If you’re sexually active, you already know how important it is to protect yourself from sexually transmitted infections, a term often used interchangeably with sexually transmitted diseases. Using a condom “consistently and correctly” during penetrative sex can offer significant protection from STIs spread by bodily fluids, such as HIV, gonorrhea and syphilis. “Those things live in the urethra and cervix, so intercourse is a very efficient way of spreading them,” says Dr. Lauren F. Streicher, clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine in Chicago.
But intercourse isn’t the only way to have sex — and it’s not the only way to spread STIs. Here are five other ways infections can be transmitted, and how to protect yourself from each.
Outercourse
Some STIs, such as herpes and the human papillomavirus (HPV), spread through skin contact. Rubbing skin without underwear on, known as “outercourse,” can transmit these viruses from genital to genital or even genital to hand. If the other party has a bloodborne infection like HIV, chlamydia or syphilis, you can get infected if your partner has a cut or bleeding in or around their genitals. These small wounds don’t have to be dramatic and can stem from things like shaving or friction. Bodily fluids like pre-ejaculate or vaginal discharge can also transmit infection.
Condoms might seem like an ideal solution to everything, but they don’t protect you from skin contact. The best way to protect yourself from skin infections during non-penetrative sex is to wear clothes. It may not be as fun, but keep in mind that underwear doesn’t cover all the skin that could be infected, like on your thighs or butt.
Oral sex
Mouth-to-genital contact is another way to get an STI. If you peform oral sex without protection on a partner with an STI on their genitals, your mouth may become infected. The same is true in reverse: If your partner has herpes in their mouth and performs oral sex on you, you could contract an infection in your genitals or wherever their mouth touches.
A barrier is essential to prevent transmitting an infection during oral sex. Dental dams, a latex sheet in the oral sex–giver’s mouth, can help. In a pinch, you can make your own dental dam by cutting the tip and end off an unlubricated condom to make a square.
Some people like using latex panties as protection, and Streicher says many users report increased sensation. An FDA-approved product called the FC2 Female Condom also offers high levels of protection. “The condom goes inside the vagina, protecting from ejaculation, but it also covers the vulva,” says Streicher.
Anal sex
Anal sex may prevent pregnancy, but it’s a common route for spreading STIs. To prevent sharing bodily fluids during anal sex, use a condom and avoid oil-based lubricant, which can cause condoms to break. To protect yourself and your partner from skin infections during other types of anal contact, whether using fingers or the mouth, Streicher recommends wearing latex panties.
Kissing
You already know you can catch a cold or Covid-19 from kissing. Mouth-to-mouth contact can also transmit viral STIs, such as herpes. Skip kissing if either party has an active cold sore. If you head south, use protection to prevent spreading the herpes to the other party’s genitals.
Sex toys
Sharing sex toys, especially if you don’t thoroughly wash them, can also spread STIs. Using a vibrator, for example, then sharing without washing it could transmit skin infections like herpes. If someone uses a penetrative vibrator, the toy could spread chlamydia or syphilis. Streicher says bacterial vaginosis, a “sexually associated condition,” commonly spreads when people share toys. Any toy that’s been used anally should never go in the vagina, and vice versa.
If you are feeling generous, Streicher recommends using a condom on your toy or washing it between partners. “They also make wipes for sex toys if you’d rather not jump out of bed and go to the sink,” she says.
What to do if you think you have an STI
If you find out you were exposed to an STI or you have symptoms, check in with your doctor. Streicher says some primary care doctors screen for STIs. People with vaginas often need full gynecological exams to be tested, so your PCP may refer you to a gynecologist. If you have a penis, getting tested usually involves an external exam or urine test, which some primary care doctors can do.
When you get tested, be sure to mention the exact concerns you have. “There’s no way to get screened for everything, so if you’re worried about something specific, like anal or oral transmission, you need to tell your provider,” Streicher says.