Sexually transmitted infections: how to stay protected

Condoms can protect against infection with the human immunodeficiency virus (HIV), and thus also against the disease AIDS which is caused by it, with up to 90% certainty if they are used consistently and correctly. Most people know this, thanks in part to the “Gib AIDS keine Chance” (“Don’t give AIDS a chance”) campaign that has been actively run in Germany for over 30 years. In addition, HIV medication offers protection. But what about other sexually transmitted infections (STIs)? 

In principle, a condom offers up to 60% protection against an STI. The reason for this is that sexually transmitted infections are not invariably transmitted via the genital region or the rectum. Some pathogens, such as those of syphilis, can also be transmitted via skin ulcers and the tiniest skin lesions. Human papillomaviruses (HPV), which cause genital warts and cancer, behave in a similar way. In addition, many STI pathogens can in principle infect any area of the skin and mucous membranes of a healthy person.

Furthermore, hardly anyone thinks about using a condom during oral sex. Syphilis, gonorrhea, human papillomavirus (HPV), or even the painful genital herpes can spread in this way, even when kissing afterwards.

Using condoms is important to avoid sexually transmitted infections. But there are gaps in protection, depending on the situation or sexual preferences. Vaccinations, medications, and tests are therefore a good supplement to protect against an STI.

Provided it is used properly, a condom reliably protects against unwanted pregnancy and a number of sexually transmitted infections. Protection lies between 50 and 90%. During the 1980s and 1990s, the condom was considered the only protection against the then fatal infection with the HI virus.

However, the condom can also reduce the risk of infection with treponema pallidum (the cause of syphilis), hepatitis B viruses, chlamydia, trichomonads, mycoplasma, or gonococci (the cause of gonorrhea). This level of condom protection can be expected, at minimum, when sexual acts are limited to intercourse or anal intercourse. Where mucous membranes and skin areas remain unprotected and exposed, i.e., the rest of the body, there is still a risk of infection, especially with syphilis, genital herpes, or genital warts caused by viruses.

To be best protected by the condom during sexual and/or anal intercourse, the following rules will help:

• Before putting on the condom, pay attention to the expiration date on the package and to the correct size.
• Creams or chemicals should not be used in connection with condoms, as they could affect the latex.
• The condom packaging should not be opened with sharp objects, fingernails or even teeth, so as not to damage the wafer-thin condom.
• Condoms come in different sizes, to fit the size of the penis. A well-fitting condom is less likely to tear or slip off.

For some, however, the condom as protection against sexually transmitted infections also causes problems, for example due to latex intolerance. Pre-exposure prophylaxis (PrEP) helps here as protection against HIV.

Since 2018, it has been possible in Germany to protect oneself against the HIV virus without a condom. A pre-exposure prophylaxis (PrEP) is a way for healthy people to take a medication that protects from HIV as a precaution. The drug accumulates in the mucous membranes, so that the HI virus, to put it simply, is prevented from penetrating.

This method is particularly common among men who have sexual contact with men. Pre-exposure prophylaxis is more than 95% effective when taken correctly and reduces the risk of HIV infection. This is true for both men and women.

In addition to PrEP, people should seek advice on other protective measures against other sexually transmitted infections (STIs). This is because PrEP only reduces the risk of infection with HIV, but not with other STIs.

Women must start taking the prophylaxis a few days sooner because the mucous membrane in the vaginal area needs longer to accumulate sufficient active substance. In the anal area, on the other hand, the active ingredient concentration that offers protection is reached very quickly, in both men and women. In principle, pre-exposure prophylaxis protects men and women with equal effectiveness against HIV infection.

A third option for the prevention of sexually transmitted infections (STI) is vaccination. On the one hand, there is vaccination against hepatitis B, which is recommended by the Standing Committee on Vaccination (STIKO) and should be completed as a triple vaccination within the first year of life.

In addition, there is another vaccination against an STI: the vaccination against human papillomavirus (HPV). This vaccination protects against infection from up to nine different HP viruses. Two of these viruses cause genital warts (condylomas). The other seven viruses can cause cancer in humans.

The HPV vaccination became well known starting in 2007 through the campaigns to protect young girls from cervical cancer. This type of cancer is almost 100% caused by human papillomaviruses. Vaccination is recommended for girls between the ages of 9 and 14. Since 2018, the vaccination has also been available for boys of the same age.

It makes sense to vaccinate both sexes, because studies confirmed that human papillomaviruses can cause not only cervical cancer, but also penile and anal cancer, oral cancer, and laryngeal cancer. It is important that vaccination takes place as early as possible in childhood and adolescence, but at the latest, before the first sexual contact.

Because the risk of infection depends in part on each individual’s behavior, 100% protection against sexually transmitted infections (STIs) is not always possible. For this reason, testing for STIs is important to prevent further spread. In addition, early treatment alleviates symptoms and reduces the risk of complications. 

Testing plays a particularly important role in high-risk contacts, which include one-night stands or frequently changing partners, for example. 

To assess your own risk for sexually transmitted infections (STIs), the anonymous online STI risk test from WIR – Walk In Ruhr, Center for Sexual Health and Medicine can help.

You can protect yourself from sexually transmitted infections (STIs) in different ways. First and foremost is the condom. In addition, there is the precautionary use of a drug, known as pre-exposure prophylaxis, to protect against HIV infections. Vaccinations against human papillomaviruses (HPV) and hepatitis B viruses as well as tests also contribute to protection. 

A combination of these measures that matches one’s sexual behavior (risk-adapted behavior) is the best way to protect against infection. In the event of infection, early treatment can also help prevent long-term effects and further spread. Furthermore it is important to also treat sexual partners.

Liebesleben is the website of the Federal Center for Health Education (BZgA). You can find information about love, sex, and protection there.