Sexually Transmitted Infections
How Do Sexually Transmitted Infections Affect People with HIV?
Sexually transmitted infections (STIs) are very common among people who are sexually active. Anyone who has sex is at risk, including people with HIV. STIs are also commonly referred to as sexually transmitted diseases (STDs).
STIs are infections that are spread from person to person through sexual activity, including anal, vaginal, or oral sex. They are caused by bacteria, parasites, and viruses.
HIV is an STI. Other types of STIs include:
- Chlamydia—A common STI that can cause in infection in women and men. Chlamydia is easily treated and cured but can make it difficult to get pregnant if left untreated. Untreated chlamydia may increase a person’s chances of getting or transmitting HIV.
- Genital herpes—A common STI, but most people do not know they have it. There is no cure, but there are treatments for the symptoms.
- Gonorrhea—A common, treatable STI that can cause infection in the genitals, rectum, mouth, and throat. Untreated gonorrhea can increase a person’s chance of getting or transmitting HIV.
- Human papillomavirus (HPV)—The most common STI in the United States, but most people with HPV have no symptoms. HPV can cause some health effects, such as cervical cancer and anal cancer, and there is a higher prevalence of both among people with HIV. HPV is preventable by a vaccine (see below).
- Syphilis—An STI that can have very serious problems when left untreated. It is simple to cure with the right treatment.
Hepatitis A, hepatitis B, and hepatitis C can also be transmitted through sexual contact and pose health risks to people with HIV. There are vaccines for hepatitis A and B (see below). There is no vaccine for hepatitis C.
STIs in the United States have increased in the past 5 years and are a public health crisis. Many STIs do not have symptoms, but when left undetected and untreated they can lead to serious health consequences. If you have HIV, it can be harder to treat STIs, especially if you have a low CD4 count. That’s why STI testing should be part of your regular HIV care if you’re sexually active.
What Activities Can Put You at Risk for STIs?
Behaviors that put people at risk for HIV also increase their risk for other STIs. These behaviors include:
- Having anal, vaginal, or oral sex without a condom.
- Having sex with multiple partners, especially anonymous partners.
- Having sex while using drugs or alcohol. Using drugs and alcohol can affect your judgment, which can lead to risky behaviors.
What Can You Do to Prevent Getting STIs?
If you have HIV, the best thing you can do to stay healthy is to take HIV medicine (called antiretroviral therapy or ART) exactly as prescribed and get and keep an undetectable viral load—a level of HIV in your blood so low that a standard lab test can’t detect it. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex.
But even if you are taking HIV medicine and your viral load is undetectable, it will not prevent you from getting other STIs, such as gonorrhea, chlamydia, or syphilis.
The only 100% effective way to avoid getting other STIs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do the following things to lower your chances of getting other STIs:
Choose less risky sexual behaviors.
- Reduce the number of people you have sex with.
- Don’t drink alcohol or use drugs before and during sex.
Use condoms correctly every time you have sex.
- Use a new condom for every act of vaginal, anal, and oral sex throughout the entire sex act (from start to finish).
- Condoms are highly effective in preventing STIs, but not foolproof. Read this fact sheet from the Centers for Disease Control and Prevention (CDC) on how to use condoms consistently and correctly.
Get the vaccines that are recommended.
- Hepatitis A is preventable when you get the vaccine, which consists of two shots administered six months apart. Learn more.
- Hepatitis B is also preventable with a vaccine. You can receive this vaccine in a series of two, three, or four injections. Learn more.
- HPV vaccination prevents cancer-causing infections and pre-cancers. It is recommended for youth aged 11–12 and young adults through age 26 who are not up-to-date with vaccine recommendations. It is also recommended for women and men with HIV ages 13 through 26. Learn more.
- There are no vaccines for other STIs. Talk to your health care provider about what is right for you.
Talk to your health care provider about doxy-PEP: medicine to prevent STIs.
- A research study found that the oral antibiotic doxycycline reduced STIs by two-thirds when tested among men who have sex with men (MSM) and transgender women, including individuals with HIV, who took the medication within 72 hours of having condomless sex. This prevention approach is called doxy-PEP or STI PEP. However, the research also showed a slight increase in antibacterial resistance. Talk to your provider about whether doxy-PEP is right for you.
Protecting Your Sexual Partners
If you have HIV, are taking HIV medicine exactly as prescribed, and get and keep an undetectable viral load, you will not transmit HIV to an HIV-negative partner. However, while having an undetectable viral load will prevent you from passing HIV, it will not prevent you from transmitting other STIs to your sexual partners. Using condoms the right way every time can prevent the transmission of other STIs like gonorrhea and chlamydia. Routine testing for STIs is also important (see below).
If you have a detectable viral load and another STI, you are at risk for transmitting both HIV and other STIs to your partners. But you can protect your partners from HIV and other STIs by using condoms and choosing less risky sexual behaviors.
And if you have an HIV-negative partner who has another STI, they may have skin ulcers, sores, or inflammation that may increase their risk of getting HIV during sex.
An HIV-negative partner can take medicine to prevent HIV, called pre-exposure prophylaxis, or PrEP, but PrEP does not protect against other STIs. PrEP is an HIV prevention option for people who don’t have HIV but who are at risk of acquiring HIV. PrEP involves taking HIV medicines exactly as prescribed to reduce the risk of HIV infection. Both oral HIV medicines and a long-acting injectable form of PrEP are available.
Get Tested and Treated for STIs
If you are sexually active, getting tested for STIs is one of the most important things you can do to protect your health and your partners’ health. Make sure you have an open and honest conversation about your sexual history and STI testing with your health care provider and ask whether you should be tested for STIs.
Depending on your symptoms and sexual activities, the provider may perform a three-site test of your throat, genitals, and rectum. Don’t be embarrassed to get tested for an STI. Your health care provider is used to discussing sexual health. Besides, CDC estimates that there are more than 20 million new STI infections every year. So you are not alone and aren’t the only person talking to your health care provider about an STI.
Encourage your partner(s) to get tested too. You or your partner(s) might have an STI without having symptoms. You and your partner should determine what sexual behaviors and prevention practices are going to be used in your relationship—and outside of it if you are not exclusive. The goal of this communication is to keep you BOTH healthy and free from new infections. Here are some great tips on talking with your partner.
If you test positive, know that getting an STI is not the end! Many STIs are curable and all are treatable. If either you or your partner is infected with an STI that can be cured, both of you need to start treatment immediately to avoid getting re-infected.
STI National Strategic Plan
The U.S. Department of Health and Human Services (HHS) released the first-ever STI National Strategic Plan (STI Plan) in December 2020, providing a road map for STI prevention, diagnosis, care, and treatment.
In June 2023, HHS released the STI Federal Implementation Plan, a companion document outlining federal actions to reduce the burden of sexually transmitted infections in the United States through 2025.