Chances are you’ve heard some sketchy information on the subject of sexually transmitted infections. Rumors and myths about STIs are common. We don’t all have access to reliable sex education, and even accurate information can become outdated. But maybe, most of all, talking about STIs can feel icky.
1. What’s the difference between an STI and an STD?
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. STIs can be spread through bodily fluids such as semen, vaginal fluid, and blood, and via skin-to-skin contact.
Technically, “disease” implies that symptoms are present—which is often not the case with STIs. “Disease” may also feel more stigmatizing. Most sexual health educators say “STIs.”
2. Which STI gets around the most? And how can I fend it off?
Human Papilloma Virus (HPV) is one of the most common STIs across all age groups in the US. In the US, 79 million people have HPV, and more than 14 million people become infected every year, according to the CDC. Most of the people who are infected are in their late teens and early 20s.
Nearly all sexually active men and women become infected with HPV at some point in their lives. Many strains of HPV do not usually cause harm, but some strains of HPV can cause genital warts and cancers of the cervix, anus, penis, vulva, mouth, and throat.
- There’s a vaccine that protects against some strains of HPV—you can get it up to the age of 26 for women and 21 for men. You can also be vaccinated for hepatitis A and hepatitis B. Talk to your parent or healthcare provider about getting vaccinated.
- Research shows the HPV vaccine is helping to reduce the rates of genital warts and other strains of HPV among teens, according to the CDC. You can also be vaccinated for hepatitis A and hepatitis B. Schedule a visit with your health care provider to get vaccinated. In some states, you may be able to get the vaccine without parental consent.
- Use a condom and/or dental dam every time. These do not guarantee protection but do reduce your risk.
- If you’re sexually active, get tested once a year or with every new sexual partner. Discuss the availability and accuracy of tests with your health care provider.
- Get comfortable talking about sex and STI prevention. This means:
- Feeling empowered to talk about what you want or don’t want
- Becoming comfortable with getting tested and asking partners to get tested as well
- Discussing the use of condoms (internal and external), lubrication, and dental dams (oral dams) to reduce exposure to STIs
- Discussing what feels good to both of you
- Discussing methods of birth control to prevent pregnancy
3. Am I more likely to accidentally get pregnant or get an STI?
You’re more likely to get an STI than you are to get accidentally pregnant.
Rates of unintended teen pregnancy are declining, but still, approximately 456,000 teens become pregnant every year. About three quarters of those pregnancies are unintended. Meanwhile, about 10 million new STI cases are diagnosed each year in people 15 to 24, according to the CDC.
By age 25, most US adults have acquired at least one STI.
4. Is HPV another name for herpes—or what?
What. Human papillomavirus (HPV) is often confused with herpes (herpes simplex virus, or HSV). These are two different viruses. They are both transmitted through skin-to-skin contact.
HPV can cause genital warts and cancers of the cervix, anus, penis, vulva, mouth, and throat. Many strains of HPV do not usually cause harm, however. Men up to age 21 and women up to age 26 can get a vaccine that protects against some strains of HPV. Talk to your health care provider.
Herpes can cause sores at the point of infection, which may be in the genital area or on the mouth (e.g., cold sores). Many people who have been infected with herpes experience no symptoms or have mild symptoms that they attribute to other conditions. Treatment can help minimize the symptoms and lower the chance of transmission.
5. Which STIs should I get tested for?
Getting tested for STIs is a gateway to treatment and helps you protect yourself and your partner(s). Most tests are noninvasive and simple. Get tested for these conditions once a year or whenever you have a new sexual partner. Discuss with your health care provider whether to get tested for other STIs as well.
Medication can help minimize outbreaks but cannot cure herpes.
What’s the test like?
Testing usually involves a health care provider taking a swab of the affected area and/or a blood test.
These can be present without symptoms and can cause fertility problems in men and women if left untreated. Both are curable with antibiotics.
What are the tests like?
Usually a health care provider will ask for a urine sample or take a swab of the genital area.
One in six people in the US who have HIV don’t know it. If you’re at high risk of HIV, check out pre-exposure prophylaxis or PrEP. This medication can help reduce your risk.
What’s the test like?
A swab can be taken from the inside of the mouth or a health care provider will take a blood sample.
Can cause severe complications such as brain damage or blindness if left untreated (usually after many years). It can be cured with antibiotics, but antibiotics can’t reverse any permanent damage caused by the disease. New cases are most common in men who have sex with men.
What’s the test like?
It usually involves a blood test or a sample taken from a sore.
6. How likely am I to get a STI?
By age 25, most US adults have acquired at least one STI. Teens and young adults are the most at-risk demographic for STIs. Nearly half of the 20 million new STI diagnoses each year are in people aged 15 to 24, according to the CDC.
Are STIs your fate?
No. To minimize your risk of becoming infected:
- Use a condom or dental dam every time.
- Get tested with every new sexual partner or once a year if you have the same partner.
- Get comfortable talking about sex and STI prevention.
Why are teens and young adults at greater risk of STIs?
- Behavior: e.g., not using safer sex methods, having multiple sexual partners, and not getting tested. You can control behavioral risks.
- Culture: e.g., discomfort talking about sex and STI prevention, pressure to have sex, and expectations associated with gender roles. Being aware of these influences can help you address them.
- Biology: The physical development of young adults can make you more susceptible to STI infection. For example, in young women, the surface of the cervix is more exposed to some sexually transmitted organisms (e.g., HPV) than in older women.
7. What does an infection look like?
Often, an STI infection doesn’t look like anything. Most STIs don’t have visible symptoms. People who look perfectly healthy can be infected with STIs.
If you’ve ever looked at pictures of STI symptoms, be warned: In real life, symptoms often don’t look like those images. And most symptoms aren’t visible anyway.
Want to know if you or your partner has an infection? STI testing is the only way.
8. How can I talk to my partner about STIs?
What gives STIs their big advantage? Awkwardness. “Embrace the awkward. It’s awkward no matter how old you are to talk about STIs,” says Lizzy Appleby, a youth program manager and sexuality educator in Illinois.
- Don’t wait until you’re caught up in the moment—talk about it ahead of time. “Think about what you want to say in advance,” says Appleby. There’s no one right way to say it—use whichever communication style feels most authentic to you, she says. “Do you like using humor? Use humor. Are you a very direct person? Be direct.”
- Make the first move—a conversational move. Don’t wait for them to initiate the STI talk.
- Explain that this is not about trust and it’s not about cheating.
- If you’re anxious, acknowledge it: “OK, so this is awkward, but I’m pretty sure we can handle awkward. It’s important to me that we go get tested together.”
- If a partner tells you they have an STI, respect their honesty and maturity and their consideration for you and your needs. Protect their confidentiality.
- If you discuss this sensitively and yet your partner doesn’t want to get tested, be cautious. “Communicating about anything related to sex is about communicating about boundaries,” says Appleby. Healthy relationships require mutual respect and responsibility. If someone doesn’t respect your boundaries, that’s a red flag.
- If you hear something you weren’t prepared for, remember you can always come back to the conversation later, says Appleby. “Say, ‘let me think about this and get back to you.” You don’t always have to have an answer right away.”
9. Does size matter? And other questions about condoms and dental dams (like: What is a dental dam?)
Are students using condoms frequently?
Yes. About 60 percent of sexually active students reported using a condom for birth control the last time they had sex, according to the 2017 Youth Risk Behavior Surveillance Survey.
Can any other method help prevent both STIs and pregnancy?
No—only condoms (internal and external versions). Latex and latex-free (e.g., polyurethane) condoms are available and are proven to reduce the risk of transmitting STIs. 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.
Does condom size matter?
Yes. The condom may stretch, but is it comfortable and pleasurable? Too tight, and the elastic base could cut off blood flow or cause discomfort. Too loose, and it could come off during sex. Condoms are available in varying shapes and sizes, so explore the best fit.
What’s a dental dam?
Dental dams (oral dams) probably lower your risk of STIs (but not pregnancy). A dental dam is a thin cover placed over the vulva or anus for oral sex. You can cut a condom or medical glove into a dental dam, or substitute plastic wrap. The effectiveness of dental dams (including plastic wrap) in preventing STI transmission has not been adequately studied; nevertheless, the use of dental dams is recommended by many sexual health professionals.
How can I get some?
Dental dams are available in some specialty stores, such as condom stores, or online, for about $1.50 each.
10. Which is more common: having a cat or having herpes?
It depends on which type of herpes we’re talking about. In the US, about 36 million people have a cat, according to the American Veterinary Medical Association (2012).
More people have a cat than have herpes type 2.
Herpes type 2 (HSV2) is traditionally known as genital herpes. In the US, 1 in 6 people aged 14–49 have genital herpes (CDC) and 776,000 new cases are diagnosed each year.
More people have herpes type 1 than have a cat.
Herpes type 1 (HSV1) causes cold sores and genital sores. In the US, Johns Hopkins University estimates that anywhere between 50–90 percent of adults have oral herpes. Although we think of HSV1 as causing cold sores, this strain of the virus can be transmitted through oral sex and is responsible for more cases of genital sores than HSV2 is.
Herpes is very common.
To reduce your risk of acquiring or passing on a herpes infection, use a condom or dental dam every time you’re sexually active.
Christine Sturgeon, community educator in sexual and reproductive health at the Sheldon M. Chumir Health Centre, Alberta.
Lizzy Appleby, M.S.W., youth program manager at Youth Services of Glenview/Northbrook in Illinois
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