People all around the world are sexually active, having intimate experiences with partners old and new, making it all the more important to ensure safe sexual practices. However, in the United States, 1 in 5 people have a sexually transmitted infection (STI) as a result of several different factors that dictate how at risk one may be for infection. Studies show that the four main pillars of determining risk are where one lives, what they do, their identity, and who they love. Understanding which unique attributes of our lives may contribute to our risk for contracting an STI or STD is an important step in taking control of our sexual health.
Where one lives may indicate a higher risk of contracting an STI; for example, states like Idaho and Utah carry the lowest risk of infection, while states like Minnesota and Louisiana carry the highest. Additionally, different areas and metros are at risk for various types of STIs. The Pacific Northwest and West Coast are most commonly diagnosed with syphilis, while the Midwest most often battles chlamydia. HIV is the most common disease in the northeast, and the south is highly susceptible to gonorrhea. Specific densely populated metros in these areas also have high rates of positivity, such as Detroit, Philadelphia, Montgomery, Memphis, and Baltimore. Overall, one is most at risk if they live in the south or in and around a larger metropolitan city.
One’s lifestyle choices can also play a significant role in their odds of contracting a sexually transmitted infection. Having unprotected sex is one of those choices, causing the odds of contracting a disease like syphilis or gonorrhea to skyrocket. Using inadequate protection measures may also lead to infection. Some of the best forms of protection to prevent STIs include condoms, topical spermicides, or pre-/post-exposure vaccines. However, non-barrier contraception, female surgical sterilization, and traditional morning-after pills will not do much to help prevent the spread. Having more than one sexual partner also heightens risk, as research has shown that women with 5 or more sexual partners are 8 times more likely to have an STI. The unknown involved with dating apps or engaging in sexual acts while under the influence can also lead to the spread of STIs. Although dating app users are 1.8x more likely to get screened for STIs, they are also 1.3x more likely to test positive for them. Substance abuse has also been positively associated with risky sexual behaviors and subsequent STI diagnoses. The populations at the highest risk are those who are having unprotected sex with multiple partners, with a high degree of unknown or uncertainty towards those partners.
There are a variety of identity-based factors that also bring a unique level of risk to the table. By ethnicity and nationality, black people are disproportionately more likely to contract both gonorrhea and syphilis than other groups. Additionally, studies show that those who use public transportation, do not have health insurance, or overall have an income below the poverty level are more likely to contract an infection. There are also risks associated with age, as young people overall report STIs more than older people. In fact, people ages 15-24 made up 48% of all reported cases of chlamydia, gonorrhea, and syphilis in 2023. Religious upbringing, sex assigned at birth, and educational experience can also play a role. As a whole, one is more at risk for an STI if they are a young adult male between the ages of 15 and 24.
Finally, who we love is a key component to understanding and taking control of our sexual health. The intimate relationship dynamic and the type of sex that heterosexual versus homosexual couples engage in bring a variety of different risk factors to the table. Homosexual men are more likely to contract gonorrhea, syphilis and anal warts than heterosexual men, while heterosexual men are more susceptible to nongonococcal urethritis, genital herpes and pediculosis pubis. Heterosexual women are most susceptible to syphilis, while homosexual women are more likely to contract bacterial vaginosis. Overall, gay and bisexual cisgender men suffer at the highest positivity rate of STIs at 35%, followed closely by nonbinary people and transgender women. The type of sex being had is also important to consider, as studies have shown that anal intercourse is 10x more likely to result in HIV than vaginal intercourse.
There are several options for those looking to lower their risk of STIs. The most common risk reduction options are abstinence, STI testing before a sexual relationship, and using barrier-based protection. Vaccines are also widely available to prevent certain types of diseases from spreading. Although the only foolproof method for stopping the spread and contraction of sexually transmitted infections is abstinence, knowing one’s options is an important step in safely remaining active. For anyone looking to continue their personal health journey or become sexually active in the future, knowing prevention methods is paramount.
