The risk of sexually transmitted infections (STI) with open relationships

When you live in an open-style relationship, whether that’s ethical non-monogamy, a monogam-ish style couple, polyamory or swinging, one undeniable trait separates you from most monogamous people: Your total number of sex partners will increase, either on the short term or permanently.

With an increased number of sexual encounters come an increased risk of contracting a sexually transmitted disease (STD) or more accurately a sexually transmitted infection (STI), as it’s called today.

How do you prevent getting an STI?

In all honesty, there is no way to prevent it beyond being fully abstinent. Which is obviously no fun.

Instead, you should aim to reduce your risk and make regular testing a scheduled activity with your doctor or at an open clinic. You need to be honest with your doctor, so that they test for everything you could likely be exposed to. So don’t bullshit them and act as if you’re monogamous if you’re not – they might test for fewer things if they think that.

How to reduce your risk

Reducing your risk of STIs is both a question of choosing the right partners, making the right preventative choices and then protecting yourself during the actual sex act.

How risky is your partner?

Choosing the right partners is down to determining your risk in interacting with someone new. Do they have a lot of different partners? Are they being safe with those partners? Do they do STI testing? The answers to these questions will usually tell you all you need to know about your risk from a new partner.

What do you do if a new partner is high risk and you don’t want high risk – Don’t have sex with them?! Duh?! Find another proverbial fish in the sea.

Vaccinations

These days, several STIs are so well understood that you can actually combat many of them using the right preventative measures.

Take the human papillomavirus (HPV) for example. There are many different variants of HPV, some creating no issues, others causing genital warts and a few causing various cancers (e.g., cervical, penile and more). There are no screening tests for most of these, but you can actually prevent many of them by getting an HPV vaccine. In many countries, this vaccine is now standard for young preteens as a means to erradicate many HPV variants before these young people become sexually active.

While usually aimed at the younger population, older individuals can also benefit from the vaccine, since you’re unlikely to have contracted all HPV variants the vaccine protects against. Even if you have one or two of them dorment in you, the vaccine might prevent the really dangerous ones from ever getting to you.

So if there’s one thing I really recommend everyone do, it’s get the HPV vaccine – it’ll likely cost you some money, but it’s a worthwhile investment. Both Sara and I have the HPV vaccine and paid for it ourselves as adults. Well worth it.

Barrier methods (e.g., condoms)

When you’ve decided to go ahead and have sex, the next step would be to employ a barrier method to reduce infection risks. Using condoms is obviously one of the easiest things you can do to not only protect against pregnancy, but also protect against many sexually transmitted diseases (STIs).

Despite what many think though, condoms won’t protect against all pregnancies and it also won’t protect against all STIs. Some examples of STIs it won’t protect against are herpes (HSV-1 and HSV-2), HPV (e.g., genital warts) and scabies. Really just anything that can transmit through skin to skin contact, seeing as the condom only covers some of the guy’s private parts.

You’re probably also not going to use condoms or dental dams for oral sex (almost no one does), so there’s also the risk of transmitting something like syphilis that way.

At the end of the day here, you’re not aiming for ‘perfect’, but rather ‘good enough’.

What is the actual risk of an STI?

Thankfully, for the most part, STIs are more of a nuisance than an actual problem, since many of the most common STIs are completely cureable or suppressable to the point where they don’t really matter. There’s a lot more stigma surrounding STIs than there’s actual risk of long-lasting effects from them.

As long as you keep an eye on your STI status and communicate any updates, the actual risk involved is pretty low.

Take for example syphilis. If left untreated it can create damage to your organs and nerves, as well as leave you infertile. However it’s incredible treatable and 100% curable with very little effort. Usually just one injection of an antibiotic and that’s that. In many ways, syphilis is less of a problem than the flu – when you know you have it.

This is actually the case for many of the most common STIs. Both syphilis, gonorrhoea, chlamydia and trichomoniasis are normally completely curable with little effort.

So getting those STI really should not create any panic in neither you, nor your partners. Just keep an eye on it and don’t wait for symptoms. Do regularly scheduled testing.

But what about uncurable STIs?

While some STIs are completely curable, there are others that are not. Most of these are thankfully also much less of a problem than some people make them out to be.

Herpes is one of the common STIs with a ton of stigma. It’s essentially uncurable, with Herpes Simplex Variant 1 (HSV-1) creating sores on your mouth and lips and Herpes Simplex Variant 2 (HSV-2) creating sores on your genitals. It’s one of those STIs where condoms also don’t really protect you, as infection comes from skin to skin contact.

Here’s the thing though: Many people are afraid of Herpes, but at the same time completely clueless about what it is and how prevelant it is. A whopping 2/3 of the entire world’s population have HSV-1. Your new sex partner is more likely to have HSV-1 than blue eyes. You are more likely to already have HSV-1 than you are contracting it from someone you meet.

What about HSV-2 then? Genital herpes (HSV-2) is generally considered to be worse than HSV-1, despite it obviously being the same overall sensation, just in a different place. It is also less prevalent, but a ton more than people think. As of 2016, 13.2% of the entire world’s population have HSV-2 according to WHO. Aiming in on America specifically, it’s just under 17% or 1/6 according to WebMD. That means that a great deal of people you know are living with this uncurable disease that, for the most part, doesn’t seem to affect their lives much.

Why doesn’t it affect them much? Because it’s often asymptomatic. It can create symptoms in some and it can also resurface. But it’s generally made out to be much more problematic than it actually is. Some have it bad yes, but even for them there’s treatment to keep it mostly at bay and anti-viral medication to keep infection spread risks low.

You can test for HSV-2 using a blood test, but you do often need to actively ask your doctor to do so. So bare that in mind if you’re wondering if you already have it. 1/6 of you probably do, despite not knowing.

What about HIV/AIDS?

Sure, there’s HIV and AIDS – the big bad STI that everyone fears. Historically this fear has been very warranted with over 40 million dead from AIDS worldwide.

Thankfully though, we’re not in the 80s anymore. Your risk of actually getting HIV is extremely low. Beyond blood transfussions with infected blood, the highest risk factor is receiving unprotected anal sex from an HIV-positive person. But even then the risk is surprisingly low – around 1,3% per act (136 out of 10000).

Even if you were so incredible unlucky to contract HIV, your doctor can help control the infection to such a degree that you likely won’t ever develop AIDS and your risk of infecting anyone with your HIV is greatly reduced. If you do engage in activities with an increased risk of interacting with HIV-positive individuals, it is however recommended to do a preventative treatment called Pre-Exposure Prophylaxis or PrEP. Doing PReP reduces the risk of contracting HIV by a whopping 99%. If you’re curious if PrEP is right for you, contact your health professional.

In general, if you’re a part of a community where HIV-infection is more common, I would always recommend consulting your doctor before engaging in any risky behaviour. Despite treatment options and HIV not likely killing you anymore, it’s still a very serious disease. Your particular situation may warrant being extra cautious.

Should you disclose your status to new sex partners?

In general yes, you should share any current issues and when you were last tested.

Having sex with any partner is all about consent. If they don’t understand the risk they’re taking by engaging in sexual activity with you, their consent isn’t really valid.

That being said, should you tell them about suppressed infections that don’t pose a significant risk to them?

Assume for example you have HSV-2, you’re taking anti-viral medication and you don’t have an active outbreak. Or maybe you know you must have a dorment HPV infection, since you had genital warts 10 years ago, but you’ve had no issues since then?

In these cases I would still say you should ideally disclose this, but I honestly understand if you don’t. There’s still a lot of stigma surrounding STIs and people fundamentally don’t understand the actual risk involved. You can very easily be labeled “unclean”, while in reality you’re more careful than most, because you actually went to the trouble of testing and taking precautions.

Most adults have several variants of HPV, but don’t know about it. In fact, it’s estimated that more than 90% of men and 80% of women get at least one HPV infection during their lifetime. They may even have had warts, but just didn’t notice or didn’t get them tested before they went away on their own. Also, seeing as 1/6 in the US have HSV-2, it’s a safe bet many of your sex partners had it, but either never had symptoms or just didn’t tell you.

Thankfully, both Sara and I are still HSV-2 free. I say that not because the infection worries me, but rather because of the largely unwarranted stigma surrounding that particular diagnosis.

So I do recommend being open – but I also begrudingly understand if you’re not with these super common infections, especially if you’ve been unfairly rejected out of ignorance before.

STI stigma – a real life example

We’ve only ever experienced a few people tell us they had HSV-2 (a lot less than 1/6 btw). One such situation was a woman we’d had sex with prior and had invited to a sex party where another couple and two single people attended as well. Because she was open and told us about her dorment and controlled HSV-2, the other couple asked her to not come.

Did she actually pose a risk to any of us? No, she was on anti-viral medication that suppresses viral shedding and she didn’t have an outbreak. Our real-life risk was very low – arguably much lower than if we had sex with a random person we picked up at a bar. But she was disgarded none the less.

Do I blame the other couple? No, I completely understand their point of view – why have sex with her, when there are other women who don’t have HSV-2 (or don’t know they do).

But it’s events like that, that make me much less judgemental of those who don’t disclose common infections like HSV-2 and HPV. Disclosing opens you up to massive rejections, while omitting does not and doesn’t necessarily expose your partners to any more appreciable risk than if they went with someone else.

I really wish everyone could just be open about every risk factor and everyone react rationally to that information. But sadly, that’s not the world we live in. At least not yet.

So please try to be as honest as possible. But I do get why some omit some of it. When you’ve been burnt a few times for being honest, you start being strategically honest.

Always be open about serious infections

While I do understand (but not condone) not disclosing controlled and dorment HSV-2 or HPV, I don’t think there’s a reasonable argument for not being open about serious infections like HIV and Hepatitis B. In fact, in many countries, not disclosing an HIV positive status could constitute a crime. Take for example the Missouri man charged with exposing 300 people to HIV infection through unprotected sex.

If you’ve had any of those diseases diagnosed, you’re going to have to be open about it. Despite treatments, those are still very serious diseases and require life-long medication to suppress and can actually kill you if you don’t keep treating them.

Bottom line: Take precautions, but don’t worry too much

Yes, a few STIs are scary. No, you’re likely not going to get the scary ones. Some other STIs are a nuisance. You might eventually get one of them, but they’re likely either completely curable with relative ease, or they’re suppressable or dorment enough that you’ll never get much grief from them.

For the most part, the stigma of an STI is a lot worse than the actual STI. Try to be mindful of that when confronted with other honest and loving sex partners that care enough about your self-agency to be honest about their status and any dorment infections. They’re not telling you because you should be scared to be with them, they’re telling you to show they respect you and trust you to be rational.

At the end of the day, the people you should be worried about are not the people who honestly tell you they have well-treated HSV-2 and have had syphilis one time. It’s the person who says they’ve never been tested because they always use condoms or never had symptoms. Those are the clueless ones.

Attributions

Post image courtesy of Anthony Tran – thank you.