When it comes to condoms, we cannot sing their praises enough. Condoms—both external and internal (“female”), along with dental dams—are a cornerstone in the prevention of sexually transmitted infection (STI) spread. When used correctly, condoms are highly effective in preventing most STIs, including chlamydia, gonorrhea, asymptomatic syphilis, and HIV.
As a sex educator, I recommend condom use for anyone who is sexually active, including for oral, anal, and vaginal intercourse, in order to protect yourself and your partner.
With all that being said, condoms are not perfect. There are some STIs that can still be spread even if you use condoms every single time you engage in sex. While most STIs (such as HIV) are spread through blood and genital fluids, there are a few that are transmissible through skin-to-skin contact. A condom on a penis only covers the shaft, which means that the scrotum, perineum, and anus are exposed. Similarly, an internal condom sits inside the vaginal canal, leaving the vulva exposed.
Before we dive into the specifics of skin-to-skin transmission and the related STIs, it’s important to note that it is possible to spread nearly all STIs even when using condoms. While latex barriers are the best method we have in curbing the spread of STIs, “barrier methods aren’t 100% effective at preventing STI transmission (nothing is, other than not having sexual contact with someone else), so all STIs can still be transmitted (even chlamydia and gonorrhea),” Anne Hodder-Shipp, ACS, a certified sex educator and founder of Everyone Deserves Sex Ed, tells TheBody.
Because of this, it is important that you are screened regularly for STIs. The Centers for Disease Control and Prevention (CDC) recommends a once-yearly panel, but if you’re having sex with multiple partners, it would be wise to go every few months. STIs are incredibly common. We need to get over the tired stigma around them. While engaging in safer sex is important, STIs are “as common as catching a cold or flu (two things that also can be transmitted via sexual contact, even just kissing), and STIs are part of the deal when you’re a sexually active person,” Hodder-Shipp says.
With all that being said, here is what you should know about those STIs that are spread through skin-to-skin transmission. Because even though STIs are incredibly common, information always makes us stronger and better equipped to protect ourselves.
Herpes Virus (HSV-1 and HSV-2)
Both the oral and genital strains of the herpes virus are passed through skin-to-skin contact. Because condoms don’t cover the entire genital area, one can transmit the virus even while using them.
What’s more, a herpes sore does not need to be present to spread the virus to a partner. “This skin-to-skin transmission can occur from normal-appearing skin that happens to be shedding [the virus]. For example, you can spread oral herpes to the genitals if you give your partner oral sex,” sexual health expert Ina Park, M.D., tells TheBody. “Even if one’s partner has no symptoms, they can still be shedding the virus from the genital or anal area and transmit the virus to their partner, causing genital herpes.” Park is the author of Strange Bedfellows, a book on STIs.
Herpes is incredibly common and, unlike some other STIs, is just not a big deal. Ninety percent of people who are currently positive for the herpes virus will never show symptoms. This is why herpes is not present on your average STI panel. There just isn’t a need for it in a medical sense. “Sex is about maximizing mutual pleasure and can still be accomplished with an STI like genital herpes,” Park adds.
If you suspect that you have the herpes virus—that is, if you have an outbreak—make an appointment with your doctor ASAP. This way, they can prescribe an antiviral drug that can greatly reduce your risk of infecting other partners.
HPV (Human Papillomavirus)
HPV can cause cell changes on the cervix that result in cervical cancer. There are hundreds and hundreds of different strains, most of which clear up on their own. HPV is the most common STI that exists. According to the CDC, nearly 79 million Americans currently have the virus. Nearly every sexually active person will have HPV at some point in their lives.
There is a highly effective HPV vaccine that protects against nine of the more aggressive strains. Children (regardless of gender) should receive the vaccine at around the age of 12, as a preventative measure.
“HPV prevention can be difficult because of the lack of testing options, but for folks with cervixes, having annual Pap smears can be helpful,” says Hodder-Shipp. This way, your doctor can determine if there are abnormal changes to the cervix. If there are changes, further measures to assess them will be taken.
Felice Gersh, M.D., founder and director of the Integrative Medical Group of Irvine, in California, says that that there is no test available for men (and all penis-owners)—and therefore, risk-reduction measures should be taken. “Men with prior partners with HPV may be infectious, so just asking about prior history is a good idea,” says Gersh, who is also the author of PCOS SOS Fertility Fast Track. “Ask if prior partners had HPV or Pap smear problems. Knowing one’s risk can at least help with decision-making.”
Syphilis, a bacterial infection, is usually spread through the bloodstream and through genital fluids in the same manner as chlamydia, HIV, and gonorrhea. It is currently having a rebirth. The CDC reports that cases of syphilis are currently the highest they’ve been since 1995. This is why we need to talk about it in today’s sexual culture.
According to the CDC, “Correct and consistent use of latex condoms can reduce the risk of syphilis when the infected area or site of potential exposure is protected. However, a syphilis sore outside of the area covered by a latex condom can still allow transmission, so caution should be exercised even when using a condom.”
This means that when there is an active sore present, this STI can be spread through skin-to-skin contact. If you use condoms, you’re less likely to contract syphilis than the herpes virus—because there needs to be an active sore present. The CDC notes that nearly half of men who have sex with men in the United States who test positive for syphilis are also living with HIV.