Reducing STD Risk

Nine behaviors to change, starting now.
By Rich Maloof for MSN Health & Fitness

Can you enjoy an active sex life and still be well protected against sexually transmitted diseases? By adopting healthy habits—some intuitive, some not—and avoiding a few dangerous behaviors, you can greatly reduce your STD risk. Here are nine important changes to make.
1. Don’t decide about sex when under the influence of drugs or alcohol.
Just as you wouldn’t endanger yourself or a friend by getting behind the wheel, don’t make sexual decisions when your judgment may be impaired. If your singles scene is one in the same with the bar scene, this can be a difficult guideline to follow. But under the influence of drugs or alcohol, people tend to relax their own rules and standards. In such a state one is more likely to choose the “wrong” partner—especially an anonymous one—and less likely to use protection.
Drugs and sex mix together in an even more dangerous cocktail when one partner has HIV or hepatitis B. Both of these blood-borne illnesses can be contracted by needle and then passed along through sexual contact, or vice versa.

2. Think ahead.
On a great date or a fun night out with friends, it’s easy to be taken adrift by waves of adrenaline, intoxication, or passion. If you decide ahead of time what you will and will not do—and perhaps tell a friend who can look out for you—your good judgment may come to the rescue later in the night. Thinking ahead goes hand in hand with No. 1 (“Don’t make decisions under the influence”).

3. Have a candid discussion with your partner.
Information is protection. While this may not be the sexiest notion out there, it’s invaluable to know everything your partner knows about his or her sexual health—bearing in mind that a person could be infected with HIV, HPV or herpes without knowing it.
Granted, initiating such a conversation is awkward.
“People can get defensive about this, so make it a two-way conversation—not a lecture or monologue,” advises Fred Wyand, media and communications manager at the American Social Health Association (ASHA). “Insist on using protection, and if the issue of testing comes up then it’s something both partners can do. The reality is that STDs can affect anyone regardless of number of partners, so it’s not a question of sleeping around.”
If you manage the situation well and your partner is still not mature enough to have the conversation, you may want to rethink the sex. Also, it’s hard to establish much trust on a one-night stand—another reason to use protection or resist anonymous encounters altogether.

4. Decrease the number of sexual partners.
“People most commonly think that by having two partners instead of one, they will only double their chances of contracting an STD. But that is dramatically incorrect at the population level,” says Dr. Douglas Kirby, a veteran research scientist at ETR Associates, a nonprofit health education organization.
We don’t add risk with each new partner—we multiply it. How can this be? Think back to Sex Ed 101, where we learned that we “sleep with everyone our partner sleeps with.” According to a nationwide survey released in 2007 by the Centers for Disease Control and Prevention, the median number of sexual partners over a lifetime is seven for men and four for women. With a first encounter we make our debut into that sexual network.

5. Avoid concurrent sexual partners (and partners with concurrent partners).
“Concurrent” partners means having two or more sexual relationships simultaneously. “Sequential” partners, on the other hand, have relationships that follow one another in succession with no overlap.
If for no other reason than to reduce STD risk, stick with sequential partners. The average sexually active person has between one and three partners at a time. But small increases in that number have a huge impact on the size of the network. It’s kind of like that old shampoo commercial where you tell two friends, and they tell two friends, and they tell two friends. But instead of getting clean hair, they’re getting gonorrhea.
Consider a man with four concurrent partners. We’ll call him Charlie. If any one of Charlie’s partners infects him with an STD, he will infect the other three women. They are all swimming in the same viral pool.
But if Charlie has four sequential relationships instead, the number of infected people is likely to be fewer. Let’s say he first has a relationship with Lucy, then with Patty, then Marcy, then Violet. If Marcy gives Charlie syphilis, he may infect Violet but not Lucy or Patty.

6. Increase the time gap between sexual partners.
Sequential partnering provides further protection when time elapses between relationships. As a rule, viral loads decrease with time. If someone contracts an STD, the viral load may decline enough over a few months to the point that it’s not transmissible to the next partner at all.

7. Use a condom correctly and consistently during every act of sex.
Men have been known to use condoms in any number of creative albeit inadvisable ways. Errors include flipping a condom inside out to re-use it; washing and re-using it; putting it on immediately prior to climax but after penetration; using the same condom for two different acts of penetration; continuing sex after it slips off; and not buying one in the first place.
One inadvertent misuse is when a man attempts to wear a condom but realizes it won’t roll on because the wrong side is facing him. So he simply flips it around. But a small amount of semen will remain on the first side where he tried to push through. If he has an STD, that side is infected—and that’s the side exposed to his partner.

8. Get tested and treated for STDs.
The CDC has suggested that screening and treatment for chlamydia, the most common STD among young women, could reduce incidence of pelvic inflammatory disease (PID) by more than 50 percent. Yet a lack of awareness—and of clinical resources—leaves more women susceptible than not. Plus, women can become re-infected by male partners who have not been diagnosed or treated.
Tests and treatments are a powerful combination for fending off STDs, especially for people who also maintain monogamous relationships. Says Kirby, “Assuming neither partner has an incurable STD and the relationship really is mutually monogamous, that’s a very safe [scenario] for them. Each knows the other has been tested and treated safely. If you look at people of college age, being in a mutually monogamous relationship is probably the most common method of preventing STD.”

9. Get vaccinated.
STD vaccinations remain somewhat controversial, in part because they are less than 100 percent effective and because side effects are possible. Still, the two most common vaccinations—for hepatitis B and human papillomavirus—have been gaining mainstream acceptance. The HBV vaccine is estimated to provide over 90 percent protection. The HPV vaccine now recommended for young girls does not cover all strains of the virus, but it prevents two strains that cause 70 percent of cervical cancer cases and two strains that cause 90 percent of genital warts.
As Kirby is quick to acknowledge, changing nine behaviors is a lot to ask. Just remembering nine ideas is tough, especially when passion comes into play—you can almost picture all this good will meeting a quick end as a man fumbles for a condom with one hand and his list of behaviors with the other. Armed with a little awareness, though, we can take the first steps toward keeping ourselves and our partners safe.