How to have sex after an STD diagnosis, according to an expert

Dr. Kristen Mark, PhD, MPH is a sex and relationships researcher, educator, and clinician. She holds the Joycelyn Elders Endowed Chair in Sexual Health Education at University of Minnesota Medical School in the Institute for Sexual + Gender Health. Dr. Mark is on the advisory committee for the World Association for Sexual Health, has published her scientific work extensively in top journals in the field and given hundreds of talks on the science of sex and relationships. She also values making sure the public understands what scientists are learning about her field of research.


While the past few years may have been filled with hand sanitizer, face masks, and social distancing to ensure the health and safety of both ourselves and those around us — even the preventive measures of the COVID-19 pandemic didn’t stop the spread of 2.4 million new STD cases.

In fact, the CDC reported STDs have reached all-time high for the sixth consecutive year. And what’s more, additional data from an Everly Health study shows that screening and testing also decreased by 63% for men and 59% for women during the pandemic.

Sure, these numbers are alarming. But they’re also a helpful reminder that STDs are common and that getting tested is one of the best ways you can take control of your sexual health.

“There’s a lot of stigma surrounding an STI diagnosis, but they’re actually quite common,” said sex and relationships researcher, educator, and clinician, Kristen Mark, PhD, MPH . “Due to the stigma, people just don’t tend to talk about it.”

Luckily, there are some pretty clear guidelines to follow for when to resume sexual activity if you should test positive, and according to Dr. Mark, having a totally healthy sex life is entirely possible post-STD diagnosis and treatment.

Below, we spoke with her to further break down what happens when you test positive for these common STDs:


Chlamydia

What does treatment look like if you should test positive?
Treatment for chlamydia is just a round of antibiotics. The two most commonly prescribed antibiotics for chlamydia are doxycycline (one pill a day every day for a week) or azithromycin (one 1g dose on the first day, followed by 500mg for two days).

Do any partners need to get tested and treated as well?
Absolutely. You’ll need to have your partner(s) get tested as well. Make sure they get tested in the site within which sexual activity occurred (i.e., if oral sex was involved, swab the throat…if anal sex was involved, swab the anus, etc.). If they test positive, they’ll need treatment. But they don’t need treatment unless they test positive.

Should you test again to confirm the infection has cleared? When is it okay to return to sexual activity?
If you were treated with doxycycline, you can resume sexual activity after the full run of the antibiotics is done. If you were treated with azithromycin, wait 7 days after treatment to resume sexual activity. Don’t engage in sexual activity during the treatment period, and per the CDC, retest to make sure the Rx was effective.

Is there anything else folks should know?
Chlamydia often doesn’t have any symptoms, but that doesn’t mean it is a less severe version or doesn’t need treatment. If left untreated, it can result in infection in the uterus and fallopian tubes causing pelvic inflammatory disease (PID) leading to infertility, or it can result in swelling in the testicles.

Gonorrhea

What does treatment look like if you should test positive?
Treatment for gonorrhea involves taking an antibiotic. The most common is an injection of 500mg of ceftriaxone or an oral dose of azithromycin.

Do any partners need to get tested and treated as well?
Yes, you should tell your partner(s) and they should get tested. If they test negative, they don’t need to get treatment, but they need treatment if they test positive.

Should you test again to confirm the infection has cleared? When is it okay to return to sexual activity?
You don’t need to test again to confirm the infection has cleared; you can return to sexual activity 7 days after the antibiotic treatment is complete (as long as you don’t have any symptoms). If you still have symptoms 7 days after the antibiotic treatment, test again, and if positive, you may need another round of antibiotics.

Is there anything else folks should know?
Similar to chlamydia, gonorrhea often doesn’t have any symptoms, but that doesn’t mean it is a less severe version or doesn’t need treatment. If left untreated, it can result in infection in the uterus and fallopian tubes causing pelvic inflammatory disease (PID), and this can lead to infertility.

Hepatitis

What does treatment look like if you should test positive? Is there a vaccine?
There is no direct treatment for hepatitis A, B, or C because they’re all viruses, but you can receive treatment for any symptoms, and will be monitored to make sure your symptoms are under control until the virus is totally suppressed in your system or it goes away on its own. In most cases for hepatitis A, your liver will heal itself within 6 months and there shouldn’t be any lasting damage. For hepatitis B, treatment involves antiviral drug treatment, used to slow the damage hep B causes to your liver. For hepatitis C, treatment also involves an antiviral drug treatment, and treatment is usually quite effective.

With new innovations in antiviral drug treatments, many people find that the virus is eradicated at least 12 weeks post-treatment. There are vaccines for both hepatitis A and B and these are widely available, effective, and encouraged.

Do any partners need to get tested and treated as well?
Yes, especially if you engaged in a higher risk transmission behavior like anus-to-mouth without washing the penis first, or sexual behavior where tearing may have occured and exposed the bloodstream.

Should you test again to confirm the infection has cleared? When is it okay to return to sexual activity?
Your doctor will monitor what the virus is doing to your liver, and you should avoid engaging in any higher risk activities (mostly anus-to-mouth activities or activities that expose the bloodstream) after a positive diagnosis until you receive a negative test, regardless of symptoms.

Is there anything else folks should know?
Hepatitis impacts the liver, so the longer it goes untreated or undiagnosed, the more likely you are to cause damage to the liver and lead to cirrhosis of the liver, which is deadly.

Trichomoniasis

What does treatment look like if you should test positive?
If you test positive, trichomoniasis can be treated through an antiprotozoal or antibiotic - typically this involves 2g of tinidazole in a single dose or 500mg of metronidazole twice a day for 7 days.

Do any partners need to get tested and treated as well?
Yes, partners need treatment for trichomoniasis regardless of test result to prevent reinfection, especially if your sexual partner has a penis.

Should you test again to confirm the infection has cleared? When is it okay to return to sexual activity?
You can return to sexual activity 7 days post-treatment for both partners. Just make sure that all partners one encountered have been treated or it can just keep being passed back and forth.

Is there anything else folks should know?
If left untreated for trichomoniasis, women are at a higher risk of contracting HIV if exposed to HIV (Kissinger & Adamski, 2013). Additionally, about 70% of people don’t have symptoms for trichomoniasis, so getting regularly tested is important.

Syphilis

What does treatment look like if you should test positive?
If you test positive for syphilis, treatment doses depend on what phase of syphilis you caught the bacterium in, but because it is bacterium, it can be treated with antibiotics. Treatment typically involves a single injection of long-acting benzathine penicillin G to treat the early stages of syphilis (primary, secondary, or early latent stage). If you caught syphilis at late latent syphilis or latent syphilis of an unknown duration, usually this is treated with three doses of the injection of long-acting benzathine penicillin G weekly for three weeks.

Do any partners need to get tested and treated as well?
Yes, partner(s) of someone who tested positive for syphilis should definitely receive testing. They do not need treatment unless they also test positive.

When is it okay to return to sexual activity?
Wait 7 days post-treatment to resume sexual activity. However, if there are any symptoms present after those 7 days (such as a lesion or a rash), wait until symptoms are gone before resuming sexual activity.

Is there anything else folks should know?
If syphilis goes into late latent stage, it can be deadly. So it is important to catch it as early as possible. Additionally, syphilis is often spread through contact with a lesion or rash, so if that area is not covered by a barrier method (e.g., if it is on the scrotum or the mons pubis), it will not be protected by a barrier method, and transmission can occur.

HIV

What does treatment look like if you should test positive?
If you test positive for HIV, there are a lot of treatment options for ensuring HIV does not progress to become AIDS. Treatment involves taking antiretroviral therapy (ART) drugs on a daily basis. This doesn’t cure HIV, but it does prevent HIV from becoming AIDS and can suppress the virus so much that it can become undetected (and therefore untransmittable).

Additionally, there are now preventative measures such as PEP and PrEP. Post-exposure prophylaxis (PEP) is a one-time preventative medical treatment that is started after exposure to HIV in order to prevent the infection from taking hold in your body. Pre-exposure prophylaxis (PrEP) is a daily antiviral medication that can be taken by people who have not yet been exposed to HIV, but are engaging in behavior that may expose them to HIV. This provides a protective barrier in the body that can prevent infection if exposure takes place.

Do partners need to get tested and treated as well?
Yes, partners need to get tested and you should notify any partners you’ve had contact with since your last HIV test to ensure they know to get tested as well.

When is it okay to return to sexual activity? What other precautions need to be taken?
When someone receives a diagnosis of HIV, they should get on antiretroviral therapy to try and minimize the viral load in their body. It usually takes antiretroviral therapy around 6 months to get the body to an undetectable viral load. Transmission of HIV to others is highly unlikely if you have an undetectable viral load. However, using barrier methods is very effective to close the gap before the viral load is undetectable.

Is there anything else folks should know?
If HIV is left untreated, it can progress to AIDS, which results in severe damage to the immune system. This typically takes place about 8 to 10 years after an untreated HIV infection.


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References:

1. New data suggest STDs continued to increase during the first year of the COVID-19 pandemic. CDC. URL. Accessed May 11, 2022. 2. Reported STDs Reach All-time High for 6th Consecutive Year. CDC. URL. Accessed May 11, 2022. 3. Everly Health Releases New STD Testing Data Demonstrating At-Home Sample Performance Amid Growing Infection Rates Nationwide. Business Wire. URL. Accessed May 11, 2022. 4. STI Treatment Guidelines. CDC. URL. Accessed May 11, 2022. 5. Trichomoniasis and HIV interactions: a review. National Library of Medicine. URL. Accessed May 11, 2022.

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