Your genitals aren’t the only place a sexually transmitted infection (STI) can land and set up shop.
“There are many STIs that can occur in areas other than the genitals,” says Michael Ingber, MD, a board certified urologist and female pelvic medicine specialist at The Center for Specialized Women’s Health in New Jersey.
News to you? Scroll down for our nongenital STI guide.
Anywhere there’s a mucous membrane, an STI can develop, says Ingber.
The most common of those areas include:
The infectious agents that cause STIs do not discriminate, explains Felice Gersh, MD, author of “PCOS SOS: A Gynecologist’s Lifeline to Naturally Restore Your Rhythms, Hormones, and Happiness.” They will infect whatever area they can get a hold of!
There are also blood-borne STIs like HIV and hepatitis B, adds Carol Queen, PhD, Good Vibrations sexologist and curator of the Antique Vibrator Museum. Blood-borne STIs can’t be categorized as genital or non-genital STIs. Instead, they are known as full-body infectious agents.
So, you got tested for genital STIs, and the tests came back negative. Cool, you don’t have a genital STI!
Unfortunately, that doesn’t mean anything for nongenital STIs. Anal, oral, and other nongenital STIs are still a possibility.
As Queen says, “A person can have a nongenital STI alongside a genital STI, or they can have a nongenital STI [even] if they don’t have any kind of genital infection.”
Depending on the acts in your sexual repertoire, yes.
Let’s say you have a partner who has a penis, and they’ve been diagnosed with genital herpes.
You probably already know that if you and your partner have vaginal sex without a condom — or put the condom on too late, the condom broke, or you otherwise used the condom incorrectly — you’re at risk for developing vaginal herpes.
Well, if you had anal intercourse with, or gave oral sex to, that same partner without adequate barrier protection, you’re at risk for developing the herpes simplex virus (HSV) in or around your mouth and anus, too.
“If you’re given an oral antibiotic, that should clear up the infection everywhere,” says Gersh.
Theoretically, this should completely cure the infection wherever it’s located in or on the body.
A doctor or other healthcare professional will likely recommend that you return about 8 weeks after diagnosis to make sure that the treatment worked and you don’t still have the STI.
Here’s where it gets sticky: If you and your clinician don’t know that you have a bacterial STI in another part of the body, they won’t be able to confirm that the infection has truly gone away.
Ingber offers another example:
“If you’re taking oral acyclovir for genital herpes, it will clear up any oral symptoms of the virus, too.”
But the treatment for genital warts is more localized.
“Someone may be prescribed podofilox, a topical cream for genital warts, but that wouldn’t cure warts that are present in other parts of the body that aren’t having the cream applied,” Ingber says.
“The sooner an STI can be found and treated, the more likely there will be only minimal damage or effect on the body,” says David B. Samadi, MD, urologist and men’s health expert at Robotic Oncology in New York.
The exact side effects of leaving an STI untreated depend on the particular infection:
- Chlamydia. It can lead to pelvic inflammatory disease in vulva owners, which can cause painful scarring of the fallopian tubes and infertility. It can also cause infertility in people with penises.
- Gonorrhea. In rare cases, gonorrhea can spread throughout the body, causing damage and severe pain. It can also lead to pelvic inflammatory disease and even infertility in vulva owners. It can cause infertility in people with penises, too.
- Herpes. If you don’t take an antiviral drug to help reduce the risk of an outbreak, the risk of having an outbreak and transmitting the infection to a partner is higher.
- Hepatitis B. Untreated, this virus can invade and damage liver cells, increasing a person’s lifetime risk of liver cancer.
- HIV. HIV attacks your body’s immune system, which can make you more susceptible to illnesses. While people with HIV can live long, healthy, pleasure-filled lives with antiretroviral therapy (ART), untreated HIV can progress to AIDS.
- Human papillomavirus (HPV). There are several types of HPV that infect the mouth and throat. Left untreated, it can lead to throat, neck, head, mouth, cervical, vulvar, and penile cancer.
- Molluscum contagiosum. While this virus typically causes benign lesions, in rare cases, scratching at them can lead to secondary infection or scarring.
- Syphilis. If untreated, syphilis can damage your other internal organs like the brain, nerves, eyes, and joints. In severe cases, it can lead to blindness, paralysis, and death.
- Trichomoniasis. Untreated trichomoniasis can increase your risk of contracting HIV if you’re exposed to the infection.
“Beyond the health risks, if you leave an infection untreated, the risk of transmitting that infection to someone else is incredibly high,” says Gersh.
All genital and nongenital STIs can either be cured or treated.
Bacterial and parasitic STIs can be cured. This includes:
- molluscum contagiosum
Viral STIs like HPV, HIV, and HSV cannot be cured, but they can be managed through a combination of holistic and medicinal approaches.
Basically, all of them can be transmitted from mouth to genitals or from genitals to mouth.
However, some are more easily transmitted than others. This includes:
There have been no confirmed reports of hepatitis B or C from oral play.
In addition to skin-to-skin STIs,
- hepatitis A and B
- intestinal parasites, such as Giardia
- bacteria, such as E. coli and Shigella
What increases the risk of transmission?
The main risk factor? Not using a barrier method with a partner with a known STI or whose STI status you don’t know.
“Using barrier methods, such as dental dams or condoms, during oral sex can greatly reduce chances of contracting an STI during any kind of oral play,” says Samadi.
“Almost all of the STIs can be transmitted through anal penetration,” says Ingber.
Chlamydia, gonorrhea, syphilis, HIV, HSV, HPV, hepatitis A, B, and C can all be transmitted to the rectum if you have unprotected penis-in-anus sex with a partner with one of these infections, he says.
Anal fingering and penetrative anal play with toys can also transmit STIs if there is an exchange of bodily fluids, notes STI expert Emily Rymland, DNP FNP-C, clinical development manager at Nurx.
What increases the risk of transmission?
This is gonna sound familiar, but not using barrier protection with a partner with a known STI or whose STI status you don’t know increases transmission risk.
Going too fast, too deep, too hard, or too aggressive can also increase the risk of transmission.
“Because the tissues of the anal canal are so delicate, there’s a heightened risk of developing small nicks or tears in the tissues,” explains Samadi.
“[This] allows bacteria and infection to more easily get into a person’s system.”
In the case of anal penetration with a penis, showering ahead of time can help reduce the risk of bacteria transmission into the anus.
Similarly, washing your hands (and cleaning beneath your fingernails) ahead of anal fingering is a good move.
When it comes to using a toy, washing it ahead of time can help. It’s also important to use a toy made of a nonporous material, such as:
- stainless steel
“Most STIs are asymptomatic, which means you can have an STI and spread it to your partner whether you have symptoms or not,” says Ingber.
That’s why he recommends you get tested for anal and oral STIs as often as you should be getting tested for genital STIs. Depending on the individual, this frequency can be:
- once a year
- after every new partner
- after having sex without a barrier method with a partner who has an STI
- after having sex without a barrier method with a partner whose STI status you do not know
You should also get tested if there was a barrier mishap with a partner who has a known STI or whose STI status you don’t know.
Common mishaps include:
- the condom breaking
- the condom sliding off
- the dental dam slipping out of place
Most people who have an STI don’t experience any symptoms at all. But in the case that you do, here’s what to expect.
Oral STI symptoms include:
- mild sore throat
- sores, bumps, or warts around your lips, on your tongue, or in your throat
- swollen glands
- difficulty swallowing
- vocal changes
- dental pain
Anal STI symptoms include:
- painful bowel movements
- pain during penetration
“Eye pain and eye discharge are the most common symptoms of eye STIs,” says Rymland. “If you’ve been experiencing them and recently got semen or vaginal fluids in your eye, you should get tested.” (Routine screening of the eyes without symptoms is not recommended, she says).
“Testing for oral and anal STIs can be quick and easy,” says Samadi.
“Depending on which STI, you’ll need to give a blood sample, have the area swabbed, or provide a urine sample.”
|STI||Blood sample||Swab area||Urine sample|
|HSV (no sores)||X|
|HSV (visible sores)||X|
|HPV (oral)||sample of lesion taken for biopsy to determine if it’s cancerous|
|Syphilis (no sores)||X|
|Syphilis (visible sores)||X|
Can you get them both at the same time? At the same time as genital testing?
Yes and yes!
When you’re getting one area tested, you should get your other areas tested, too.
What if an oral or anal STI is diagnosed — are they treatable?
All STIs are either treatable (meaning the symptoms can be managed) or curable (meaning that they go away completely after treatment).
But (!): “The longer someone waits to get treatment, the more dangerous these STIs can be,” says Ingber.
The first step? Learn your own STI status, and ask any potential partners what their STI status is and when they were last tested.
Use barrier protection
If you’re getting hot and heavy with someone who has an STI or who doesn’t know their current STI status, use barrier protection — for all sex acts!
Putting lube on the inside of the condom or on the vulva side of a dam can make barrier protection more comfortable for the wearer.
And putting lube on the outside can make penetration and performing oral more enjoyable for the giver. Yeehaw!
Consider preventive medication
You might also ask a doctor or other healthcare professional if there’s any medication you or your partner(s) can take to reduce the risk of transmission.
For example, they may recommend you take preexposure prophylaxis (PrEP) if your partner has HIV (or might have HIV) — or vice versa.
If your partner has herpes, your provider may recommend that they take an antiviral drug to decrease the risk of the virus getting transmitted to you — or vice versa.
No matter what kind of sex you’re having, it’s important to know your STI status!
That way, you can treat any genital or nongenital STI you do have and share your status with your partner or partners.
This will allow you each to make an informed decision about what safer sex practices you want to use.
If you don’t feel comfortable asking your typical healthcare professional to test you for genital, oral, or anal STIs, it may be time to find a new clinician! “There are sex-positive providers who have these conversations every single day in a way that will make you comfortable, seen, heard, and informed,” says Queen.
Planned Parenthood and other clinics that specialize in sexual health and STI testing are generally your best bet for this kind of care.
Gabrielle Kassel is a New York–based sex and wellness writer and CrossFit Level 1 Trainer. She’s become a morning person, tested over 200 vibrators, and eaten, drunk, and brushed with charcoal — all in the name of journalism. In her free time, she can be found reading self-help books and romance novels, bench-pressing, or pole dancing. Follow her on Instagram.