STDs (Sexually Transmitted Diseases) and How to Avoid Them

Sex can be fun and liberating, but between one friendly sex worker and another, there is the possibility of ending up dealing with unwanted STDs: bacteria, viruses, fungi… in short, a little zoo that no one wants to host.

The concern about possibly encountering one of the many STDs during your experiences is more than legitimate, especially for an Apprentice Punter just starting out with sex workers. Even the most seasoned and experienced don’t stop thinking about it from time to time, and that’s a good thing. Considering that your friendly neighborhood Editor has taken his own risks on more than one occasion, this is not meant as a moral sermon, but as a practical guide to enjoy certain experiences without getting into trouble.

Of course, it’s always wise to consult a doctor in case of symptoms or doubts, but you don’t need to be an expert to have fun without stress: practical information, smart prevention, and awareness of the risks are enough. With some targeted testing, correct condom use, attention to your health, and a bit of common sense, you can drastically reduce the risk of infections and complications. In this guide, you will also find advice on regular screening, treatment, and follow-up, presented in clear language without beating around the bush.

Ready to become a “master of conscious sex”? – Here you will find information on the main sexually transmitted diseases: Chlamydia, Gonorrhea, Syphilis, Herpes, HPV, Trichomoniasis, Hepatitis, HIV, Candida, with details to understand what they are, how they manifest, what risks they involve, and, most importantly, how to avoid them.

1 – Chlamydia

La clamidia è un’infezione batterica sessualmente trasmessa (IST) causata da Chlamydia trachomatis, spesso asintomatica ma in grado di provocare complicanze come infiammazione dell’uretra e dei testicoli, che possono compromettere la fertilità. La diagnosi si effettua tramite test di laboratorio su urine o tamponi uretrali, mentre il trattamento prevede antibiotici specifici e l’astensione dai rapporti sessuali fino al completamento della terapia per entrambi i partner, al fine di evitare reinfezioni.

Definition: Infection caused by the bacterium Chlamydia trachomatis, transmitted sexually.
Clinical manifestations: often asymptomatic, may cause genital discharge, pain on urination; in women pelvic pain, in men epididymitis.
Complications: pelvic inflammatory disease (PID), infertility, ectopic pregnancy; in men, testicular inflammation.
Diagnosis/controls: urine test or urogenital swab (NAAT).
Recommended frequency: sexually active subjects, women <25 years, multiple partners.
Treatment: antibiotics (doxycycline, azithromycin) and partner treatment.
Prevention: proper condom use, partner reduction, monogamy.
Follow-up: retest at 3 months to detect reinfection.
Importance of early diagnosis: avoids often irreversible complications.
Special aspects: test also rectal/oral if exposure.

Notes for prevention, visible symptoms in women: abnormal or heavier-than-usual vaginal discharge, burning or pain during urination, pelvic pain or cramps, bleeding between menstrual cycles. Chlamydia is often asymptomatic; noticing any changes in secretions or discomfort during urination is important to encourage the partner to get tested.

2 – Gonorrhea

Gonorrhea is a sexually transmitted bacterial infection (STI) caused by Neisseria gonorrhoeae, which can affect the genitals, rectum, and throat. It is often asymptomatic, but when symptoms occur it can cause burning during urination, unusual genital discharge, pelvic pain, and, in the case of throat infection, sore throat or no symptoms. Diagnosis is made through laboratory tests using urine samples or swabs, while treatment involves specific antibiotics and abstaining from sexual activity until both partners have completed therapy to prevent reinfection. If left untreated, gonorrhea can cause complications such as painful inflammation and difficulties in conceiving, making prevention through condom use and regular check-ups essential.

Definition: Neisseria gonorrhoeae infection that can affect genitals, rectum, and throat.
Clinical manifestations: purulent discharge, urinary burning, pelvic pain; often asymptomatic.
Complications: PID, infertility, systemic dissemination (joints, heart).
Diagnosis/controls: swab or urine (NAAT) also in extra-genital sites.
Recommended screening: annual at high risk, every 3-6 months if high risk.
Treatment: antibiotics, watch out for resistance.
Prevention: condom, screening and partner treatment.
Follow-up: clinical follow-up and partner management.
Importance of early diagnosis: reduces transmission and systemic damage.
Special aspects: need for specific throat/rectum pads.

Notes for prevention, visible symptoms in women: thick, yellow, or green vaginal discharge, burning or pain during urination, bleeding between cycles, pelvic pain. Many women do not show obvious symptoms; paying attention to any changes in secretions or pain during urination helps prevent transmission.

3 – Syphilis

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum, which can appear in different stages and affect the skin, mucous membranes, internal organs, and nervous system. It is often asymptomatic in the early stages, but when symptoms occur they may include painless sores, rashes, fever, and swollen lymph nodes. Diagnosis is made through laboratory tests, while treatment consists of specific antibiotics, usually penicillin, and abstaining from sexual activity until both partners have completed therapy to prevent reinfection. If left untreated, syphilis can cause serious long-term complications, making prevention through condom use and regular check-ups essential.

Definition: Treponema pallidum bacterial infection articulated in multiple stages.
Clinical manifestations: initial painless ulcer, subsequent rash, possible neurological/cardiac damage.
Complications: neurosyphilis, cardiovascular disease, congenital syphilis.
Diagnosis/controls: treponemal and nontreponemal serologic tests.
Recommended screening: annual in at-risk individuals, pregnancy.
Treatment: second-stage penicillin; partner treatment.
Prevention: condoms, partner reduction, periodic testing.
Follow-up: serological monitoring 6-12 months.
Importance of early diagnosis: prevents serious and permanent damage.
Special aspects: essential to notify and deal with contacts.

Note per la prevenzione, sintomi visibili nelle donne: piccola lesione indolore sui genitali o sulle labbra vaginali (sifiloma), eruzioni cutanee nelle fasi successive, linfonodi ingrossati. Le lesioni iniziali possono passare inosservate; la presenza di piaghe o eruzioni cutanee richiede immediata attenzione medica.

4 – Genital Herpes

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV), mainly types 1 and 2, which causes painful lesions on the skin and mucous membranes of the genitals and surrounding area. The infection can be recurrent, with periods of lesion appearance alternating with periods of quiescence, and it can sometimes be asymptomatic, making transmission possible even without obvious symptoms. Diagnosis is made through clinical examination and laboratory tests on lesion or blood samples, while treatment involves antiviral medications that reduce the severity and duration of symptoms without completely eliminating the virus. Abstaining from sexual activity during active phases of the infection and using condoms are essential to prevent transmission to other partners.

Definition: HSV-1/HSV-2 viral infection on genital/anal area.
Clinical manifestations: painful blisters, ulcers, flu-like symptoms; often asymptomatic.
Complications: facilitates HIV transmission; severe neonatal herpes.
Diagnosis/controls: lesion swab, type-specific serology.
Recommended screening: not indicated in asymptomatic.
Treatment: antivirals (acyclovir/valacyclovir).
Prevention: condom, avoidance of intercourse in active phase, suppressive therapy.
Follow-up: relapse management, counseling.
Importance of diagnosis: infection even without visible lesions.
Special aspects: asymptomatic “shedding.”

Notes for prevention, visible symptoms in women: painful vesicles on the vaginal lips, vulva, or perianal area, redness and itching in the genital region, possible clear discharge from the lesions. Avoiding sexual activity during active phases of the infection and paying attention to unusual vesicles or redness helps prevent transmission.

5 – HPV

HPV, or human papillomavirus, is a sexually transmitted infection (STI) caused by a very common virus, which can cause benign lesions such as genital warts or, in the case of high-risk types, various cancers, including those of the anus, penis, and head-and-neck region. Most infections resolve spontaneously, but in some cases they can persist and cause long-term health problems. Diagnosis in men is made through clinical examination and specific tests on visible lesions or affected tissue, while treatment does not eliminate the virus but aims to remove lesions and prevent complications. Vaccination and condom use are essential prevention tools.

Definition: viral infection with oncogenic and wart-producing types.
Clinical manifestations: condylomas, precancerous lesions.
Complications: cancer anus, penis, vulva.
Diagnosis/controls: Pap test, HPV-DNA.
Recommended screening: according to national guidelines, women >21 years old.
Treatment: lesion removal (cryotherapy, laser, surgery).
Prevention: HPV vaccine, condoms, partner reduction.
Follow-up: periodic checks.
Importance of early diagnosis: screening saves lives.
Special aspects: condom reduces but does not eliminate risk.

Notes for prevention, visible symptoms in women: genital warts on the vaginal lips, vulva, or anus, precancerous lesions on the cervix (visible only through a Pap test, and therefore not directly recognizable without a medical examination). Men may notice warts or growths on their partner; avoiding direct contact with these lesions and using condoms reduces the risk of transmission.

6 – Trichomoniasis

Trichomoniasis is a sexually transmitted infection (STI) caused by the protozoan Trichomonas vaginalis, which can affect the urethra and penis in men, causing symptoms such as burning during urination, itching, and urinary discharge, although the infection is often asymptomatic. Diagnosis is made through clinical examination and laboratory tests on urine or urethral swabs, while treatment involves specific antiparasitic medications, usually based on metronidazole or tinidazole, administered to both the patient and their sexual partner to prevent reinfection. Condom use and safe sexual practices are essential prevention tools.

Definizione: infezione da Trichomonas vaginalis.
Clinical manifestations: foul-smelling vaginal discharge, burning, itching; in men urethritis.
Complications: increased HIV risk, problems in pregnancy.
Diagnosis/controls: vaginal examination, NAAT molecular tests.
Recommended screening: symptomatic or high-risk.
Treatment: metronidazole or tinidazole, partners included.
Prevention: condom, treated partners.
Follow-up: evaluate healing.
Importance of early diagnosis: reduces transmission and complications.
Special aspects: often underestimated.

Notes for prevention, visible symptoms in women: frothy and foul-smelling vaginal discharge, vulvar redness, itching, pain during urination or sexual intercourse. Observing changes in your partner’s secretions or signs of irritation and treating both the patient and their partner helps prevent reinfection.

7 – Hepatitis B (sexual route)

Hepatitis B is a viral infection caused by the HBV virus, which primarily affects the liver and can cause acute inflammation or progress to chronic disease, with possible complications such as cirrhosis and liver cancer. Transmission occurs mainly through contact with infected blood and unprotected sexual activity. The infection can be asymptomatic or present with symptoms such as fatigue, jaundice, nausea, and abdominal pain. Diagnosis is made through blood tests that detect the presence of the virus or antibodies, while treatment for chronic cases involves antiviral medications that control viral replication. Prevention is primarily based on vaccination, condom use, and adopting safe practices to avoid exposure to infected blood.

Definition: viral infection that is also sexually transmissible.
Clinical manifestations: jaundice, nausea, fatigue; may be asymptomatic.
Complications: chronic hepatitis, cirrhosis, liver cancer.
Diagnosis/controls: HBsAg, anti-HBs, anti-HBc.
Recommended screening: infected partners, at-risk individuals.
Treatment: antivirals in chronic sufferers.
Prevention: vaccine, condom.
Follow-up: liver monitoring and viral load.
Importance of early diagnosis: reduces progression.
Special aspects: highly effective vaccination.

Notes for prevention, visible symptoms in women: symptoms similar to those in men, such as jaundice, dark urine, fatigue, nausea, abdominal pain; in chronic cases, possible liver complications. Observing any signs of jaundice or unusual fatigue and using condoms greatly reduces the risk, while vaccination remains the primary preventive measure.

8 – Hepatitis C (sexual route under specific conditions)

Hepatitis C is a viral infection caused by the HCV virus, which primarily affects the liver, causing inflammation and, in some cases, chronic damage such as fibrosis, cirrhosis, or liver cancer. Transmission occurs mainly through contact with infected blood, and less frequently through unprotected sexual activity. The infection can remain asymptomatic for years, making it difficult to detect without specific tests. Diagnosis is made through blood tests that detect the presence of the virus or antibodies, while treatment involves direct-acting antiviral medications that can completely cure the infection. Prevention is based on using sterile equipment, controlling risk factors, and, during sexual activity, using condoms.

Definizione: infezione da HCV, raramente sessuale salvo fattori favorenti.
Clinical manifestations: often silent, possible liver symptoms.
Complications: cirrhosis, liver carcinoma.
Diagnosis/controls: anti-HCV, HCV RNA.
Recommended screening: adults at risk, HIV+.
Treatment: direct-acting antivirals with high efficacy.
Prevention: condom, no fluid exchange.
Follow-up: hepatic and virological monitoring.
Importance of early diagnosis: treatment possible.
Special aspects: increased relevance in high-risk populations.

Notes for prevention, visible symptoms in women: often asymptomatic; in advanced cases, jaundice (yellowing of the skin and eyes), dark urine, fatigue, liver enlargement. Most cases are not visible; knowing the risk factors and testing a partner if exposed to infected blood is essential.

9 – HIV/AIDS

HIV (human immunodeficiency virus) is a sexually transmitted infection (STI) caused by a virus that attacks the immune system, reducing the body’s ability to defend against other infections and diseases. The infection can remain silent for years without obvious symptoms, but if untreated it can progress to AIDS, a severe condition characterized by opportunistic infections and cancers. Diagnosis is made through laboratory tests on blood or body fluids, while treatment involves antiretroviral therapy (ART), which does not eliminate the virus but controls its replication, allowing infected individuals to live long lives with good quality of life. Condom use, reducing the number of sexual partners, and regular testing are essential prevention tools.

Definizione: infezione da HIV che compromette progressivamente il sistema immunitario.
Clinical manifestations: initial flu-like symptoms, then latency and immunodeficiency.
Complications: opportunistic infections, cancers, mortality.
Diagnosis/controls: combined antibody/antigen test.
Recommended screening: all those at risk.
Treatment: antiretroviral therapy (ART).
Prevention: PrEP, PEP, condom.
Follow-up: viral load, CD4, therapeutic adherence.
Importance of early diagnosis: excellent prognosis with therapy.
Special aspects: U=U (not transmissible if viral load undetectable).

Notes for prevention, visible symptoms in women: often no symptoms in the early stages; in advanced cases, weight loss, frequent skin or mucous infections, oral or vaginal lesions from opportunistic infections. Since early symptoms are not evident, regular testing and condom use remain the main prevention tools.

10 – Candida

Genital candidiasis is an infection caused by the fungus Candida albicans, which can affect the penis and surrounding area, causing itching, redness, burning during urination, and white discharge. The infection can occur following alterations of the bacterial flora, antibiotic use, diabetes, or a weakened immune system. Diagnosis is made through clinical examination and, if necessary, laboratory tests on secretion samples, while treatment involves local or systemic antifungal medications to eliminate the fungus. Personal hygiene, wearing breathable underwear, and managing any predisposing conditions are essential to prevent recurrences.

Definizione: infezione micotica causata da Candida albicans, che può colpire genitali, bocca o pelle.
Clinical manifestations: itching, burning, redness, white “cottage cheese–like” discharge in women; redness and burning in men; white patches in the mouth (thrush); skin lesions in moist areas.
Complicanze: rare se non immunodepressi; recidive frequenti, discomfort locale.
Diagnosis/controls: clinical examination, swab or culture.
Recommended screening: only when there are frequent symptoms or recurrences.
Treatment: topical or systemic antifungals (fluconazole).
Prevention: maintain balanced hygiene, cotton underwear, avoid prolonged humidity.
Follow-up: assess healing, manage recurrences.
Importance of early diagnosis: reduces symptoms and recurrence.
Special aspects: not always sexually transmitted, but intercourse with colonized partners can promote reinfection.

Notes for prevention, visible symptoms in women: intense vulvar itching, redness, burning during urination, thick white discharge, pain during sexual intercourse. Observing itching, redness, or unusual discharge in your partner and avoiding sexual activity until full recovery helps prevent transmission.

Test MST e Considerazioni generali

No test covers everything: you need specific tests for each pathogen and anatomical site.
Personal risk assessment: type of relationships, multiple partners, previous STI.
Regular screening: annually/every 3 to 6 months for casual and frequent sex worker relationships/at least every 3 months if high risk.
Comprehensive examinations: HIV, syphilis, Chlamydia, Gonorrhea are the basis.
Negativity ≠ immunity: consider the constant risk of reinfection; being negative once does not mean being negative forever.
Extra-genital sites: oral and rectal swabs according to one’s habits about oral or anal sex.
Partner management: assessing sexual habits and prevention aptitude of the person with whom they have sex.
Counseling: communication with partner and requesting precautions in “risky” relationships.
Vaccinations: Essential HPV and HBV.
Stigma reduction: always remember that prevention is health, not shame.

Guidelines for periodic checks (screening)

Sexually active people in stable relationships

• Frequency: Once a year

• Recommended Controls: HIV, Syphilis, Chlamydia/Gonorrhea (urine or swab)

• Additional Notes/Prevention: Very low risk if there are no changes of unknown partners.

People with multiple casual partners

• Frequency: Every 3 months

• Recommended controls: HIV, Syphilis, Chlamydia/Gonorrhea (urine), Chlamydia/Gonorrhea (rectum/oro-pharynx if anal/oral sex), Trichomoniasis if symptoms

• Additional Notes / Prevention: Regular screening essential

Sex Worker regulars

• Frequency: Every 3 months

• Recommended controls: HIV, Syphilis, Chlamydia/Gonorrhea (urine), Chlamydia/Gonorrhea (rectum/oro-pharynx if anal/oral sex), Trichomoniasis if symptoms

• Additional Notes/Prevention: Liver function check every 6-12 months; PrEP recommended

Active or passive anal relationships

• Frequency: Every 3-6 months

• Recommended checks: HIV, Syphilis, Chlamydia/Gonorrhea (also rectal/oral)

• Additional Notes/Prevention: If HIV positive, add hepatitis screening.

People with previous STD

• Frequency: Every 3 months

• Recommended checks: HIV, Syphilis, Chlamydia retesting at 3 months post-cure

• Additional Notes/Prevention: High probability of reinfection, continuous monitoring

People with symptoms

• Frequency: Immediate

• Recommended Controls: Lesion swab, Urogenital swab, Throat/rectum swab, Serological tests

• Additional Notes/Prevention: Don’t wait for symptoms to go away on their own.

Precautions for unprotected intercourse

• Frequency: Before contact

• Recommended Controls: HIV, Syphilis, Chlamydia/Gonorrhea, Hepatitis B/C

• Additional Notes/Prevention: Both partners must be tested.

Vaccinations

• Frequency: Once / according to guidelines

• Recommended checkups: HPV (up to age 45), Hepatitis B

• Additional notes / Prevention: Vaccines dramatically reduce risk of STDs

General tips to reduce risk

• Frequency: Continuous

• Recommended controls: Condom use, avoid intercourse with injuries or irritated genitalia, limit partners at the same time, open communication with partners, PrEP, PEP within 72h

• Additional Notes / Prevention: Daily preventive measures.