Healthy living Sexually transmitted infections: how to stay protected

Sexually transmitted infections are caused by pathogens that can be passed on during sex. The pathogens that cause STIs are viruses, bacteria, fungi or parasites. 

Examples of STIs include:

• HIV infections and AIDS
• chlamydia infections
• syphilis
• gonorrhea (“the clap”)
• infections with human papillomavirus (HPV)
• genital herpes
• hepatitis A, B and C
• bacterial vaginosis
• pubic lice

Mpox can also be passed on during sex.

If you are infected with one STI, your risk of contracting another type of STI is increased.

As there are many different STIs, the symptoms vary widely. Possible symptoms include discharge from the urethral opening (hole at the tip of the penis) or vagina, skin changes and pain. In many cases, there are no symptoms and so the infection goes unnoticed. 

Most STIs can be treated effectively and resolve without any long-term effects. However, some sexually transmitted infections can have serious consequences, especially if they are not treated.

How exactly do people get an STI?

The transmission route differs depending on the pathogen. Some STIs are passed on via body fluids, such as sperm or secretions from the mucous membrane lining of the intestines. HIV is one example of these. Other STIs, such as chlamydia, are passed on through direct contact with infected skin or mucous membranes. Smear infection is also possible, for example, via hand contact or use of sex toys.

How can people protect themselves from getting infected?

There are various ways to prevent infection with a sexually transmitted disease. These measures are referred to as safe sex (or safer sex). Condoms and femidoms reduce the risk of infection. 

For HIV, there is also medication that can be taken by people who have an increased risk of infection. The same applies to syphilis and chlamydia. Vaccines offer protection against hepatitis A and B and against human papillomavirus. Vaccination against meningococcal bacteria may possibly offer protection against gonorrhea.

Testing for STIs is also possible if a person is experiencing symptoms or on a precautionary basis.

One or more of these methods should be used, depending on individual sexual practices and the associated risks. This is the best way for people to protect themselves and others from infection.

Condoms can be worn on the penis during vaginal, anal and oral sex. When used consistently, condoms offer a high degree of reliability in preventing an infection with HIV. 

Condoms also significantly reduce the risk of infection with other STIs. However, they unfortunately do not offer 100 percent protection. The reason for this is that condoms only prevent STIs from being passed on via the skin and mucous membranes of the penis, vagina or intestinal tract. However, some STIs are not only passed on through contact with the genitals or rectum of an infected person. Some pathogens can also be transmitted via skin contact. These include human papillomavirus and the pathogens that cause syphilis and genital herpes. If an STI is present on any mucous membranes or areas of skin that remain uncovered, it can still be transmitted despite the use of condoms. 

Condoms also offer protection against STIs when worn during oral sex. STIs such as syphilis, gonorrhea human papillomavirus (HPV) or painful genital herpes can be transmitted during unprotected oral sex. Dental dams also offer protection when engaging in this sexual activity. These are thin sheets that are placed between the mouth and vagina or anus during oral sex. 

Femidoms offer an alternative to condoms. Femidoms work in a similar way to condoms and offer the same protection. However, they are placed inside the vagina. 

What is important to remember when using condoms?

Condoms can be purchased almost anywhere – in supermarkets, drugstores, pharmacies, filling stations, condom vending machines or online. The following will help to ensure the best possible protection with condoms:

• Before putting on the condom, pay attention to the expiration date on the package and to the correct size.
• A CE mark on the packaging indicates that the condoms have been manufactured in accordance with strict guidelines and meet specific quality criteria.
• Creams, oils or chemicals should not be used in conjunction 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.

Condoms without latex are also available for people with a latex intolerance. 

On the “Liebesleben” (Love life) website of the Federal Institute for Public Health (Bundesinstitut für Öffentliche Gesundheit, BIÖG), you will find more information about using condoms. The website also provides general information about the topics of sexual pleasure, sexuality and sexually transmitted diseases.

It is possible to use medication to avoid infection with the HIV virus. Pre-exposure prophylaxis (PrEP) involves taking tablets to prevent infection with HIV on a precautionary basis. PrEP is intended for people who are at an increased risk of getting infected with HIV. 

With PrEP, the medication accumulates in the mucous membranes, so that, in simple terms, the HIV virus is unable to take hold in the body.

When taken correctly and consistently, PrEP is up to 99 percent effective in preventing infection with HIV. This is true for both men and women.

In individual cases, using an antibiotic to prevent syphilis and chlamydia may be considered. However, this only applies to certain groups of people following situations that involve a particularly high risk of infection. Taking this medication should be discussed with a doctor in advance. As the drug is not approved for preventive treatment in Germany, individuals have to cover the cost themselves. 

For more information about HIV, AIDS and PrEP, see our article “HIV and AIDS”.

A vaccine is available to protect against certain sexually transmitted infections (STIs). 

Vaccines against hepatitis

There is a vaccine against hepatitis B, which is recommended by the Standing Committee on Vaccination (STIKO) and should be administered within a child’s first year of life.

It is also possible to get vaccinated against hepatitis A. This vaccine is recommended for people who are at an increased risk of infection with the hepatitis A virus due to their sexual preferences or for other reasons.

HPV vaccine

There is also a vaccine against human papillomaviruses (HPV). This vaccination protects against infection from up to nine different HP viruses. Two of these viruses cause genital warts (also known as condylomas). The other seven viruses can cause cancer. HPV infections are among the most common sexually transmitted infections.

Cervical cancer is caused by HPV in almost 100 percent of cases. In addition to cervical cancer, HPV can also cause cancer of the penis, anus, oral cavity and larynx.

Gonorrhea vaccine

No vaccine against gonococci bacteria, the pathogen that causes gonorrhea, has been developed to date. However, certain vaccines against meningococcal group B bacteria may also give some vaccinated individuals protection against gonococci. Vaccination may be considered if a person is at high risk of contracting gonorrhea. 

100 percent effective protection against sexually transmitted infections (STIs) is not normally possible for sexually active people. Some STIs cause no symptoms initially. In some cases, people may not even realize that they have an infection. This is why testing is important, as early treatment can reduce later-stage symptoms and the risk of complications. If an infection is detected early, the risk of the pathogen being unknowingly passed on to other people is also decreased.

Who should get tested?

Anyone with symptoms of an STI or whose sexual partner has been diagnosed with an STI should get tested. It is also useful to get tested for STIs on a regular basis if you change sexual partners frequently. 

People in a committed partnership who want to have sex without condoms should always discuss fidelity and STIs first. It may be useful to test for HIV and other STIs before deciding not to take any precautions.

How can I get tested for STIs?

Doctors specializing in skin diseases, sexually transmitted diseases, gynecology and urology all provide testing for STIs. Public health authorities and test centers operated by the German AIDS Federation (Deutsche Aidshilfe) also offer testing for HIV and, in some cases, for other STIs. 

A blood sample or urine sample is required in order to test for some STIs. Others require a swab taken from the relevant site on the body, e.g., the vagina or anus.

It is possible to perform a self-test for HIV. There are also at-home sample collection kits that you can use to take swabs and a small blood or urine sample. These can then be sent to a lab by mail.

For more information about STI tests, visit the website of the German AIDS Federation (Deutsche Aidshilfe). You can also use this site to find a test center close to you.

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

The website of the German STI Society (Deutsche STI-Gesellschaft, DSTIG) offers a wide range of information about STIs and sexual health, aimed largely at medical professionals.  

On the “Liebesleben” (Love life) website of the Federal Institute for Public Health (Bundesinstitut für Öffentliche Gesundheit, BIÖG), you will find information about support and advisory services, including phone and online options. The website also provides information about love, sex and protection.

The Caritas website offers information about support and advisory services in your area as well as anonymous online support.