This page provides information about the various infections that you want to be aware of to
better manage your sexual health. If you have any questions, please feel free to
post them in our Trans Health Forum or
send us a message with what you need to know! If we don't
have the answer, we will try to get it.
Some general issues related to risk for trans persons include the effects of hormone
adjustments and genital surgery on risks. Trans men who take hormones or have had a
hysterectomy or oophorectomy (removal of the ovaries) may be at increased risk of contracting
HIV and STIs if they engage in sex using their front hole because decreased levels of
estrogen (and possibly increased levels of testosterone) can cause the inner lining
to become more fragile and more susceptible to skin breakage, allowing infections
easier pathways to the bloodstream. Some trans men have tried local application of estrogen
creams or insertable rings, but there have been no studies about how effective this practice
is. Trans men should note that the external skin of their penis is likely also more subject to
tears and breakage than is the external skin of a cisgender man's penis. This may be less
of an issue for trans men who have undergone phalloplasty due to the locations from which
skin grafts are taken.
Trans women who take estrogen might find the skin of an original clit, especially along
folds, to be more delicate and subject to breakage than it was prior to starting hormones.
Any broken skin can leave one more at risk for acquiring HIV or STIs. Trans women who have
had genital surgery using the inversion method may have inner vaginal tissue that is stronger
and less subject to tearing than that of a cisgender woman's inner tissue, and the skin
cells may be somewhat more resistant to HIV and bacterial infections for at least some time,
although reportedly after a few years the difference becomes minimal. Other methods, such as
colovaginoplasty, which uses a segment of the colon, may have different risks
(bacteria love mucus membranes such as those of the colon). Care should be taken during
rough sex or large-object insertion as the inner tissues may not stretch as much and scar
tissue can be subject to damage. Questions and comments about risk and experience are
welcome at our Trans Health Forum, and you can submit comments
by email at our contact page.
Much of the information on this page comes from the Centers for Disease Control and
Prevention's (CDC) "Sexually Transmitted Diseases Treatment Guidelines, 2014".
Additional information was drawn from the pages at Planned Parenthood's discussion about STDs. Last, the CDC's 2015 STD treatment guidelines were just
released at the end of June 2015.
HIV is an infection that usually causes an initial reaction in the body similar to a cold or the flu. Your body tries to fight off the initial infection, then it becomes a less noticeable disease that over time seriously harms your immune system (your body's ability to fight off infections in general). There may be little or no symptoms that a person has HIV until the immune system has been seriously compromised. HIV infection can be treated to reduce its effect on the body, but it cannot be cured.
It should be stressed that HIV is a risk whether you are trans or cis, femme or masculine identified, non-binary (enby), or any other gender or orientation. HIV risk is related to activities and protection, not your gender, the gender of who you love, or your orientation!
The most common means of acquiring HIV is unprotected anal sex, so if you use no other protection, please at least use protection when having anal sex. HIV is less likely to be transmitted through oral sex, kissing, or skin-to-skin contact, and you cannot acquire HIV by drinking after someone or similar shared activities.
[ Image from Feministing: "Transgender Women are 49 Times More Likely to be HIV Positive"—an article about the disproportionate effect that stigma, discrimination, and prejudice have on HIV infection rates in the trans community. ]
Syphilis is a bacterial infection that progresses through three stages. The initial stage might produce small ulcers or sores at the site of infection (usually the genitals or anus); these sores, also called chancres, are not painful. The second stage can include broad skin rashes (like on the palms of the hands and feet as well as elsewhere) and sores in the nose and throat. The third stage can include nerve damage, hallucinations, and other serious problems. Syphilis can be treated and cured with antibiotics, but damage done to the body during infection will not be reversed.
Syphilis is thought to be transferred only during about the first year of infection, when sores are present. It can be transmitted by skin-to-skin contact generally with the genital area, where there are more likely to be sores. Syphilis can be transmitted by oral sex, rimming, anal sex, or penetration of the front hole or vagina. Condoms and other barriers are effective at preventing transmission.
Gonorrhea is the second most frequently reported infectious disease in the US, with only chlamydia being more common. Cisgender men often experience significant pain during urination soon after infection, but cisgender women (and some cisgender men) may not experience symptoms until additional problems (such as PID, or pelvic inflammatory disease) have occurred. There doesn't appear to be any data on how these symptoms may differ among trans persons with different body characteristics and hormone balances. Pain during urination, discharge from the genitals, and more frequent need to pee can be symptoms that anyone may experience. Gonorrhea can usually be treated and cured with antibiotics. However, gonorrhea can develop resistance to treatments, and treatment-resistant strains are expected to become more common.
Gonorrhea is spread through contact with the genital or anal area. You can acquire gonorrhea or give it to someone else by contact with the genital area, during oral sex, rimming, anal sex, or penetration of the front hole or vagina. You can also get it if you touch or finger an affected body part, then touch yourself in areas where mucus membranes are present (including your nose, eyes, mouth, anus, and genital areas). It should be noted that gohorrhea infections of the mouth and throat, acquired usually through giving oral sex, can be more difficult to treat than those of the urethra or rectum. Condoms and other barriers, as well as frequent hand-washing with warm soapy water if using your fingers, are effective at preventing transmission.
Chlamydia is the most frequently reported infectious disease in the US, and it occurs most often in persons 24 years of age and younger. There may be no symptoms, but symptoms can include burning during urination, discharge from the genitals, and pain in the lower abdomen or genital area. Chlamydia can be treated and cured with antibiotics. Like gonorrhea, treatment resistant strains of chlamydia are known and are expected to become more common in the near future.
Chlamydia is caused by a bacterium transferred during contact with the genital or anal area. You can acquire chlamydia or give it to someone else by skin-to-skin contact generally with the genital area, during oral sex, rimming, anal sex, or penetration of the front hole or vagina. You can also get it if you touch or finger an affected body part, then touch yourself in areas where mucus membranes are present (including your nose, eyes, mouth, anus, and genital areas). Condoms and other barriers, as well as frequent hand-washing with warm soapy water if using your fingers, are effective at preventing transmission.
Hepatitis A is common, it goes away on it's own. Hepatitis A is passed via fecal matter, so rimming, anal fingering, and anal intercourse can transmit hepatitis A between partners. Hepatitis A rarely causes significant health problems, but if you engage in activities at high risk for hepatitis A, you may want to consider asking your physician about vaccination against this type of the virus.
Hepatitis B may go away, or it may persist, and persons with compromised immune systems can have flare-ups even if it has been in remission. Long-term infections can lead to liver damage and eventual liver failure. One can contract hepatitis B through contact with infected blood or blood-based body fluids such as semen or vaginal fluid. High-risk activities include unprotected insertive sex (front hole, vaginal, or anal) and shared needles used for injecting drugs (including hormones and silicone or other body-shaping materials). Symptoms are seldom obvious. There is treatment to help address the negative effects of hepatitis B, but there is no cure. Condom and other barriers can help prevent transmission, and there is a vaccine to protect against hepatitis B as well.
Hepatitis C is a life-long infection that can lead to liver damage and eventual liver failure. Nearly 3 million persons are estimated to carry hepatitis C in the US. One contracts hepatitis C most commonly through exposure to infected blood, often through shared needles used for injecting drugs (including hormones and silicone or other body-shaping materials). Caution should be used when sharing razors, toothbrushes, and even toys that may have been exposed to blood; if a person with hepatitis C is menstruating, they should be very careful about possible transmission during sex activities. Note that hepatitis C is very resilient and can live for about a week in dried blood. Hepatitis C is not generally transmitted through sexual contact, however there is evidence that HIV+ persons are able to transmit hepatitis C through sexual contact. Symptoms are seldom obvious. There is treatment and a cure for hepatitis C, but the cure is very expensive at this time.
Genital herpes is a life-long viral infection, and at least 50 million people in the US have genital herpes, and a significant number have not been diagnosed. Symptoms can include small painful sores, but not everyone has these sores, and most will not have them all the time. Genital herpes can be treated but not cured.
Genital herpes is a virus transferred during contact with the genital or anal area when sores are present (sores can sometimes be present but not visually obvious). You can acquire genital herpes or give it to someone else by skin-to-skin contact generally with the genital area, during oral sex, rimming, anal sex, or penetration of the front hole or vagina. Condoms and other barriers are effective at preventing transmission.
Oral herpes, often called cold sores, can also be transmitted to the genitals during oral sex. The majority of the adult population in the US has oral herpes, and in most cases treatment is not necessary unless one has a compromised immune system.
Pubic lice, or crabs, are less common these days because many people shave or closely trim their pubic hair, but this issue is still with us. The symptoms are itching in the genital area as well as visible eggs (called nits) and crawling lice (about 1 to 1.5 millimeters in length). Lice are most often spread through sexual contact, and they cannot be spread by animals or via surfaces such as toilet seats, although clothing, towels, and bed sheets used by an infested person may spread lice to another person. Lice cannot live for long away from a human body. Treatment usually consists of using a lice-killing lotion, available without a prescription at drug stores and pharmacies.
BV is a condition where the normal bacteria mix of the front hole or vagina is upset, sometimes causing discharge or odor, but also with no symptoms. BV can be related to multiple sex partners of any gender and exposure to a variety of microbes that can upset the natural microbial balance. BV can increase the risk of contracting STIs, and increase the risk of HIV transmission (either to or from a partner). It is not known if BV may be more common among men with a front hole who have balanced their hormone levels. BV can be treated and cured.
PID is actually several disorders involving the pelvic area of persons who retain reproductive organs above the cervix. If these organs are not present, you do not have a risk for PID. Symptoms include discharge, pain in the lower abdomen or back, pain when walking, fever, chills, nausea, and vomiting. PID can be treated and cured with antibiotics.
PID may be caused by chlamydia or gonorrhea, but the infections may have other causes as well. PID is generally spread by sex involving front hole or vaginal insertion. Condoms and other barriers are effective at preventing transmission.
Trich (pronounced "trick"), as it is usually called, is caused by a parasite and is the most prominent nonviral STI in the US. Symptoms include pain, burning, or itching of the genitals during urination or ejaculation, discharge, and odor. However, over 70% of those infected show no symptoms. Infection can significantly increase one's risk of acquiring HIV. Trich can be treated and cured.
Trich is readily passed from one person to another during insertive sex where one partner has a front hole or vagina. Trich is not transferred through anal sex. Condoms and other barriers are effective at preventing transmission.
Epididymitis is swelling of the tube that stores and carries sperm (the epididymis), so only persons who have an epididymis can acquire this infection. Trans women who have had an orchiectomy almost certainly no longer have an epididymis. Symptoms can include pain in the area, possible discharge, fever, and blood in the urine. Epididymitis can be treated and cured with antibiotics.
Epididymitis is usually caused by a bacterial infections such as gonorrhea or chlamydia. One may develop epididymitis after bacterial exposure generally during insertive genital, oral, or anal sex. Condoms and other barriers are effective at preventing transmission.
HPV has over 100 variations, and at least 40 affect the genital area. HPV typically has no associated symptoms, but can cause abnormal cell growth that can lead to a variety of cancers in the reproductive organs, mouth, throat, and anus; HPV can also cause genital warts. Most sexually active persons probably become infected with HPV at least once in their lives. Most infections will go away within 8 to 13 months, but some may persist for years. There is currently no treatment or cure for HPV as it is usually harmless. Treatments do exist for abnormal cancerous cell growths. There is an HPV vaccine for persons with a cervix; the vaccine protects against the types of HPV most associated with cervical cancer.
HPV can be transmitted by any skin-to-skin contact, including contact involving the genital area, oral sex, rimming, anal sex, or penetration of the front hole or vagina. Condoms and other barriers are fairly effective at preventing transmission.
Most genital warts, which are simply abnormal cell growths, are caused by HPV (see Human Papillomavirus). They may be painful or itchy, and may vary in size. They are typically located around the front hole or vagina, under foreskins, along the shaft of a penis or clit, around the anus, and may be internal to any openings at these locations. They are most commonly associated with receptive anal intercourse. Treatment involves application of ointment or removal by cutting, freezing, or other means. Some may go away on their own within a year.
As these warts are caused by HPV, infection is the same as that for HPV: skin-to-skin contact, including contact involving the genital area, oral sex, rimming, anal sex, or penetration of the front hole or vagina. Condoms and other barriers are fairly effective at preventing transmission.
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