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When you hear the phrase “sexually transmitted infection,” most people think about their genitals.
But guess what: That spot about 2 inches south isn’t immune to STIs. That’s right, anal STIs are a thing.
Below, sexual health professionals break down everything you need to know about anal STIs — including who needs to get tested for them, what testing looks and feels like, and what happens if you leave an anal STI untreated.
Almost any STI that can take root in your genitals can take root in your anus.
According to STI expert Emily Rymland, DNP-C, DNP, AAHIVS-certified HIV specialist, and director of clinical Operations at Nurx, these include:
Technically, HIV is a virus that attacks the entire body — meaning, it isn’t site-specific. However, left untreated, it can lead to anal-specific symptoms such as rectal pain, rectal bleeding, anal discharge, and bumps and lumps.
“Anyone having symptoms needs to be tested,” says Michael Ingber, MD, board certified urologist and female pelvic medicine specialist with The Center for Specialized Women’s Health in New Jersey.
Common STI symptoms include:
- unusual discharge
- blisters or sores
- painful bowel movements
- soreness while sitting
- rectal spasms
You should also get tested if you’ve engaged in any type of unprotected anal sex — even in the absence of symptoms.
Yes, that includes rimming (oral-anal sex).
“Oral-anal sex can transit HPV, HSV, gonorrhea, chlamydia, and syphilis to the anus,” says Rymland. How? Well, if a partner has a throat or oral STI — and most people who have one, don’t know it! — it could be transmitted to your rectum.
That also includes anal fingering. If a partner has an STI, touches their own genitals, and then anally fingers you, STI transmission is possible.
Good on you for getting screened for genital STIs!
However, that doesn’t change the fact that you need to get anal STI tested, too.
“It’s very possible to have an anal STI but no genital STI,” says Felice Gersh, MD, author of “PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones and Happiness.”
“It’s also possible to have one anal STI and another genital STI,” she says. Basically, comprehensive testing is best.
Bacterial STIs — including gonorrhea, chlamydia, and syphilis — are treated with oral antibiotics, which are considered systemic therapies.
“If you were diagnosed with a genital or oral STI and took antibiotics for it, it would typically clear up any infection of that STI that’s located in the anus as well,” explains Ingber.
That said, a doctor or other healthcare professional will typically have you come in about 6 to 8 weeks later to make sure the treatment worked.
But if you and your clinician didn’t know that you had the STI in your anus, they can’t confirm that the infection has gone away.
Other STIs are managed or treated with topical creams. For instance, herpes symptoms are occasionally managed with topical cream.
“Applying the cream to the penis or vagina isn’t going to relieve any outbreaks located in the perineum or anus,” he says. Makes sense.
Again, you can have one STI of the genitals, and another STI of the anus. Treating one STI won’t treat a different STI.
The health consequences of leaving an STI untreated depend on the specific STI.
“Most will progress to more advanced disease, which is why they need to be treated,” says Ingber.
For example, “Syphilis, if untreated, can travel throughout the body, and in severe cases, can affect the brain and be deadly,” says Ingber. “Certain strains of HPV can grow and actually cause cancer if untreated.”
And of course, leaving an STI untreated increases your risk of transmitting that STI to a partner.
STIs don’t magically appear. If the person you’re ~anally exploring~ with doesn’t have any STIs, they can’t transmit one to you.
So, anytime you have sex without a barrier method with a person whose STI status you do not know, or who has an STI, transmission is possible.
The same goes if you use protection — such as a dental dam for rimming or a condom for anal penetration — but don’t use it properly.
If there’s any penile-to-anus or oral-to-anus contact before the barrier is put in place, transmission is possible.
For penetrative anal intercourse, not using enough lube or going too fast can increase the risk.
Unlike the vagina, the anal canal doesn’t self-lubricate, which means you need to provide that lubrication.
Without it, anal intercourse can cause friction, which creates tiny microscopic tears in the anal lining.
This can increase the risk of transmission if one or more partners has an STI.
Starting with a finger or butt plug, going slow, and breathing deeply can also decrease the risk of injury (and pain) during penetrative anal sex.
No, it doesn’t matter whether you’re experiencing symptoms — most STIs are asymptomatic.
Gersh says the recommendation for anal STI screening is the same as the general STI screening protocol:
- at least once a year
- between partners
- after unprotected — in this case, anal — sex
- any time there are symptoms
“Whenever you get STI screened, you should get tested for oral STIs if you’ve been engaging in oral sex and tested for anal STIs if you’ve been engaging in anal sex,” she says.
Most anal STIs can be tested for by culturing anal swabs, says Kecia Gaither, MD, MPH, FACOG, who is double board certified in obstetrics and gynecology and maternal-fetal medicine and is the director of perinatal services at NYC Health + Hospitals/Lincoln.
This usually involves using a mini Q-tip-like device to swab the anal canal or anal opening.
This is the typical testing method for:
- HSV, if lesions are present
- syphilis, if lesions are present
“This isn’t as uncomfortable as it may sound, the instrument is quite small,” says Gersh. Good to know!
However, some STIs can be tested for via a blood test. This includes:
“Your doctor may also issue a tissue biopsy or an anoscopy, which involves looking inside the rectum if they believe it’s necessary,” adds Kimberly Langdon, MD, OB-GYN, and medical advisor to Parenting Pod.
All STIs can be either treated or managed.
So long as they’re caught early enough, “bacterial STIs like gonorrhea, chlamydia, and syphilis can all be treated with proper medication,” says Langdon. Parasitic STIs like pubic lice and trichomoniasis can also be cured.
“Viral STIs like hepatitis B, HIV, HPV, and herpes can’t be cured, but they can be managed with medication,” says Langdon.
For starters, know your own STI status! Then, share your status with your partner and ask for theirs.
If they have an STI, don’t know their current STI status, or you’re too nervous to ask, you should be using protection.
That means dental dams for rimming, condoms for penetrative anal intercourse, and finger cots or gloves during anal fingering.
And remember: When it comes to penetrative anal play, there’s no such thing as too much lube.
What sex acts can transmit anal STIs?
If you receive anal-oral or anal penetration from a person who has an STI, it’s possible for an STI to be transmitted.
An anal sex toy can also transmit an STI if it was used by a person who has an STI immediately before you use it, according to Rymland.
How often should you test for anal STIs?
You should get tested for anal STIs anytime you’re experiencing anal STI symptoms, or have anal sex with someone who is STI-positive, or whose STI status you do not know.
Besides that, plan to get anal STI tested at the same cadence as you get genital STI tested. (At least once a year).
Which anal STIs are curable?
Any bacterial or parasitic STI can be cured, meaning that it will go away with proper treatment.
Curable anal STIs include:
- public lice (crabs)
Important: You do not become immune to these infections after having them once. That means if you come into contact with the infection again, you can be infected by it a second (or third, or more) time.
Can I test for anal STIs at home?
Yes, you can test for some anal STIs at home — but not all.
It’s easiest to find an at-home anal STI test for anal gonorrhea and anal chlamydia. Popular at-home STI testing providers myLAB Box and Nurx, for example, offer those options. (Nurx offering also tests for HIV, syphilis, and hepatitis C).
You have a number of options for testing for HIV at home.
How long do anal STIs take to go away?
Bacterial and parasitic STIs, which can be cured, can clear up in under a week with proper treatment.
Viral STIs like HIV and HSV cannot be cured, which means they will not simply “go away.” However, their symptoms can be managed and controlled with proper treatment.
STIs are a risk of being sexually active. And depending on the sex acts in your sexual repertoire, that includes anal STIs.
To reduce the risk of anal STIs, follow the same advice you do to prevent genital STIs: Get tested, talk about STI status, and use protection consistently and correctly.
Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.