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 of acquiring one, including people with HIV. STI testing, prevention, and treatment should be part of regular HIV care for sexually active people.

STIs—also commonly referred to as sexually transmitted diseases (STDs)—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.

Mpox is not technically an STI, but can be spread through sexual contact.

Learn more about these and other STIs.

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
• Having anonymous sex partners
• Having sex while using drugs or alcohol. Using drugs and alcohol can lower your inhibitions and result in greater sexual risk-taking

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:

Get the vaccines that are recommended to prevent some STIs.

• Hepatitis A vaccine usually consists of two shots, given six months apart. Getting both shots provides the best protection against hepatitis A.
• Hepatitis B vaccine is a series of two or three shots depending on the vaccine brand. If you get the vaccine that is just two doses, you get them about one month apart. You need to get all of the shots to be fully protected.
• HPV vaccine prevents cancer-causing infections and pre-cancers. It is recommended for youth aged 11–12 and can be given starting at age 9 years. Teens and young adults through age 26 years who didn’t start or finish the HPV vaccine series also need HPV vaccination. It is recommended for women and men with HIV through age 26 who have not already been fully vaccinated. Some adults with HIV aged 27 through 45 years who were not already vaccinated might choose to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and possible benefits of vaccination for them.
• Mpox vaccine is a two-dose vaccine developed to protect against mpox and smallpox. It is safe and effective for people with HIV. Two doses of the vaccine provide the best protection against mpox.
• There are no vaccines for other STIs. Talk to your health care provider about what is right for you.

Reduce the number of people you have sex with.

Don’t drink alcohol or use drugs before and during sex.

Use condoms the right way 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. Learn how to use condoms consistently and correctly.

Talk to your health care provider about doxy PEP: medicine to prevent STIs.

• Doxy PEP is a way to prevent getting an STI. It involves taking a dose of the antibiotic doxycycline ideally within 24 hours but no later than 72 hours after condomless oral, anal, or vaginal sex. The drug can help prevent the STI from spreading to your system. The sooner you can take it after sexual contact, the better!
• Doxy PEP has been proven to reduce your chances of getting a bacterial STI (syphilis, chlamydia, and gonorrhea) by about two-thirds. But it is not for everyone. Doxy PEP has been proven effective in gay, bisexual, and other men who have sex with men (MSM) and transgender women. Studies of doxy PEP effectiveness among cisgender women are ongoing.
• Doxy PEP requires a prescription, so you’ll need to see a health care provider to get it. Talk to your provider and tell them you’re interested in taking doxycycline as PEP for STIs. You can also contact a local STI clinic and see if they are offering it. Find a clinic near you. They will write a prescription so that you have doxy PEP on hand when you may need it.

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 through sex. 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, choosing activities with lower chances of HIV transmission, and never sharing injection drug equipment, and using condoms.

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.

There is also a companion document, the STI Federal Implementation Plan, outlining federal actions to reduce the burden of sexually transmitted infections in the United States through 2025.