How to Have Safe Sex (and a Fulfilling Sex Life) When You Have an STI

Photo: StocksyMauro Grigollo
When it comes to Things You Never Want to Hear Your Doctor Say, “Your STI test came back positive” is right up there with “I’ve never seen something like this before!”

Sexually transmitted infections are popularly cast as boogeymen of the bedroom—and considering all the damage having one can (supposedly) do to your sex life, receiving a diagnosis might as well come with a free chastity belt. On a Reddit thread titled, “Redditors with STDs, how have they affected your life?,” one woman describes the emotional tailspin in which she found herself: “When I was diagnosed with genital warts [HPV], my self-esteem plummeted to nothing. I thought that was it. I remember feeling disgusting, and like no one would ever want to be with me again.”

At least one professional opinion contends this woman's experience and feelings are an unfortunate result of unnecessary negative socialization. “In our culture, STIs are often presented as a dark side of sex and punishment for having sex,” says therapist and sexuality expert Kathryn Stamoulis, PhD. Just think back to sex ed: “Instead of giving people the facts about HPV­ (human papillomavirus)—an incredibly common STI—we blow up slides of untreated genital warts and project them on massive screens during sex ed. Most outbreaks are very mild, but they’re made to look scary and disgusting,” she says.

"It’s time to start accepting STIs as a normal part of human sexuality and not an aberration,” —Oluwatosin Goje, OB/GYN

While reactions and stigmas attached to diagnoses may differ from infection to infection (“In my practice, I see the most emotional breakdown with herpes compared with other STIs,” says Oluwatosin Goje, MD, an OB/GYN at the Cleveland Clinic), the feeling of devastation doesn’t discriminate. Plenty of people feel shame, sadness, and despair regardless of which STI card they’re dealt. “In the moment, learning that you have an STI can feel like the end of the world,” says Dr. Stamoulis—the defining end of a full, sex-filled life. “But it’s time to start accepting STIs as a normal part of human sexuality and not an aberration,” she adds.

To put it simply, STIs aren't a reason to devoid yourself of pleasure or a sex life. Research says one in two sexually active people will contract an STI by age 25, and if you’re one of them, “not feeling worthy of a happy, satisfying sex life is simply an irrational belief,” says Dr. Stamoulis. STI stigmas be damned: “Everyone deserves a happy sex life.”

Chris Donaghue, PhD, a therapist and the director of clinical education at the Sexual Health Alliance, totally agrees. Keeping an open mind about what sex means can facilitate a happy sex life, he says. “Sex is a big umbrella term and doesn’t need to involve penetration or even genitals,” Dr. Donaghue says. “Safer sex includes mutual masturbation, use of toys, porn, one partner’s anatomy only, or even kink. All of this is both lower-risk and allows for continued sexuality despite any STI. Sex is about fun, pleasure, and feeling good—and safer sex practices bring all of that.”

Perhaps the best way to internalize your deservedness is to educate yourself on how to deal if you do contract an infection. Ideally, “your test is positive” was only the start—not the end—of your STI conversation with your doctor. If you were left hanging, explicitly ask what happens next (or find a new doc who cares enough about your health and your sexual satisfaction to discuss everything in detail). Bacterial STIs, like chlamydia, gonorrhea, and syphilis, can usually be cleared up with medication, typically requiring only a brief hiatus from sex. Ditto for parasitic STIs, such as pubic lice and trichomoniasis. And the ones that can’t be cured—such as HPV, herpes, and HIV—can usually be managed with proper treatment.

“Not feeling worthy of a happy, satisfying sex life is simply an irrational belief. Everyone deserves a happy sex life.” —Kathryn Stamoulis, PhD, sexuality expert

"When a patient tests positive for an STI, we offer immediate treatment and intensive counseling,” Dr. Goje says of her practice. “The role of counseling during treatment is important because we can help educate patients about consistently and properly using condoms during all sexual activities.” And since safe-sex best practices aren’t one size fits all—in fact some infections only allow for safer sex, since transmission isn't 100 percent avoidable—patients also learn about extra precautions they might need to take.

For instance, with herpes (an infection that spreads via skin-to-skin contact), it’s crucial to lay off sex when you have an outbreak and even when you feel one coming on. It’s possible to transmit herpes without any symptoms, but having sex during or just before an active outbreak makes transmission more likely. “Research suggests that women with genital HSV who aren't having active outbreaks run a 4 percent risk of transmitting the virus to a male partner during intercourse," reads a 2015 article in the Washington Post. "Men carry a 10 percent risk of transmitting to a female. Condoms cut the risk in half.” Dr. Goje also notes that some patients benefit from going on continuous suppression therapy—e.g., taking antiviral medications—to reduce herpes outbreaks. And when you’re asymptomatic and back in friskyville, condoms are a must. While they don’t completely eliminate the risk of transmission, barrier methods do significantly reduce the odds.

HPV is another STI that deserves an asterisk next to the generic “use condoms*” advice many people hear, since the primary function of condoms is to be a barrier to semen. *While condoms are definitely still important with this infection, the truth is that HPV can be spread through anal, vaginal, or oral sex, or through other close skin-to-skin touching, and even (although it’s rare) kissing. “HPV can live on all kinds of places on the skin, so there is no such thing as total protection,” says Lauren Streicher, MD, professor of clinical obstetrics and gynecology at Northwestern University. In both of these cases, significantly lower-risk sex is possible but totally safe sex is not, making communication with partners about diagnoses all the more crucial.

But no matter how you choose to proceed, don’t wait until you're in the heat of the moment to discuss your situation with your partner(s) or to disclose your STI. “I tell my patients who are nervous about disclosure that it’s not something they have to do, but not something they should get all in their heads about,” says Dr. Streicher. (A dose of perspective: Given how common STIs are, don’t be surprised if the person you’re telling says, “Yeah, me too!") The calmer and more matter-of-fact you are, the better. Doing your research beforehand is the best way to keep your cool—that way, you’ll be able to talk confidently about what can be done to minimize the risk of transmission as well as address questions your partner may have about any possible health risks (to either one of you).

If you’re still nervous about sharing, try to think of it as an efficient way to weed out the people who don’t deserve to take up space in your life—or in your bed. If someone reacts in a less-than-ideal way, accept their decision and let them go. Just as important: Don’t take on their judgment as a sign that you’re unworthy or unlovable. “We all need to become better about how we treat each other around STIs, especially since we all have the possibility of contracting one if we are sexual,” says Dr. Donaghue. "No one is ‘dirty,’ bad, or broken due to a diagnosis.”

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