This article was written by Jacob, RN, BSN, ACRN, Katie Taibl, RN, and clinically reviewed by Haley, FNP.
Clinical language disclaimer: We use the term “front hole” and “vagina” to describe genitalia in this article to talk about anatomy.
- STIs are sexually transmitted infections (AKA STDs or sexually transmitted diseases) and can be transmitted through different kinds of sexual activities.
- Young adults and adolescents are at a higher risk for STI symptoms and need quality information on STI testing and treatment.
- Common STIs to test for include gonorrhea, syphilis, chlamydia, trichomoniasis, and HIV.
For many queer and transgender folks, sex is a fun, exciting, and affirming part of life. Sexually transmitted infections (STIs) are an inherent risk of being sexually active. Still, basic knowledge about STIs (also known as STDs or sexually transmitted diseases) is decreasing, especially among adolescents and young adults.
Despite the number of new sexually transmitted diseases increasing each year, knowing what symptoms to look out for, how to get tested, and what to do if you test positive for an STI can help minimize any risk factors.
Knowledge about STI symptoms, how to get tested for STIs, and what treatment is necessary for the most common STIs is key to a fun, fulfilling sex life!
What is an STI?
STIs are infections that are transmitted through sexual contact between sexual partners. There are many different STIs out there, and this guide will cover some of the most common curable STIs and HIV. Although bacterial vaginosis (BV) isn't considered an STI, it can often be caused by sexual contact and will also be included.
How are STIs transmitted?
STIs are transmitted through sexual contact with body parts and/or sex toys. Most STIs are passed through bodily fluids such as ejaculate, pre-ejaculate, genital fluids, discharge, and blood. Some STIs can even be passed through saliva and skin-to-skin contact. For this article, we'll focus on STI transmission through sexual contact, like oral sex, penetration, and sharing of sex toys.
Sexual activities like anal, oral, and front hole or vaginal sex between partners, sharing sex toys, and switching from anal to oral and/or front hole sex without cleaning a sex toy or swapping condoms are risk factors for STI transmission. Trauma to body tissues can also increase the prevalence of transmitting an STI, so using lube is important, especially for sexual activities involving fisting or larger sex toys. There is no such thing as too much lube!
It's important to remember that penetration and sexual contact are not required to transmit STIs. Needle play, for instance, carries the potential for STI transmission because it often involves blood.
How do I know if I have an STI?
The only way to know for sure if you have an STI is to get tested. How often you want to get tested depends on several factors, most notably, what kind of sex you're having and how many partners you have. Most LGBTQ folks who are sexually active should get tested at least once a year.
There are some instances in which more frequent testing is recommended, including having more than one sex partner, having a partner who has had multiple sex partners, and engaging in sex work or transactional sex.
How do I get tested?
There are many options for getting STI testing done! Many local public health departments offer free testing available for certain STIs. Public health STI testing usually includes chlamydia, gonorrhea, HIV, and syphilis. Free at-home HIV testing is also available nationwide.
Some lab companies will allow you to pay out of pocket for STI testing without a lab order from a clinician. This can be done in person with a company like Quest or with an at-home testing kit ordered online.
Starting August 1st, 2023, you can also request STI testing here at FOLX! If you are already a FOLX member and are interested in sexual health services, you can reach out to your clinical care team to discuss your options.
What are some of the most common STIs?
Gonorrhea is caused by bacteria and most commonly affects the throat, rectum, and urethra. It's possible to have gonorrhea and be asymptomatic.
For those who are symptomatic, the most common symptoms are discharge, pain while peeing, and genital inflammation.
Discharge appears as unusual front hole/vaginal discharge that is thin or watery with a yellow or green color; or discharge from the tip of the penis that is white, yellow, or green. Other gonorrhea symptoms include pain or burning when peeing and swollen or inflamed foreskin. Rarer symptoms include pain in the testes or in the lower stomach area, heavier periods, and bleeding after sex.
Pharyngeal gonorrhea, or gonorrhea in the throat, typically doesn't have symptoms. When symptoms do occur, they usually manifest as a sore throat and swollen neck lymph nodes.
Testing for gonorrhea is done through a urine test. Your clinician might also recommend swabbing your throat and rectum if you’ve had oral or anal sex.
Chlamydia is a bacterial infection and often shows only very mild symptoms if any at all. Because of this, most people with chlamydia often don't realize it until they get tested.
Symptoms to look out for include:
- Yellowish front hole discharge with a strong odor.
- Whiteish penile discharge with a strong odor.
- Painful front hole penetration.
- Painful urination.
When chlamydia is present in the rectum, symptoms can include rectal pain, discharge, and bleeding. Chlamydia most commonly tends to affect the cervix, so those who've had their cervix removed have a greater likelihood of not having symptoms.
Similar to gonorrhea, testing for chlamydia is done by a urine test, as well as a rectal swab test for those who have anal sex.
Syphilis is divided into stages. The first two stages generally show symptoms. The first sign of a syphilis infection tends to be a chancre, or a sore, that develops in the same spot where syphilis entered your body. That means that if a chancre does develop, it could be inside the body and difficult or impossible to see. One key symptom of secondary syphilis is a rash that's typically on the palms of the hands and soles of the feet. Syphilis is treatable at every stage, though the effects of tertiary syphilis can be permanent, so it's better to test regularly and get treatment if you test positive.
Testing for syphilis is typically via a blood test and can be detected as early as 2 weeks after exposure. Tests are most accurate, however, around 90 days after exposure.
Trichomoniasis or trich is a common STI caused by a parasite. The parasite is carried in sexual fluids, like semen, pre-cum, and genital fluids. Trich can also infect your urethra.
- Irritation and itching.
- Smelly discharge.
- Painful or frequent peeing.
- Vaginitis (itching, soreness, or pain).
STI screening for trich depends on what anatomy is present. For people with penises, a urine sample is collected. For those with a front hole/vagina, a sample is collected by inserting a swab and gathering material from genital fluids.
HIV stands for human immunodeficiency virus and is the only STI discussed in this article that requires ongoing care and treatment. However, similar to syphilis, HIV is divided into stages, and the symptoms present depend on the stage a person is in. Early symptoms of HIV usually happen within 2-4 weeks after infection. These symptoms include:
- Muscle aches
- Sore throat
- Swollen lymph nodes
Early-stage HIV can look very similar to the flu, so getting tested regularly is important if you are at risk.
When attention is paid to which activities have a higher probability of HIV transmission and other preventative measures, it can be quite easy to remain HIV-negative. And although we aren't huge fans of the "risk" language, the Centers for Disease Control and Prevention "risk" estimator tool can be helpful for exploring the likelihood of HIV transmission through insertive/receptive anal or vaginal sex. You can practice HIV prevention through conscious and safer sexual behaviors.
HIV testing is done by taking a blood sample, either in a lab or at home, through the use of a rapid test. If the test result comes back as reactive, it means there were antibodies or HIV antigens found in your blood and that follow-up testing needs to be done. Follow-up testing includes a repeat of the initial test to confirm the results, as well as a viral load test, which tells us how much of the virus is present in your body.
Although HIV is not curable, it is very treatable, and the medication options that are available today make it possible to live a long, healthy life! Regular, consistent use of medication can also lead to so little virus in your body that current tests cannot detect it. This is called being undetectable and means it is impossible to pass along HIV to others (AKA undetectable = untransmittable).
PrEP (pre-exposure prophylaxis) is medication taken before possible contact with HIV. PrEP generally refers to a once-daily pill taken to lower your chances of getting an HIV infection from anal or vaginal/front hole sex.
It's important to get tested regularly, especially if you're having sex with multiple partners. It keeps sex consensual, safe, and fun when you know your status. We think there's nothing sexier than taking care of your sexual health.
To learn more specifically about STIs for folks taking testosterone, check out this Library article, and others in the Library. If you want to learn more about STIs or getting tested, schedule a virtual primary care visit or reach out to your FOLX clinical care team. For questions about starting a FOLX membership, including our sexual health offerings, visit the FOLX Help Center to connect with our friendly Member Navigators, who are here to answer any questions you may have.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!