What are the best practices for safe sex?

Best Practices for Safe Sex

The most effective way to prevent sexually transmitted infections is to avoid sexual intercourse with an infected partner, but if you choose to have sex with someone whose infection status is unknown, use a new latex condom with each act of intercourse. 1

Primary Prevention Hierarchy

Abstinence and Partner Selection

• Abstaining from sexual intercourse with infected partners provides complete protection against sexual transmission of HIV and other STIs 1
• Both partners should get tested for STDs, including HIV, before initiating sexual intercourse 1
• Careful selection of sexual partners reduces risk, though this alone is insufficient protection 2, 3

Barrier Methods: The Cornerstone of Protection

Male Latex Condoms

• When used consistently and correctly, condoms are very effective in preventing HIV, gonorrhea, chlamydia, and other STIs 1
• Condom breakage rates are low in the United States (≤2 per 100 condoms), with failure typically resulting from incorrect use rather than product defects 1

Proper Condom Use Technique 1:

• Use a new condom with each act of intercourse
• Handle carefully to avoid damage from fingernails, teeth, or sharp objects
• Put the condom on after the penis is erect and before any genital contact
• Ensure no air is trapped in the tip
• Use only water-based lubricants (K-Y Jelly or glycerine) with latex condoms—never oil-based lubricants (petroleum jelly, mineral oil, massage oils, body lotions, or cooking oil) as these weaken latex
• Hold the condom firmly against the base of the penis during withdrawal while the penis is still erect

Female Condoms

• The female condom (polyurethane sheath) serves as an effective mechanical barrier against viruses including HIV when male condoms cannot be used 1

Spermicides and Other Methods: Limited Protection

Important Limitations 1:

• Vaginal spermicides alone (without condoms) reduce risk of cervical gonorrhea and chlamydia but protection against HIV has not been established
• Spermicide-lubricated condoms are not more effective than other lubricated condoms for STI prevention 1
• Vaginal sponges and diaphragms do not protect against HIV or other STD pathogens that infect through the vagina or vulva 1

Critical Pitfall: Women using non-barrier contraception (oral contraceptives, Norplant, Depo-Provera) or who have been surgically sterilized or had hysterectomies may incorrectly perceive themselves at no risk for STDs—these methods offer zero protection against STIs and HIV 1

Vaccination as Prevention

• Hepatitis B vaccination is recommended for all unvaccinated patients being evaluated for an STD 1
• Hepatitis A vaccination is recommended for homosexual or bisexual men and persons who use illegal drugs 1

Behavioral Counseling

High-Intensity Counseling Recommended For 1:

• All sexually active adolescents
• Adults at increased risk for STIs
• Persons identified as high risk through sexual history screening

Counseling Should Include 1:

• Personalized risk assessment using open-ended questions and nonjudgmental language
• Abstinence from sexual activity if STD-related symptoms develop
• Information about HIV testing (both partners should know their status)
• Specific, realistic prevention plans tailored to individual risk factors

Special Populations

For Injection Drug Users 1:

• Enroll or continue in drug treatment programs
• Never use injection equipment (needles, syringes) that has been used by another person
• If needles can be obtained legally, obtain clean needles
• If sharing equipment, clean thoroughly with bleach and water first (though this does not guarantee HIV inactivation)

For Women Who Have Sex With Women 1:

• Use condoms on sex toys, gloves, and dental dams
• Avoid sharing sex paraphernalia
• Dispel the misconception that STI transmission between women is negligible

Screening and Early Detection

• Regular STI screening for sexually active individuals, especially those with multiple partners, helps detect infections before they progress to cause complications including sexual dysfunction 4
• Early detection and treatment of STIs is crucial to prevent progression to conditions like epididymitis in men or pelvic inflammatory disease in women that can cause sexual dysfunction 4

Emergency Contraception

• Levonorgestrel (emergency contraception) should be taken as soon as possible within 72 hours after unprotected sex to prevent pregnancy, with effectiveness decreasing over time 5
• This does not protect against STIs and should not be used as regular birth control 5