A BASHH guide to Safer Sex

Safer sex is not ‘all or nothing'

You can make sex safer by doing some of the things suggested in this guide- for instance, just for some types of sex or with some sexual partners - even if you don't do all of them all of the time.

What is safer sex?

Safer sex means having sex with less risk of transmission (catching or passing on) a sexually transmitted infection (STI). STIs include HIV, syphilis, chlamydia, gonorrhoea, trichomonas, Herpes simplex (Herpes simplex virus/HSV), hepatitis B, and warts (human papilloma virus/HPV).
The risk of catching each infection is different, and also varies according to the type of sex you are having (such as oral, vaginal or anal sex).
For example
Herpes is often passed on through oral sex, but HIV is rarely passed on this way.
Anal sex carries the highest risk of passing on infections such as HIV and hepatitis, followed by vaginal and then oral sex.
Non-penetrative sex (such as body rubbing and mutual masturbation) carries the lowest risk, but some infections (such as warts and herpes) can be passed on in this way.

How do I make sex safer?

You can reduce the risk of all infections by:
Using condoms for all types of penetrative sex (vaginal, anal sex especially; you may also want to consider condoms for oral sex)
Having non penetrative sex (such as body rubbing and mutual masturbation)
Being tested for STIs before having sex with someone new, and advising that they also get tested.
Reducing the number of partners you have sex with. Getting vaccinated against certain infections.
For example, hepatitis B (and A). If you are at risk - ask a doctor, nurse or health advisor about this.
Planning on how you will protect yourself and your sexual partners from infections when under the influence of alcohol or other recreational drugs.

How risky is oral sex?

Oral sex can include fellatio (sucking a penis), cunnilingus (licking female genitals) or oro-anal contact (anal licking or "rimming")
Herpes, warts, gonorrhoea, chlamydia, syphilis, HIV, hepatitis B and, possibly, other infections can be transmitted through oral sex.
For most infections (except herpes), the risk of catching an infection is greater for the oral partner (the one giving oral sex).
Most people do not use protection (condoms or dental dams) for oral sex.
The risk of catching an STI through unprotected oral sex is lower than for unprotected vaginal or anal sex, but is not zero.

How do I make oral sex safer?

Reduce the number of partners with whom you have oral sex.
Avoiding oral sex with ejaculation reduces the risk of HIV (and possibly other infections)
Insertive fellatio (being sucked) is lower risk than receptive fellatio (sucking a penis).
Avoid brushing teeth or flossing before having oral sex.
Avoid oral sex if you have oral cuts or sores, or a sore throat. Use condoms for fellatio.

Other sorts of sex

No form of sexual contact is entirely without risk of STI transmission. Non penetrative contact (body rubbing, mutual masturbation without penetration) carries the lowest risk. Herpes can be transmitted through kissing, and it may be possible to transmit other STIs (including syphilis and Hepatitis B) in this way, although the risk is lower than for penetrative sex.
If you are fingering, using sex toys or fisting your partner, the risk of transmission is related to the degree of trauma - how much damage is done to the delicate lining of the vagina or anus.
Use latex or non-latex gloves for digital penetrative sex if there is a risk of trauma.

What if my partner(s) or I are living with HIV?

All the previous advice applies to you.
If you are living with HIV, staff at your clinic will be able to give you detailed advice on safer sex.
Taking effective antiretroviral therapy (ART) and having an undetectable plasma/blood HIV viral load significantly reduces the risk of HIV transmission during sex.
Even with an undetectable viral load, there is still a small risk of HIV transmission.This is higher for anal sex than for vaginal or oral sex.
Continuing to use condoms for vaginal, anal (and oral) sex will further reduce any remaining risk of transmission.
Poor adherence (missing doses of ART) may increase the risk of HIV transmission.
If you are living with HIV or you have partners who are or may be HIV positive, have an STI check regularly depending on your sexual activity, and at least once a year if you're sexually active.

Information on Condoms here


More information:

Guidelines

January 2012 Leaflet produced by the Clinical Effectiveness Group of the British Association for Sexual Health & HIV

Copyright BASHH 2012