How to prevent sexually transmitted infections (STIs)

What is sexually transmitted infections?

Sexually transmitted infections or STIs are infections that are spread during sexual contact with another person. According to the World Health Organisation (WHO) more than 1 million sexually transmitted infections (STIs) are acquired every day worldwide.¹ More than 30 different bacteria, viruses and parasites are known to be transmitted through sexual contact. Eight of these organisms are linked to the greatest incidence of sexually transmitted disease in Africa and elsewhere.

Of these 8 infections, 4 are preventable and currently curable:

• Chlamydia
• Gonorrhea
• Syphilis
• Trichomoniasis

The other 4 are viral infections which are preventable but not curable:

• Hepatitis B
• Herpes simplex virus (HSV or herpes)
• HIV
• Human papillomavirus (HPV).

STIs can have serious general and reproductive health consequences beyond the immediate impact of the infection itself.

So, how can you prevent catching STIs?

The only guaranteed method to prevent catching STIs is to abstain from all sexual contact. For most people this is not a practical remedy.

So, what to do? Prevention is the key and there are steps you and others can take to limit your risk of catching STIs.

Protection before sex

Effective STI prevention can be organized under two broad levels; the individual and public.

Individual protection

These are some steps to take in order to reduce your STI risk before having sex:

• Always be mindful that you are at risk, since there is no way to know whether your partner has STI just by looking at him/her.

• Limit the number of your sexual partners. The more partners you engage with, the higher your risk of catching STIs.

• Avoid sexual contact whenever you are under the influence of alcohol or other drugs.

• Talk with your health care provider regularly and make STI testing part of your routine yearly health check.

• As may be available and affordable, get vaccinated against the human papillomavirus (HPV) and hepatitis B (HBV).

Public protection

Counselling and behavioural interventions offer the broadest public health efforts against STIs. According to the WHO, these efforts should include:¹

• Broad sexuality education coupled with pre- and post-exposure counseling and testing.
  • Such counseling can help improve people’s ability to recognize the symptoms of STIs and increase the likelihood they will seek care or encourage their sexual partner to do so.

• Public promotion of safer sex and risk-reduction counselling, including condom promotion.

• Identifying and targeting key at risk populations such as adolescents, sex workers, men who have sex with men and people who inject drugs with counseling, prevention information; and subsidized barrier products.

• Public campaign against the stigma of STI which serves as barrier to use of public efforts.

• Training of primary level health workers in early recognition of STI symptoms, and pre- and post-exposure STI prevention, counseling and testing

Practicing safe sex

Engaging in safer sex practices implies using adequate and effective barrier products for all forms of sexual activities, except when planned child bearing is an objective. Reliable safe sex practices include:

• Use of a male or female condom for intercourse
• Use of condoms or dental dams for oral sex
• Use of gloves for manual penetration

Although washing off the genital skin area with soap and clean water after sex can help remove any infectious material on your skin, this is no guarantee against STI.

Vaginal douching by women immediately after sex should be avoided as this may precipitate widespread genital infections. Women should urinate after sex. This may help reduce the risk of urinary tract infections (UTI).

When used correctly and consistently, barrier products like condoms offer one of the most cost-effective methods of protection against STIs, including HIV, even if not 100% assured.

Correct use of barrier products

When using barrier products for safer sex, it’s important to follow the manufacturer’s instructions on the box and use them correctly.

Follow these safety precautions when using condoms:

• Check the expiration date. Latex or polyurethane condoms that are past their expiry dates put you at risk of STIs.

• Test the condom package for possibility of puncture hole. If a condom package lacks air bubble when compressed, do not use.

• Put the condom on correctly by unrolling it onto the penis before sexual contact. Always leave room at the tip.

• Use condom-safe lubricant during intercourse. 

• Hold onto the condom when withdrawing after sex, so that it doesn’t slip off.

• Dispose of the condom properly.

• Never take a condom off and try to put it on again.

• Never reuse a male condom. Female diphragms are reusable. 

Potential risks of barrier products

Although condoms and other barriers are effective at preventing the exchange of infected bodily fluids and minimising skin-to-skin contact, they do not totally prevent STI transmission. It is fool-hardy to think or believe so.

More so, if you’re in a sexual relationship with someone who has herpes, syphilis, human papilloma virus (HPV) or HIV, talk to your doctor about possibility of vaccination and/or pre-exposure prophylaxis. Such therapies help to prevent and reduce the risk of relevant viral infections and further transmission without providing cure of the infection.

Here are some reasons why male condom failure occurs

• Slip off of the penis after ejaculation
• Break due to improper application
• Physical damage when opening the package
• Physical damage or slip due to latex degradation (typically from usage past the expiration date, improper storage, or exposure to oils).

The estimated rate of male condom breakage is between 0.4% and 2.3%, while the rate of slippage is between 0.6% and 1.3%.²

Big picture and takeaway

• STIs are common. They are caused by a variety of organisms. Infections by some infecting organisms are preventable and curable. Other infections are preventable and not curable.

• There are many simple and effective ways to reduce STI risk and make sex safer at individual and population levels.

• If at any time you have concerns about your STI risks, get informed by seeking reliable information especially from your doctor. Also, make STI counseling and testing part of your routine health check with your primary care provide.

• If you have reasons to believe that you have been exposed to STI from a sexual encounter, seek medical attention immediately.

• Practice safe sex. If you’re unsure about the right safe sex method for you, talk with your doctor or primary care provider.

• Be aware that there is risk of catching STI from every sexual encounter. The risks are higher when in relationship with multiple partners and low when in a committed relationship with a single partner.

• The regular use of a barrier product (e.g., male or female condom) during every sexual encounters is strongly advised except where a planned pregnancy is an objective.

• Remember, safe sexual practice is for everyone.

Related:

Common sexualy transmitted infections in Africa

Sources:

1. World Health Organisation. Overview of Sexually transmitted infection (2019) 

2. National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA. Scientific evidence on condom effectiveness for sexually transmitted disease (STD) prevention (2001).

Published: December 8, 2019

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