Health Sex and sexual health Trans sexual health Trans sexual health | STIs Anyone can get an STI, however trans people are more likely to pick up an STI for many reasons, which can include a lack of access to or lack of information about prevention methods and testing services. If you are trans you should know about STIs, the symptoms, and how to prevent them. What are STIs? STIs are infections that are passed on through different types of sex. There are several ways to prevent STIs and you can test and treat most infections. It’s important to test regularly so you can be treated, and so you don’t pass it on to anyone else. Common STIs Here is a shortlist of common STIs you should look out for and test regularly for if you have an active sex life. For a full rundown of all STIs visit our sex and sexual health pages. Chlamydia How it’s passed on: Through condomless vaginal, anal or oral sex. Sharing unwashed sex toys. Symptoms can include: Discharge from the penis, vagina or anus pain when urinating pain during sex sore throat Sometimes there are no symptoms at all. Testing: Urine test, swabs if appropriate. Talk to your clinician if you are comfortable with a swab and let them know status of lower surgery if you have begun the process. Chlamydia postal tests are also available so you can test at home. Treatment: Antibiotics which could be a single dose of azithromycin or a week-long course of doxycycline. Gonorrhoea How it’s passed on: Through condomless vaginal, anal or oral sex. Sharing unwashed sex toys. Symptom can include: Discharge from the penis, vagina or ass pain when urinating pain during sex sore throat bleeding between periods Sometimes there are no symptoms at all, particularly if you have gonorrhoea in the throat. Testing: Urine test, swabs if appropriate. Talk to your clinician if you are comfortable with a swab and let them know status of lower surgery if you have begun the process. Chlamydia postal tests are also available so you can test at home. Treatment: Antibiotic injection or a course of antibiotics. There is an antibiotic resistant strain of gonorrhoea on the rise, however so far it can be treated by another antibiotic called ceftriaxone. Syphilis How it’s passed on: Through the usual methods of sex (penetrative, oral etc) but can be far more infectious in different stages (which is why sometimes infection can occur with skin-to-skin contact). Symptoms can include: Stage one – A small painless sore or hardened lump (called a ‘chancre’) will appear ten days to three months after infection, near the point where the bacteria entered your body. This could be your ass, penis, vagina, or mouth. It's possible for this to go unnoticed, especially if it is in your ass or somewhere you can’t easily see Glands in your neck, groin or armpits may swell The sores take about two to eight weeks to heal and then disappear. The sores are very infectious. Stage two - A rash will appear on your body – often on the palm of your hands or bottom of your feet. However, it can appear anywhere Flu-like symptoms White patches in the mouth Genital wart growths (near the ass or vagina) However, some of these symptoms may be mild and hard to spot. Stage three and beyond - Often at this stage there are no obvious symptoms If unnoticed and untreated, it can cause damage to your heart, brain, bones and nervous system. Testing: A blood test and a swab of an infected area, such as a sore. Treatment: This often depends on how long you have had it. Syphilis that has lasted less than 2 years is usually treated with an injection of penicillin into your ass, or a 10-14 day course of antibiotic tablets if you can't have penicillin. Syphilis that has lasted more than 2 years is usually treated with three penicillin injections into your buttocks given at weekly intervals, or a 28 day course of antibiotic tablets if you can't have penicillin. More serious cases that affect the brain are usually treated with daily penicillin injections given into your buttocks or a vein for two weeks, or a 28 day course of antibiotic tablets if you can't have penicillin. At the latter stages of infection, you can be cured of syphilis but any damage it has caused is often irreversible. STIs, hormones and surgery Trans women and trans feminine people Not all trans people are the same. You might not have had surgery or take hormones, or you might have surgery or just take hormones. Here are some things to consider in relation to surgery and STIs. If you have recently had lower surgery and you are still healing, this could make it easier for you to get or pass on an STI as bleeding can provide a route of infection into or out of your body. After lower surgery, your anus, as well as your vagina, might be delicate while your genital area recovers. Your medical practitioner should be able to advice you on what sexual activity you can have and how soon you can do it. If you have had colovaginoplasty (where your vagina was made from part of your colon) this could make you susceptible to STIs, as your vaginal lining will be a mucus membrane that STIs can more easily penetrate. Lube is important. Depending on the type of surgery you've had you should use lots of lube, as your vagina may not naturally lubricate. Use water-based lube to help prevent tearing. Water-based lube is also the best lubricant to use with condoms. If you are using a dilator to help stretch the vaginal skin after surgery, this can cause bleeding which can leave you more susceptible to STIs. Trans men and trans masculine people Here are some things you may need to consider as a trans man and trans masculine person. Recent lower surgery could mean unhealed skin, this could make it easier for you to get or pass on an STI, as bleeding can provide a route into or out of your body. Your medical practitioner should be able to advice you on what sexual activity you can have and how soon you can do it. Hormones can also increase the chance of bleeding during penetrative frontal and anal sex. Using plenty of lube can help reduce the risk of this. It’s best to use a condom until you and your partner have tested for HIV and STIs. Regularly check for any tears. Testosterone can cause dryness, pain and bleeding while having sex. It can also sometimes cause discharge which can be mistaken for symptoms of and STI. Testosterone can affect can reduce vagina/front hole lubrication, so you might discover that you don’t produce enough, which is why using lube is so important to avoid tears and bleeding. Reduced oestrogen levels impact the thickness of the walls of the vagina/front hole and sometimes the ass, which can cause tears. Prevention methods There are a few ways to reduce your risk of STIs: Condoms – using condoms for sex is probably the most effective way to prevent the majority of STIs. However, unless you use condoms for oral sex, it won’t prevent infections in your throat and mouth. Testing – regular STI testing is the most effective way to stop the spread of STIs. If you are diagnosed, you can get treated, meaning you won’t pass it on to anyone else. You can test for all STIs in a sexual health clinic and you can test for some common STIs, such as chlamydia or gonorrhoea, at home with a postal test. PrEP – while PrEP doesn’t protect against STIs it does prevent HIV. Taking PrEP in conjunction with regular testing and using condoms when you can is the most effective way of preventing STIs and HIV. Further reading and advice For further information about sexual health for trans people, including services and testing, visit CliniQ. For further HIV information and statistics both in the UK and worldwide in relation to trans people, visit NAM aidsmap. For further advice about trans sexual healthcare including the THT Direct helpline, visit Terrence Higgins Trust. To speak to people who may be going through the same thing as you or looking for the same information, visit the LGBT HERO Forums to find help, advice and to share your story.