49 partners, 31% are infected.
Making decisions about your own risk for STDs requires that you know something about your partner’s history – how many people he or she has had sex with, any past history of STDs, and so on.
So what can you do – other than stay celibate?
The most effective all-around form of protection against STDs is the use of condoms for penetrative sexual acts such as inserting the penis in the vagina, anus, or mouth (fellatio). Condoms provide a barrier between the penis and the susceptible mucosal tissues of the vagina, cervix, anus, and mouth and stop the exchange of potentially infectious fluids such as semen, vaginal secretions and blood.
This is true of the traditional male latex condom and also the newer polyurethane condoms, including the female condom that came onto the market in the mid-1990s. Natural membrane condoms do offer some protection against STDs, but during the 1980s, research showed that microscopic pores in these devices were actually larger than some of the sexually transmitted viruses, such as hepatitis B and HIV. For this reason, public health officials began to specify latex condoms in their efforts to stop the spread of HIV and other STDs. The newer polyurethane condoms haven’t been studied as thoroughly as latex condoms, and they appear to have higher failure rates. The U.S. Centers for Disease Control and Prevention recommend latex condoms for STD prevention over condoms made with other materials.
When are condoms effective and when aren’t they?
Used properly and consistently, condoms can stop the spread of many infections, including chlamydia, gonorrhea, trichomoniasis, syphilis, hepatitis, and HIV. Their effectiveness against the viral STDs herpes and HPV, however, is not completely known. One reason is that these two STDs can be spread readily from lesions that occur in places not covered or protected by a condom. For example, even if he were wearing a condom, a man with a herpes sore on the scrotum would put a female partner at risk, because the close contact of intercourse might allow virus to spread from scrotum to labia.
The phrase “properly and consistently” also bears on the effectiveness of condoms. Condoms made of any material can fail in a number of ways if misused. They can slip off if lubricated on the inside, for example, or if an erection subsides. And latex condoms can be damaged by use of oil-based lubricants such as hand creams, skin lotions, and petroleum jelly (Vaseline). The female condom may take practice to insert correctly and can be inserted incorrectly or dislodged in a number of ways.
This is not to say you have to be a rocket scientist to use condoms correctly. You do not. They are inexpensive, widely available, and easy to use. It’s simply a good idea to familiarize yourself with the package insert of your brand to make sure your condom habits are correct.
What are the most important guidelines on using condoms correctly?
- – Store condoms in a cool, dark place. Heat and humidity are especially bad for latex.
- – When opening a condom wrapper, be careful not to damage the condom itself with your teeth or fingernails.
- – When putting on a condom, hold the tip–the part where semen will be deposited–between the thumb and forefinger and squeeze out the air, including the air in a reservoir-style tip.
- – Unroll the condom over the entire shaft of the penis.
- – After penetrative intercourse, remove the penis while it’s still erect; otherwise the condom may slip off prematurely.
- – Use a new condom for each act of intercourse.
What about spermicides?
Spermicides, as the term implies, were developed as a contraceptive–to kill sperm. It was later discovered in laboratory experiments that they also kill some of the microbes associated with STDs, and research has shown that they can prevent the transmission of chlamydia and gonorrhea. Against this backdrop, some have advocated the use of spermicides as a form of STD prevention for those who will not or cannot use condoms. This is still a controversial recommendation, however, because if used often, spermicides can cause irritation in the vagina that may actually increase the risk of getting certain infections. In addition, there are questions about the proper dose needed to neutralize or kill STDs, which may be different from the dose that works to kill sperm.
Is oral sex safer – that is, less likely to spread STDs – than other kinds of penetrative sex?
In a general sense, yes. Most STDs have the potential to be spread through oral sex, most commonly resulting in sore throat and other oral symptoms. But it’s also true, as a rule, that sexually transmitted infections in the mouth and throat are much less likely to develop than genital infections, which suggests a lower risk from oral sex. This may be because the oral cavity is a less hospitable environment for sexually transmitted microbes than the genital tract, though this remains a matter of speculation.
Oral sex, however, does account for substantial numbers of genital herpes infections and is still considered a risk for HIV, specifically because of the potential for cuts or abrasions on the gums that might give HIV an open door into the bloodstream. Hepatitis viruses, in some cases, also can be spread through oral sex.
In sum, the risk from oral sex is lower than having penetrative vaginal or anal intercourse, but it isn’t zero. For this reason, people practicing oral sex with a partner who might carry an STD are advised to use condoms for fellatio or barriers such as dental dams or plastic wrap for cunnilingus.
What’s a dental dam?
Originally developed for use in oral surgery, dental dams are square pieces of thin latex that can also be used to prevent the exchange of bodily fluids during oral sex. A dam must be held in position over the vulva or anus during oral stimulation, always keeping the same side of the dam against the body.
Dental dams can purchased through various sex boutiques and catalogs. Some authorities recommend plastic wrap as an alternative to dental dams because it’s easier to get and can be used in larger sizes.
What is outercourse? How safe is it?
Outercourse is a term coined in the 1980s as part of the effort to prevent the spread of HIV by encouraging safer sex. It refers generally to practices that can give sexual pleasure without creating the risks implicit in vaginal, oral, or anal sex. Examples include sensual massage, fantasy, self-masturbation, pleasuring a partner with the hands, and other forms of sex play.
Safety is a relative issue. Although much safer than penetrative sex, some forms of outercourse do carry the risk of skin-to-skin transmission of herpes or genital HPV.
What if a person already has an STD? How can the person’s partner get protection?
Again, there’s no universal measure to stop all STDs. With infections that can be cured with medication, the person being treated should refrain from having sex until the infection is cleared.
With chronic infections such as genital herpes or genital HPV, it’s wise to avoid contact with lesions, but as we stressed earlier, these infections can be transmitted even when no obvious lesions are present. That’s why for herpes and HPV you should discuss the issues with your partner and decide which precautions, if any, you need to take.
What about a woman who has had only a couple of sexual partners and whose annual gynecological exams have always been normal. Should she still be concerned about having a sexually transmitted disease?
The good news is that statistically a women with only a couple of partners does indeed stand a lower chance of contracting an STD than someone who has a larger number of partners. The fact that her annual Pap smears and gynecological exams have been normal and that she reports no troubling symptoms raises the likelihood that she is free of STDs.
On the other hand, as we have stressed, a number of very widespread STDs tend to be asymptomatic. And annual gynecological exams do not routinely include screening for STDs. Therefore, one can’t be entirely sure about being free of STDs based simply on routine care. Chlamydia, as an example, is both extremely common and frequently silent. And as we said earlier, it can also affect a woman’s ability to have children, which is why it’s a good idea for all sexually active women to be screened for chlamydia. Screening can also be done for other STDs in their asymptomatic phases, including herpes. It’s a good idea to talk with your health care provider about your situation and which, if any, tests might be needed.
How can I tell if my prospective sexual partner has an STD?
You can’t always tell, but you can always ask. If you’re contemplating a sexual relationship with a new partner, you should ideally discuss past sexual experiences and sexually transmitted diseases–first. For most people, the concern driving this discussion and driving the need for condom use or other “safer sex” approaches has been the fear of AIDS. But as long as you’re talking about AIDS, you might as well talk about the other STDs that are more common than AIDS. Of course, talking about it is no guarantee. There are those who will lie, and those who quite honestly don’t know that they carry an STD. Most people who have genital herpes, for example, never experience obvious symptoms. The same is true of chlamydia.
If you are sexually involved with someone, don’t turn a blind eye to any type of rash, sore, or ulceration in the genital area. Likewise, someone who has a cold sore or fever blister on or around his or her lips poses a risk of transmitting herpes through oral sex. If you are frequently having sex with people you don’t really know and with whom you have not had an in-depth “safer sex” discussion, the proper use of condoms or other barriers (such as dental dams) is in order.
How do I tell my partner I have an STD?
Telling a prospective partner you have an STD can be difficult for those who have a persistent viral infection such as herpes, genital HPV or hepatitis. Bringing up your personal history of infection is probably easiest in the context of a more inclusive safer-sex conversation. Before you become involved with anyone sexually, you deserve to know something of his or her sexual history. You have news to share, and perhaps he or she does too.
Choose a quiet, private place with a relaxed atmosphere and try to ensure that you have ample time for discussion. It’s normal to feel apprehensive about telling, and it will be normal for your partner to feel apprehensive about the possibility of contracting an infection. Remember that most people have a poor understanding of what STDs are, how common they are, how they’re transmitted, and how they’re treated.
Be prepared to answer questions, and don’t expect your partner to come to terms with the issue on the spot. Give him or her time to take it all in.