Safe sex is more than just condoms

Welcome to the golden age of STI prevention.

Of course, condoms are still an effective strategy for reducing the risk of sexually transmitted infections (STIs)—but now, they’re just one of the strategies to reduce the chance of catching a sexually transmitted infection.

These include vaccines to reduce the risk of certain STIs, and medications you can take to prevent infections — some are simple morning-after pills, and many can be mailed to your home after an online telehealth visit. It also includes new STI tests that people can take into their homes, with results available instantly or within days to enable quick and discreet testing and treatment. In a world where getting sexual health care can sometimes feel fraught with judgment, these new methods offer a level of discretion and convenience that feels nothing short of revolutionary.

In-person care is still best for getting the most comprehensive and personalized assessment and education, and we’ve got instructions on how to find that kind of care here. But even sexual health care physicians admit it’s annoying— or worse – Go to the doctor sometimes.

“Inconvenience — whether it’s cost, or travel, or parking, or getting off work, or other competing demands — is probably a big reason why people don’t necessarily … engage in sexual health care that they might otherwise benefit from,” said Douglas KrakowerAn infectious disease doctor and HIV prevention researcher at Harvard Medical School. Stigma — the feeling of shame that people who know you have an STI, whether real or imagined, looks down on you — also sometimes prevents individuals from seeking high-quality sexual health care.

Bottom line: People often prefer sexual health care that involves as many other people as possible. Now, there are more ways to get it than ever.

Not everyone benefits equally from these advances. Some come with out-of-pocket price tags or are out of reach for those who are still pregnant or may become pregnant. Still, the changes represent a leap forward for health care to get as much help as it needs.

Here’s what’s out there.

You can reduce your risk of HIV, syphilis, gonorrhea, chlamydia and more

STIs include a range of bacteria and viruses that cause unpleasant genital symptoms, threaten your ability to have pleasurable sex, and can jeopardize your ability to have a healthy baby. Barrier protection like internal and external Condoms Still the best (and usually cheapest) way to protect yourself from STIs.

However, if you are predisposed to having sex without a condom, there are now many other ways to prevent STIs. Vaccines have come a long way and Can prevent several STIsincluding HPV (a cause of genital warts and cervical cancer), herpes, and hepatitis A and B. Recent studies also suggest that vaccination against meningitis may be effective Gonorrhea protectionEspecially among gay men and those with whom they have sex.

There are also pills and injectable medications that can greatly reduce the risk of a sexual partner infecting you with HIV, syphilis, gonorrhea, or chlamydia.

HIV prevention comes in several forms: as a drug you take orally every day or every two months as an injection before sex (called PrEP for pre-exposure prophylaxis), or as a monthly regimen of oral medication you take immediately after sex. The latter option, is called PEPFor post-exposure prophylaxis, initiation must be within 72 hours of exposure to be effective. Both options work by entering the body’s cells and preventing HIV from replicating inside them.

More progress in this area is to come: Lencapavir, an injectable drug every six months to prevent HIV infection, has shown great promise in preventing HIV infection in both cases. woman And Trans and nonbinary people and may be available for US use as soon as possible By the end of 2025. Krakower says an oral option isn’t far behind.

Syphilis has been on the rise explosively in the United States over the past few years, affecting gay men and those with whom they have sex, as well as heterosexual men and women, especially those whose sexual partners include sex workers and those who inject drugs. This trend has huge risks: women can spread syphilis during their pregnancies, causing serious illness or death in their newborns.

Earlier this year, the Centers for Disease Control and Prevention released guidelines for use DoxypepA morning-after pill to prevent syphilis infection. This breakthrough technique involves taking the antibiotic doxycycline the morning after sex — and because the drug fights other germs, DoxyPEP also reduces gonorrhea and chlamydia infections.

The problem is that the effects of doxycycline in pregnancy are unclear, but there are doubts that they are not good Many physicians are therefore hesitant to prescribe it for younger patients in their care.

Still, because congenital syphilis has become such a dire national emergency, scientists are looking for ways that doxypep can protect pregnant women and their fetuses. One focus is getting more men and cohabiting women to use doxypep; Another approach may involve prescribing the drug to women at high risk of syphilis infection. In a Japanese study female sex workerThis technique reduces rates of syphilis and chlamydia.

You can test at home for various STIs

It used to be that if you had unprotected sex with a new partner or showed unusual genital symptoms—such as painful urination, vaginal discharge, or skin changes like bumps, ulcers, or rashes—you had to go through a lot. Hoops to find out if you had an STI. You’ll start by visiting a clinic or emergency room; having your parts smeared (or peeing in a cup or having blood drawn) by a doctor; waiting for a lab to process those results; Waiting for the doctor’s office to tell you these results; going back to the clinic or taking the medicine to the pharmacy; And then potentially going back again for re-examination after treatment is complete.

Now, a variety of new testing options allow clinics to get test results for STIs within hours Once these are widely adopted by clinics and emergency rooms, it will be much easier for people to get tested and treated at the point of a healthcare visit. Hopefully, this will reduce the number of people who are diagnosed with an STI but never seek treatment for it.

Another giant step forward: New tests now enable people to perform most or all STI testing and treatment procedures at home, online or by mail — without involving a doctor or other medical practitioner. “Agency is what gets people home testing,” says Yuka agreesAn infectious disease doctor at the Johns Hopkins School of Medicine who leads the home-based HIV and STI testing program, I want the kit.

The FDA has only approved a handful of these tests, and they’re not perfect. For example, the only FDA-approved test that tests for chlamydia and gonorrhea is through home-based sample collection. Simple 2 Testing – It is only allowed to test samples from the penis and vagina. means test Cannot be used to diagnose throat and rectal infectionsWhich is more common in men through oral or anal sex with other men. So while Simple 2 is a great choice for people who only engage in heterosexual sex, it excludes gay men and those with whom they have sex.

Another important innovation is First to know The syphilis test, which can detect syphilis-fighting antibodies in a blood sample within minutes Collected at home With a simple skin prick. The FDA approved the test in August. However, there’s a catch: the test doesn’t distinguish between new syphilis infections and old, already-treated infections. This means that people who have had syphilis before cannot use the test to rule out new infections.

It is worth noting that home-use HIV tests are FDA-approved More than a decadeAlthough they require follow-up tests for positive results.

Just because these tests are FDA-approved doesn’t guarantee they’ll be covered by insurance; You can check with your insurer what this will cost you. If it’s not covered, you should check to see if you live in a part of the country where free HIV, gonorrhea, and chlamydia or trichomonas test kits are available ( American Sexual Health Association Lists free HIV and STI home test kit resources).

Most of these tests will be free or low-cost if you get them in person, he said Elizabeth FinleySenior Director of Communications and Programs at the National Coalition of STD Directors. “There are some equity implications” in the fact that higher-income people can pay out-of-pocket for home-based testing facilities, while lower-income people often can’t, she says.

Choosing a test is only the beginning

Many companies have created Home-based STI testing including those not yet approved by the FDA Hepatitis B and cWhich is often overlooked. Non-validation doesn’t mean a test is rubbish – it just makes it harder to be sure it’s effective at doing what you want it to do.

“There’s no real railroad for companies to deliver quality to customers,” says Finlay. “Tests have to work, but I’m not sure consumers are fully informed, if they see a test available on social media, ‘Is it good? Is it bad?’

The appeal of this test is strong for those who hate having someone else get a sample of their genitalia. Many of them have you pee in a cup, pinprick your own finger and bleed blood onto a card, or swab various body parts at home (including your vagina or penis, your buttock or throat), then mail the sample to a lab. which runs simple tests on it, which can be retrieved in an online portal.

Home testing kits also often end-run around the process of going to a brick-and-mortar clinic to figure out next steps or pick up a drug. Many use telehealth platforms to connect people who test positive for STIs with clinicians who can provide counseling, advise partners on ways to get tested, and mail some medications directly to patients.

Many STIs require one or more antibiotic injections to cure, and experts sometimes recommend additional evaluation after diagnosis. Both of these situations require an in-person consultation with a physician. If you test positive for one of these STIs, your test company’s telehealth provider will direct you to a clinic where you can see a private physician.

Giving people the option of self-directed sexual health care is not only good for people’s sense of autonomy – it’s also a sensible response to impending health worker shortages. Out of concern for the inadequate global supply of physicians, the World Health Organization recently recommended a Range of self-care interventions For people around the world, STI self-sampling and testing is the latest innovation among them.

Now is the time, says Manabe: “We are not trusting the public enough.”

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