Sexuality is a big part of being human. Love, affection and sexual intimacy all play a role in healthy relationships. They also contribute to your sense of well-being. A number of disorders can affect the ability to have or enjoy sex in both men and women.

Factors that can affect sexual health include

• Fear of unplanned pregnancy
• Concerns about infertility
• Sexually transmitted diseases
• Chronic diseases such as cancer or heart disease
• Medicines that affect sexual desire or performance

The World Health Organization defines sexual health as a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

From a holistic perspective, sexual health includes emotional, psychological, physical, intellectual and spiritual dimensions. The following are characteristics of sexually healthy adults however sexual health is developed over a life-span, from cradle to grave. Integrating sexuality into one’s life in a balanced way is a life-time endeavor.

Communication

• Interact with all genders in appropriate and respectful ways
• Communicate effectively with family and friends
• Ask questions of other adults about sexual issues, when necessary
• Are able to communicate and negotiate sexual limits
• Communicate respectfully their desires to have sex and not to have sex
• Accept refusals of sex without hostility or feeling insulted
• Can physically express feelings of attraction and desire in ways that do not focus on the genitals (ex: holding, caressing, kissing, etc.)
• Talk with a partner about sexual activity before it occurs, including limits, contraceptive and condom use, and meaning in the relationship
• Communicate with partners their intentions for the relationship (ex: only dating, want marriage)
• Listen to and respect others’ boundaries and limits
• Are sensitive to non-verbal cues of others’ boundaries and limits

Relationships

• Develop friendships that do not have a sexual agenda
• Avoid exploitative relationships
• Choose partners who are responsible, trustworthy, safe and giving
• Can be sexually intimate without being physical (ex: talk about sexual feelings, verbally express attraction, do things that awaken desire in partner)
• Can express themselves in ways other than genitally (ex: holding, caressing, kissing, etc.)
• Take personal responsibility for their own boundaries

Self-esteem and self-worth

• Appreciate their own bodies
• Are sensually aware and able to stay conscious in their bodies
• Can touch their own bodies without feeling shame or disgust
• Allow themselves to experience pleasurable sensual and sexual feelings
• Have the capacity to nurture themselves and others, and accept nurturing from others
• Feel joy in sexual experiences of their choosing
• Know when they need touch rather than sex and try to get their needs for touch met appropriately
• Have a developed sense of self, an understanding of who they are
• Enjoy sexual feelings without necessarily acting upon them
• Accept refusals of sex without hostility or feeling personally insulted
• Allow themselves to be vulnerable
• Are comfortable with their sexual identity and orientation
• Are becoming aware of the impact of negative sexual experiences such as sexual abuse, and the impact of negative cultural messages on their sexual development
• Are taking steps to address issues that have arisen as a result of past experiences
• Feel confident in their ability to set appropriate boundaries
• Realize that, by working through sexual issues, individuals may heal psychological and emotional wounding from past experiences and damaging beliefs.

Education

• Realize the consequences of sexual activity
• Comprehend the impact of media messages on thoughts, feelings, values, and behaviors related to sexuality
• Understand that the drive for sex is powerful and can be integrated into one’s life in positive and healthy ways
• Respect the right of all people to enjoy and engage in the full range of consensual, non-exploitive sexual behaviors

Values

• Decide on what is personally “right” and act on these values
• Demonstrate tolerance for people with different values
• Are not threatened by others with sexual orientation different from theirs
• Show respect to others whose cultural values, ethnic heritage, age, socioeconomic status, religion, and gender are different from theirs

Contraception, protection, and body integrity

• Take responsibility for their own bodies and their own orgasms
• If sexually active, use contraception effectively to avoid unplanned pregnancy and use condoms and safer sex to avoid contracting or spreading a sexually transmitted disease
• Practice health-promoting behaviors, such as regular checkups, breast or testicular self-exams, regular and routine testing for STDs

Spirituality

• Honor the sacred aspect of sexual union
• Understand that sexual energy is not separate from being human
• Understand that sexual union is one way human beings connect body and soul

Cuddles, kisses, and caring conversations. These are key ingredients of our close relationships. Scientists are finding that our links to others can have powerful effects on our health. Whether with romantic partners, family, friends, neighbors, or others, social connections can influence our biology and well-being.

Wide-ranging research suggests that strong social ties are linked to a longer life. In contrast, loneliness and social isolation are linked to poorer health, depression, and increased risk of early death.

Studies have found that having a variety of social relationships may help reduce stress and heart-related risks. Such connections might improve your ability to fight off germs or give you a more positive outlook on life. Physical contact—from hand-holding to sex—can trigger release of hormones and brain chemicals that not only make us feel great but also have other biological benefits.

Marriage is one of the most-studied social bonds. “For many people, marriage is their most important relationship. And the evidence is very strong that marriage is generally good for health,” says Dr. Janice Kiecolt-Glaser, an expert on health and relationships at Ohio State University. “But if a relationship isn’t going well, it could have significant health-related consequences.”

Married couples tend to live longer and have better heart health than unmarried couples. Studies have found that when one spouse improves his or her health behaviors—such as by exercising, drinking or smoking less, or getting a flu shot—the other spouse is likely to do so, too.

When marriages are full of conflict, though, such health benefits may shrink. In NIH-funded studies, Kiecolt-Glaser and her colleagues found that how couples behave during conflict can affect wound healing and blood levels of stress hormones. In a study of more than 40 married couples, the researchers measured changes to body chemistry over a 24-hour period both before and after spouses discussed a conflict. The troublesome topics included money, in-laws, and communication.

“We found that the quality of the discussion really mattered,” Kiecolt-Glaser says. Couples who were more hostile to each other showed much larger negative changes, including big spikes in stress hormones and inflammation-related molecules. “In the more well-functioning marriages, couples might acknowledge that they disagree, or find humor in the situation, but they don’t get sarcastic or roll their eyes when the other is talking,” Kiecolt-Glaser says. In a related study, blister wounds healed substantially more slowly in couples who were nastier to each other than in those who were kinder and gentler during difficult discussions.

Couples with the “double-whammy” of hostile marriages and depression may also be at risk for weight problems. After eating a high-fat meal and discussing a difficult topic, these troubled couples tended to burn fewer calories than less hostile counterparts. “The metabolism in these couples was slower in ways that could account for weight gain across time,” Kiecolt-Glaser says. Compared to the kinder couples, the distressed spouses had signs of more fat storage and other risks for heart disease.

The quality of a marriage—whether supportive or hostile—may be especially important to the health of older couples. Dr. Hui Liu at Michigan State University studied data on the health and sexuality of more than 2,200 older people, ages 57 to 85. Good marriage quality, she found, is linked to reduced risk of developing cardiovascular disease, while bad marriage quality is tied to increased risk, particularly in women. “The association between marriage quality and heart health becomes increasingly strong at older ages,” Liu says.

Liu and colleagues are also looking at the links between late-life sexuality and health, including whether sex among the very old is beneficial or risky to heart health. “Some people assume that sex isn’t important in older ages, so those ages are often overlooked in research studies related to sex,” Liu says. “But our studies suggest that for many older people, sex quality and sex life are important to overall quality of life.”

In one recent analysis, Liu and co-workers found that older women who reported having a satisfying sex life were at reduced risk for high blood pressure 5 years later. But the researchers also found that some older men, ages 57 to 85, were at increased risk for certain heart-related problems after 5 years if they reported having frequent (at least once a week) or extremely enjoyable sex. The reasons for these increased risks aren’t clear and are still under study. Experts suggest that older men and women talk with their doctors about concerns related to sexual issues or potential health risks.

Other types of relationships are important, too. These can include friends, family, neighbors, co-workers, clubs, and religious groups. Studies have found that people who have larger and more diverse types of social ties tend to live longer. They also tend to have better physical and mental health than people with fewer such relationships. Social support may be especially protective during difficult times.

Dr. Sheldon Cohen, a psychologist at Carnegie Mellon University in Pittsburgh, has been exploring the links between relationships and health for more than 3 decades. In one study, his team exposed more than 200 healthy volunteers to the common cold virus and observed them for a week in a controlled setting. “We found that the more diverse people’s social networks—the more types of connections they had—the less likely they were to develop a cold after exposure to the virus,” Cohen says. He and his team have since found evidence that people with more types of connections also tend to have better health behaviors (such as not smoking or drinking) and more positive emotions.

The scientists have also been exploring whether simply believing you have strong social support may help protect against the harms of stress. “Long-term conflicts with others are a potent stressor that can affect health. But we’ve found that its effects are buffered by perceived social support,” Cohen says. “People who have high levels of conflict and low levels of social support are much more likely to get sick when exposed to a virus. But those with high conflict and high levels of social support seem protected.” In addition, hugging seemed to shield against stress. People who reported having more frequent hugs were less likely to develop an infection after viral exposure.

Social ties can have mixed effects on our health. But overall, research suggests that the benefits of interactions with others can outweigh any risks. “It’s generally healthy for people to try to belong to different groups, to volunteer in different ways, and be involved with a church or involved in their neighborhood,” Cohen says. “Involvement with other people across diverse situations clearly can have a very potent, very positive effect on health.”

Making Connections

Social connections might help protect health and lengthen life. Look for ways to get involved with others:

• Join a group focused on a favorite hobby, such as reading, hiking, painting, or wood carving.
• Take a class in yoga, tai chi, or another new physical activity.
• Help with gardening at a community garden or park.
• Volunteer at a school, library, hospital, or place of worship.
• Join a local community group or find other ways to get involved in things you care about.

Sexually transmitted diseases (STDs), also known as sexually transmitted infections (STIs), are very common. Millions of new infections occur every year in the United States.

STDs are passed from one person to another through sexual activity including vaginal, oral, and anal sex. They can also be passed from one person to another through intimate physical contact, such as heavy petting, though this is not very common.

STDs don’t always cause symptoms or may only cause mild symptoms. Therefore, it is possible to have an infection and not know it. That is why getting an STD test is important if you are having sex. If you receive a positive STD diagnosis, know that all are treatable with medicine and some are curable entirely.

STDs are preventable. If you have sex, know how to protect yourself and your sex partner(s) from STDs.

The diseases, conditions, and infections below are listed in alphabetical order.

Bacterial Vaginosis

Any woman can get bacterial vaginosis. Having bacterial vaginosis can increase your chance of getting an STD.

Chlamydia

Chlamydia is a common sexually transmitted disease (STD) that can be easily cured. If left untreated, chlamydia can make it difficult for a woman to get pregnant.

Gonorrhea

Anyone who is sexually active can get gonorrhea. Gonorrhea can cause very serious complications when not treated, but can be cured with the right medication.

Hepatitis

Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation.

Herpes

Genital herpes is a common STD, and most people with genital herpes infection do not know they have it.

HIV/AIDS & STDs

People who have STDs are more likely to get HIV, when compared to people who do not have STDs.

Human Papillomavirus (HPV) Infection

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Some health effects caused by HPV can be prevented with vaccines.

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID) can lead to serious consequences including infertility.

Syphilis

Syphilis is a sexually transmitted disease (STD) that can have very serious complications when left untreated, but it is simple to cure with the right treatment.

Trichomoniasis

Most people who have trichomoniasis do not have any symptoms.

Other STDs

Chancroid, scabies, and more.

Risks for HIV

The most common ways HIV is transmitted in the United States is through anal or vaginal sex or sharing drug injection equipment with a person infected with HIV. Although the risk factors for HIV are the same for everyone, some racial/ethnic, gender, and age groups are far more affected than others.

What puts me at risk for Hepatitis A

Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces or stool of an infected person. Due to routine vaccination of children, Hepatitis A has decreased dramatically in the United States. Although anyone can get Hepatitis A, certain groups of people are at higher risk, including men who have sex with men, people who use illegal drugs, people who travel to certain international countries, and people who have sexual contact with someone who has Hepatitis A.

What puts me at risk for Hepatitis B

Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

Among adults in the United States, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. Hepatitis B is 50–100 times more infectious than HIV.

What puts me at risk for Hepatitis C

Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Hepatitis C was also commonly spread through blood transfusions and organ transplants prior to the early 1990’s. At that time, widespread screening of the blood supply began in the United States, which has helped ensure a safe blood supply.
 

STDs

Risks for Genital Herpes

Genital herpes is a common STD, and most people with genital herpes infection do not know they have it.   You can get genital herpes from an infected partner, even if your partner has no herpes symptoms.  There is no cure for herpes, but medication is available to reduce symptoms and make it less likely that you will spread herpes to a sex partner.

Risks for Genital Human Papillomavirus (HPV)

HPV is so common that most sexually active people get it at some point in their lives. Anyone who is sexually active can get HPV, even if you have had sex with only one person. In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer. HPV is passed on through genital contact (such as vaginal and anal sex). You can pass HPV to others without knowing it. 

Risks for Chlamydia

Most people who have chlamydia don’t know it since the disease often has no symptoms. Chlamydia is the most commonly reported STD in the United States.  Sexually active females 25 years old and younger need testing every year. Although it is easy to cure, chlamydia can make it difficult for a woman to get pregnant if left untreated. 

Risks for Gonorrhea

Anyone who is sexually active can get gonorrhea, an STD that can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people ages 15-24 years. But it can be easily cured.  You can get gonorrhea by having anal, vaginal, or oral sex with someone who has gonorrhea. A pregnant woman with gonorrhea can give the infection to her baby during childbirth.

Risks for Syphilis

Any sexually active person can get syphilis. It is more common among men who have sex with men. Syphilis is passed through direct contact with a syphilis sore. Sores occur mainly on the external genitals, anus, or in the rectum. Sores also can occur on the lips and in the mouth. A pregnant women with syphilis can give the infection to her unborn baby.

Risks for Bacterial Vaginosis

BV is common among women of childbearing age. Any woman can get BV, but women are at a higher risk for BV if they have a new sex partner, multiple sex partners, use an intrauterine device (IUD), and/or douche.

Risks for Trichomoniasis

Trichomoniasis is a common STD that affects both women and men, although symptoms are more common in women. You can get trichomoniasis by having vaginal sex with someone who has it. Women can acquire the disease from men or women, but men usually contract it only from women.

HIV Prevention

Your life matters and staying healthy is important. It’s important for you, the people who care about you, and your community. Knowing your HIV status gives you powerful information to help you take steps to keep you and your partners healthy. You should get tested for HIV, and encourage your partners to get tested too. For people who are sexually active, there are more tools available today to prevent HIV than ever before. The list below provides a number of ways that you can lower your chances of getting HIV. The more of these actions you take, the safer you can be.

• Get tested and treated for other STDs and encourage your partners to do the same. All adults and adolescents from ages 13-64 should be tested at least once for HIV and high-risk groups get tested more often. STDs can have long-term health consequences. They can also increase your chance of getting HIV or transmitting it to others. It is important to have an honest and open talk with your healthcare provider and ask whether you should be tested for STDs. Your healthcare provider can offer you the best care if you discuss your sexual history openly. Find an HIV/STD testing site.
• Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex for HIV transmission. Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV-negative, insertive anal sex (topping) is less risky for getting HIV than receptive anal sex (bottoming). Sexual activities that do not involve the potential exchange of bodily fluids carry no risk for getting HIV (e.g., touching).
• Use condoms consistently and correctly.
• Reduce the number of people you have sex with. The number of sex partners you have affects your HIV risk. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission.
• Talk to your doctor about pre-exposure prophylaxis (PrEP). CDC recommends that PrEP be considered for people who are HIIV-negative and at substancial risk for HIV.For sexual transmission, this includes HIIV-negative persons who are in an ongoing relationship with an HIV-positive partner. It also includes anyone who 1) is not in a mutually monogamous* relationship with a partner who recently tested HIV-negative, and 2) is a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months; or heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners). For people who inject drugs, this includes those who have injected illicit drugs in the past 6 months and who have shared injection equipment or been in drug treatment for injection drug use in the past 6 months. See more information at http://www.cdc.gov/hiv/basics/prep.html
• Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable (see Can I transmit HIV if I have an undetectable viral load). Starting medicine immediately (known as post-exposure prophylaxis, or PEP) and taking it daily for 4 weeks reduces your chance of getting HIV.
• If your partner has HIV, encourage your partner to get into care and to take HIV medicine as prescribed. Taking HIV medicine as prescribed can make the level of virus in their body very low (called viral suppression) or even undetectable. A person with HIV who gets and stays virally suppressed or undetectable can stay healthy and has effectively no risk of transmitting HIV to HIV-negative partners through sex.

* Mutually monogamous means that you and your partner only have sex with each other and do not have sex outside the relationship.

Hepatitis Prevention

The best way to prevent both Hepatitis A and B is by getting vaccinated. There is no vaccine available to prevent Hepatitis C. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, such as sharing needles or other equipment to inject drugs.

STD Prevention

The only way to avoid STDs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do several things to lower your chances of getting an STD, including:

• Get tested for STDs and encourage your partner(s) to do the same. It is important to have an honest and open talk with your healthcare provider and ask whether you should be tested for STDs. Your healthcare provider can offer you the best care if you discuss your sexual history openly. Find an STD testing site.
• Get vaccinated. Vaccines are safe, effective, and recommended ways to prevent hepatitis A, hepatitis B, and HPV.
• Be in a sexually active relationship with only one person, who has agreed to be sexually active only with you.
• Reduce your number of sex partners. By doing so, you decrease your risk for STDs. It is still important that you and your partner get tested, and that you share your test results with one another.
• Use a condom every time you have vaginal, anal, or oral sex. Correct and consistent use of the male latex condom is highly effective in reducing STD transmission.

Birth Control Methods

Many elements need to be considered by women, men, or couples at any given point in their lifetimes when choosing the most appropriate contraceptive method. These elements include safety, effectiveness, availability (including accessibility and affordability), and acceptability. Voluntary informed choice of contraceptive methods is an essential guiding principle, and contraceptive counseling, when applicable, might be an important contributor to the successful use of contraceptive methods.

In choosing a method of contraception, dual protection from the simultaneous risk for HIV and other STDs also should be considered. Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STDs, including HIV. Consistent and correct use of the male latex condom reduces the risk for HIV infection and other STDs, including chlamydial infection, gonococcal infection, and trichomoniasis.

Reversible Methods of Birth Control

Intrauterine Contraception

Hormonal Methods

Barrier Methods

Fertility Awareness-Based Methods

Lactational Amenorrhea Methods

Emergency Contraception

Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.

Permanent Methods of Birth Control

Fast Facts

• Many sexually transmitted diseases (STDs) can be spread through oral sex.
• Using a condom, dental dam or other barrier method every time you have oral sex can reduce the risk of giving or getting an STD.
• There is little to no risk of getting or transmitting HIV from oral sex.

What is Oral Sex?

Oral sex involves using the mouth, lips, or tongue to stimulate the penis (fellatio), vagina (cunnilingus), or anus (anilingus) of a sex partner. The penis and testicles and the vagina and area around the vagina are also called the genitals or genital area.

How Common is Oral Sex?

Oral sex is commonly practiced by sexually-active adults. More than 85% of sexually-active adults aged 18-44 years reported having had oral sex at least once with a partner of the opposite sex. A separate survey conducted during 2011 to 2015 found that 41% of teenagers aged 15-19 years reported having had oral sex with a partner of the opposite sex.

Can STDs Be Spread During Oral Sex?

Many STDs, as well as other infections, can be spread through oral sex. Anyone exposed to an infected partner can get an STD in the mouth, throat, genitals, or rectum. The risk of getting an STD from oral sex, or spreading an STD to others through oral sex, depends on several things, including

• The particular STD.
• The sex acts practiced.
• How common the STD is in the population to which the sex partners belong.
• The number of specific sex acts performed.

In general:

• It may be possible to get some STDs in the mouth or throat from giving oral sex to a partner with a genital or anal/rectal infection, particularly from giving oral sex to a partner with an infected penis.
• It also may be possible to get certain STDs on the penis (and possibly the vagina, anus or rectum) from getting oral sex from a partner with a mouth or throat infection.
• It’s possible to have an STD in more than one area at the same time, for example in the throat and the genitals.
• Several STDs that may be transmitted by oral sex can then spread throughout the body (i.e., syphilis, gonorrhea, and intestinal infections).
• Anilingus (or oral sex involving the anus) can transmit hepatitis A and B, intestinal parasites like Giardia, and bacteria like E. coli and Shigella.
• STDs can be spread to a sex partner even when the infected partner has no signs or symptoms. If you are infected with an STD, you might not know it because many STDs may have no symptoms.

Which STDs Can Be Passed On from Oral Sex?

Chlamydia (Chlamydia trachomatis)

Risk of infection from oral sex:

• Giving oral sex to a partner with an infected penis can result in getting chlamydia in the throat.
• Giving oral sex to a partner with an infected vagina or urinary tract may result in getting chlamydia in the throat.*
• Giving oral sex to a partner with an infected rectum might result in getting chlamydia in the throat.*
• Getting oral sex on the penis from a partner with chlamydia in the throat can result in getting chlamydia of the penis.
• Getting oral sex on the vagina from a partner with chlamydia in the throat might result in getting chlamydia of the vagina or urinary tract.*
• Getting oral sex on the anus from a partner with chlamydia in the throat might result in getting chlamydia in the rectum.*

* Statements followed by an asterisk (*) have not been well studied.

Areas of initial infection:

• Throat
• Genitals
• Urinary tract
• Rectum

Initial signs and symptoms of infection:

• Most chlamydia infections in the throat have no symptoms. When symptoms are present, they can include a sore throat.
• Many genital, urinary tract, or rectal chlamydia infections have no symptoms. When symptoms are present, they can include:
  • Discharge from vagina or penis (discharge from the vagina may be bloody).
  • Burning feeling when urinating.
  • Painful or swollen testicles.
  • Rectal pain or discharge

Treatment:

• Chlamydia can be cured with the right medicine.
• The sex partners of a person with chlamydia should also be tested for infection. Those who are diagnosed with chlamydia should not have sex until 7 days after they and their sex partners have completed treatment.

If left untreated, throat infections:

• Can be spread to uninfected sex partners, particularly by performing oral sex on a male partner’s penis.

If left untreated, genital, urinary and/or rectal infections:

• Can be spread to uninfected sex partners.
• In women:
  • Can cause pelvic inflammatory disease (PID), which can lead to chronic pelvic pain, infertility, and ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb).
• In pregnant women:
  • Might result in premature birth or low birth weight in babies.
  • Can be spread to the baby during delivery, and it can cause chlamydia infection in the eyes or infection of the respiratory tract that can develop into pneumonia.
• In men:
  • Can cause epididymitis, a painful condition of the ducts attached to the testicles that may lead to ductal scarring.
• In everyone:
  • May increase risk of getting HIV infection.
  • Might increase risk of spreading HIV to sex partners.
  • May cause a reaction (reactive arthritis) throughout the body that can lead to arthritis (joint pain), conjunctivitis (pink eye), and/or a rash on the soles of the feet or elsewhere.

Gonorrhea (Neisseria gonorrhoeae)

Risk of infection from oral sex:

• Giving oral sex to a partner with an infected penis can result in getting gonorrhea in the throat.
• Giving oral sex to a partner with an infected vagina or urinary tract might result in getting gonorrhea in the throat.*
• Giving oral sex to a partner with an infected rectum might result in getting gonorrhea in the throat.*
• Getting oral sex on the penis from a partner with gonorrhea in the throat may result in getting gonorrhea of the penis.
• Getting oral sex on the vagina from a partner with gonorrhea in the throat might result in getting gonorrhea of the vagina or urinary tract.*
• Getting oral sex on the anus from a partner with gonorrhea in the throat might result in getting gonorrhea in the rectum.*

* Statements followed by an asterisk (*) have not been well studied.

Areas of initial infection:

• Throat
• Genitals
• Urinary tract
• Rectum

Initial signs and symptoms of infection:

• Most gonorrhea infections in the throat have no symptoms. When symptoms are present, they can include a sore throat.
• Symptoms of genital, urinary tract, or rectal infection may include:
  • Discharge from vagina or penis (discharge from the vagina may be bloody).
  • Burning feeling when urinating.
  • Painful or swollen testicles.
  • Rectal pain or discharge.

Treatment:

• Infections in the throat are harder to cure than genital or rectal infections but can be treated with recommended antibiotics.
• Genital and rectal infections can also be cured with the right medicine.
• The sex partners of a person with gonorrhea should also be tested for infection. Those who are diagnosed with gonorrhea should not have sex until 7 days after they and their sex partners have completed treatment.

If left untreated, throat infections:

• Can be spread to uninfected sex partners.
• Might spread through the body causing a rash and joint pain. This condition is called disseminated gonococcal infection. The heart can also be infected. This is a serious and potentially life-threatening condition.

If left untreated, genital, urinary and/or rectal infections:

• Can be spread to other sex partners.
• In women:
  • Can cause pelvic inflammatory disease (PID), which can lead to chronic pelvic pain, infertility, and ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb).
• In pregnant women:
  • Might result in premature birth or low birth weight in babies.
  • Can be spread to the baby during delivery, and can cause blindness, joint infection, or a life-threatening blood infection in the baby.
• In men:
  • Can cause epididymitis, a painful condition of the ducts attached to the testicles that may lead to ductal scarring.
• In everyone:
  • May increase risk of getting HIV infection.
  • Might increase risk of spreading HIV to sex partners.
  • May spread through the body causing skin sores and joint pain. This condition is called disseminated gonococcal infection. The heart can also be infected, which is a serious and potentially life threatening condition.

Syphilis (Treponema pallidum)

Risk of infection from oral sex:

• Giving oral sex to a partner with a syphilis sore or rash on the genitals or anus can result in getting syphilis.
• Getting oral sex from a partner with a syphilis sore or rash on the lips or mouth, or in the throat, can result in getting syphilis.
• Another important factor that affects risk of spreading syphilis is how long an infected partner has had syphilis.

Areas of initial infection:

• Lips
• Mouth
• Throat
• Genitals
• Anus
• Rectum

Initial signs and symptoms of infection:

• May not have symptoms.
• One or more painless ulcers or sores on the lips, mouth, or throat; on the skin; or on or near the genitals or anus.
• Rash on trunk, palms of hands, and/or soles of feet.
• Flu-like symptoms.

Treatment:

• Syphilis can be cured with the right medicine.
• Sex partners of a person with syphilis should also be tested for infection, including some of the infected person’s past sex partners. Some of these partners should be treated even if their syphilis test results are negative.

If left untreated, syphilis:

• Can be spread to others through contact with syphilis sores or rash.
• In pregnant women:
  • Can be spread to the baby during pregnancy.
  • Can cause stillbirth (a baby born dead).
  • Babies with untreated syphilis may become developmentally delayed, have seizures, or die.
• In everyone:
  • Can increase risk of getting HIV infection.
  • Can increase risk of spreading HIV to sex partners.
  • May cause damage to internal organs, blindness, muscle weakness, dementia, and even death.

Herpes (herpes simplex virus types 1 and 2)

Risk of infection from oral sex:

• Giving oral sex to a partner with herpes on the genital area, anus, buttocks, or in the rectum may result in getting herpes on the lips, mouth, or in the throat.
• Getting oral sex from a partner with herpes on the lips, mouth, or in the throat can result in getting herpes on the genital area, anus, buttocks, or in the rectum.

Areas of infection:

• Lips
• Mouth
• Throat
• Genital area
• Anus
• Rectum
• Buttocks

Signs and symptoms of infection:

• May not have symptoms.
• Headache or fever (during initial infection).
• Painful or itching sores at or near the area of infection.

Treatment:

• There is no cure for a herpes, but antiviral medicine can shorten and help decrease symptoms of herpes outbreaks.
• Daily antiviral medication can prevent or shorten herpes outbreaks.

Even with treatment, oral (lip, mouth and throat) infections:

• Can be spread to others, including sex partners.

Even with treatment, genital area, buttock, anal, and/or rectal infections:

• Can be spread to uninfected sex partners.
• In pregnant women:
  • May be spread to the baby during delivery, and can cause brain damage, damage to internal organs, or even death of the baby.
• In everyone:
  • Can increase risk of getting HIV infection.
  • Can increase risk of giving HIV to sex partners.

HPV (human papillomavirus)

Risk of infection from oral sex:

• Giving oral sex to a partner with an HPV-infected penis or genital area can result in getting HPV in the throat.
• Giving oral sex to a partner with an HPV-infected vagina or genital area can result in getting HPV in the throat.
• Giving oral sex to a partner with HPV on the anus or in the rectum may result in getting HPV in the throat.*
• Getting oral sex from a partner with HPV in the throat might result in getting HPV on the genital area, anus, or rectum.*

* Statements followed by an asterisk (*) have not been well studied.

Areas of infection:

• Mouth
• Throat
• Genital area
• Vagina
• Cervix
• Anus
• Rectum

Signs and symptoms of infection:

• May have no symptoms.
• Warts in the throat (laryngeal or respiratory papillomatosis):
  • May cause changes in the voice, difficulty speaking, or shortness of breath.
• Genital or anal warts.
• Abnormal changes in cells of vagina, cervix, or anus that can be found by clinical examination and tests (Pap and/or HPV tests).
• Some types of HPV can lead to vaginal or cervical cancer, anal, penile, head, and neck cancers.

Vaccine:

• HPV vaccine protects against transmission of certain types of HPV. It is recommended for all boys and girls at ages 11-12, as well as for everyone through age 26 if not vaccinated already. More details about who should be vaccinated and when are available from CDC’s HPV website.

Treatment:

• Warts in the mouth and throat:
  • May disappear, remain unchanged, or grow in size or number.
  • Surgery may be used to remove warts in the throat.
  • Treatment may reduce warts but does not cure HPV infection.
• Genital and anal warts:
  • May go away on their own, remain unchanged, or grow in size or number.
  • Treatments include medicines applied to the warts, freezing the warts (cryotherapy), or surgery to remove the warts.
  • Treatment may reduce warts but does not cure HPV infection.
• Abnormal changes in cells of vagina, cervix, or anus:
  • May need more clinical examination and testing (Pap and/or HPV tests).
  • Other procedures may be used, such as biopsy (taking a small sample of tissue) and/or removal of abnormal tissue, depending on age, pregnancy status, and test results.

Even with treatment, warts in the throat:

• Might be spread to uninfected sex partners.
• May have recurrences (recurrent respiratory papillomatosis).

Even with treatment, genital and anal warts:

• Can be spread to uninfected sex partners.
• May return but will not develop into cancer.

Mouth and throat infections by several types of HPV that do not cause warts may develop into head or neck cancer.

Abnormal changes in cells of vagina or anus:

• Might develop into cancer. Although some women have abnormal Pap and/or HPV test results, few women get cervical cancer if they get the appropriate follow-up and treatment.

HIV (human immunodeficiency virus)

Risk of infection from oral sex:

• Giving oral sex on the penis of a partner with HIV can result in getting HIV. The risk of infection is lower than the risks from vaginal or anal sex.
• Giving oral sex on the vagina of a partner with HIV may result in getting HIV. The risk of infection is thought to be very low.
• Giving oral sex on the anus of a partner with HIV may result in getting HIV. There are few reports of transmission from this type of oral sex.
• Getting oral sex on the penis from a partner with HIV may result in getting HIV. This risk is thought to be very low, and has not been well studied.
• Getting oral sex on the vagina from a partner with HIV might result in getting HIV. This risk is thought to be extremely low, and has not been well studied.
• Getting oral sex on the anus from a partner with HIV might result in getting HIV. There are few reports of transmission from this type of oral sex.
• Another important factor that affects risk of HIV spread is the virus level (i.e., viral load) in an infected partner’s blood and other body fluids at the time of the sexual encounter. An undetectable HIV viral load eliminates the risk of spreading HIV from oral sex.

Areas of infection:

• Infection of the immune system throughout the body.

Initial signs and symptoms of infection:

• May have no symptoms for many years.
• Flu-like symptoms.

Treatment

• There is no cure for HIV, but antiviral and other medicines can help people with HIV live longer with a better quality of life.

Even with treatment, HIV infection:

• Can increase the risk of getting certain infections and cancers.

Trichomoniasis (infection with T. vaginalis)

Risk of infection from oral sex:

• Giving oral sex to a partner with an infected vagina or a partner with an infected penis might result in getting trichomoniasis of the throat. There are few reports of potential spread from oral sex.
• Spread of trichomoniasis by other oral sex practices has not been reported.

Areas of initial infection

• Vagina
• Penis
• Mouth/throat (possibly)

Initial signs and symptoms of infection

• Infections of the genitals or urinary tract may have no symptoms, especially in men
• Symptoms of genital or urinary tract infection can include:
  • Discharge from vagina or penis.
  • Vaginal area redness.
  • Vaginal itching.
  • Burning feeling when urinating.

Treatment

• Can be cured with right medicine.
• The sex partners of people with trichomoniasis should also be tested for infection. Those who are diagnosed with trichomoniasis should not have sex until they and their sex partners have completed treatment.

If left untreated, genital or urinary infections:

• Can be spread to uninfected sex partners.

Is Oral Sex Safer than Vaginal or Anal Sex?

• Many STDs can be spread through oral sex. However, it is difficult to compare the exact risks of getting specific STDs from specific types of sexual activity. This is partly because most people who have oral sex also have vaginal or anal sex. Also, few studies have looked at the risks of getting STDs other than HIV from giving oral sex on the vagina or anus, compared to giving oral sex on the penis.
• Studies have shown that the risk of getting HIV from having oral sex with an infected partner (either giving or getting oral sex) is much lower than the risk of getting HIV from anal or vaginal sex with an infected partner. This may not be true for other STDs – in one study of gay men with syphilis, 1 out of 5 reported having only oral sex.
  • Getting HIV from oral sex may be extremely low, but it is hard to know the exact risk. If you are having oral sex you should still protect yourself. Repeated unprotected oral sex exposure to HIV may represent a considerable risk for spread of other STDs for which the risk of spread through oral sex has not been as well studied.
• It is possible that getting certain STDs, such as chlamydia or gonorrhea, in the throat may not pose as great a threat to an infected person’s health as getting an STD in the genital area or rectum. Having these infections in the throat might increase the risk of getting HIV. Having gonorrhea in the throat also may lead to spread of the disease throughout the body. In addition:
  • Having infections of chlamydia and gonorrhea in the throat may make it easier to spread these infections to others through oral sex. This is especially important for gonorrhea, since throat infections can be harder to treat than urinary, genital or rectal infections.
  • Infections from certain STDs, such as syphilis and HIV, spread throughout the body. Therefore, infections that are acquired in the throat may lead to the same health problems as infections acquired in the genitals or rectum.
  • Mouth and throat infections by certain types of HPV may develop into oral or neck cancer.

What May Increase the Chances of Giving or Getting an STD through Oral Sex?

It is possible that certain factors may increase a person’s chances of getting HIV or other STDs during oral sex if exposed to an infected partner, such as:

• Having poor oral health which can include tooth decay, gum disease or bleeding gums, and oral cancer.
• Having sores in the mouth or on the genitals.
• Being exposed to the “pre-cum” or “cum” (also known as pre-ejaculate or ejaculate) of an infected partner.

However, no scientific studies have been done to show whether or not these factors actually do increase the risk of getting HIV or STDs from oral sex.

What Can You Do to Prevent STD Transmission During Oral Sex?

You can lower your chances of giving or getting STDs during oral sex by using a condom, dental dam or other barrier method every time you have oral sex.

• For oral sex on the penis:
  • Cover the penis with a non-lubricated latex condom.
  • Use plastic (polyurethane) condoms if you or your partner is allergic to latex.
• For oral sex on the vagina or anus:
  • Use a dental dam.
  • Cut open a condom to make a square, and put it between the mouth and the partner’s vagina or anus.

The only way to avoid STDs 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 an STD:

• Being in a long-term mutually monogamous relationship with a partner who is not infected with an STD (e.g., a partner who has been tested and has negative STD test results).
• Using latex condoms the right way every time you have sex.

It’s important to remember that many infected individuals may be unaware of their infection because STDs often have no symptoms and are unrecognized.

If you are sexually active, you should get tested regularly for STDs and HIV and talk to your partner(s) about STDs. If you think you might have an STD, stop having sex and visit your doctor or clinic to get tested. There are free and low-cost options for testing in your area. It is important that you talk openly with your health care provider about any activities that might put you at risk for an STD, including oral sex.