Anal Sex and STIs
Anal sex may have once been thought of more taboo than other sexual behaviors, but today we know it’s a perfectly normal way to find sexual pleasure. We also know that a lot of couples are doing it. A 2024 survey from BedBible.com found that 40% of Americans had tried oral sex. This included 69% of women, 32% of heterosexual men, and 85% of gay men. Other forms of butt play—including using fingers, sex toys, and tongues on a partner’s anus—are also very popular.
Like other sexual behaviors, however, anal sex can expose you to sexually transmitted infections (STIs). Anyone who has—or is thinking about—engaging in anal sex should plan ways to keep themselves and their partner(s) safe.
What is anal sex?
Anal sex usually refers to one partner putting their penis into another partner’s anus. Anilingus (often referred to as rimming) is when someone uses their mouth or tongue on their partner’s anus. People can also use their fingers or a sex toy on/in their own or their partner’s anus.
Can you get an STI through anal sex?
Yes. Pretty much any STI that can infect your genitals can also infect your anus. Some of the STIs that are more common from anal sex include chlamydia, gonorrhea, herpes, HPV, and HIV. The risk of getting an STI is higher for the receptive partner (sometimes called the bottom).
It is possible to get an anal infection (also called a rectal infection) with many of these STIs without ever having had anal sex. The penis and the vagina are close to the anus, bacteria and viruses can sometimes travel from one place to the other through fluids like vagina secretions. You can also spread them through actions like wiping in the wrong direction after you use the bathroom or not washing your hands after touching a partner’s genitals. Sex toys that aren’t properly washed between uses can also transmit STIs to the anus.
What are the symptoms of anal STIs?
The symptoms of anal STIs vary. Possible symptoms included rectal itching, pain, or bleeding. Some STIs may also cause discharge from the anus or pain when you poop. Others may cause small sores or warts to appear in or around your anus. (See symptoms for specific STIs below.)
It is important to remember that anal infections often don’t have any symptoms.
How are anal STIs diagnosed?
Some anal STIs can be diagnosed with a visual exam. A provider might see warts or sore just by looking. Some are diagnosed using a swab or brush to collect cells from the rectum. Others can be diagnosed using a blood or stool sample. Providers may also want to do a digital rectal exam in which they insert a gloved finger into your rectum to check for sores or masses. (See below for more specific information about each STI).
Can anal STIs be treated?
All anal STIs can be treated. Antibiotics can cure rectal infection with bacteria like chlamydia and gonorrhea. Other STIs can’t be cured but can be treated with medications or topical creams to keep the infection from getting worse and manage the symptoms. Anal HPV infection may require in-office procedures to remove warts or masses. (See below for more specific information about each STI).
STIs That Can Be Passed During Anal Sex
Both men and women can get chlamydia in their rectum (the area right inside the anus). Symptoms of rectal chlamydia include rectal pain, discharge from the anus, and bleeding.
Testing: A provider can check for chlamydia by swabbing your anus. There are also at-home test kits you can get that allow you to swab your own anus and send the sample to a lab for results.
Treatment: Chlamydia can be treated with antibiotics. It is important that all partners are treated so you don’t keep giving the infection back and forth to each other.
Both men and women can get gonorrhea in their rectum. Symptoms of rectal gonorrhea including itching in or around your anus, discharge from your rectum, and pain when you poop.
Testing: A provider can check for gonorrhea by swabbing your anus. There are also at-home test kits you can get that allow you to swab your own anus and send the sample to a lab for results.
Treatment: Gonorrhea can be treated with antibiotics. It is important that all partners are treated so you don’t keep giving the infection back and forth to each other.
The primary symptom of herpes (if there are symptoms) are small, blister-like sores that often appear in a cluster. Both men and women can get herpes sores on their anus or in their rectum. Rectal herpes can sometimes lead to proctitis, which is an inflammation of the rectum. Herpes sores sometimes appear on the lower back or butt cheeks.
Testing: A herpes diagnosis is usually based on a visual examination of the sores. The most reliable test for herpes involves your provider taking swab the sores to figure out which type of the herpes simplex virus you have (HSV-1 or HSV-2). Blood tests for herpes are not considered reliable.
Treatment: Herpes can’t be cured, but there are medications that can reduce the frequency of outbreaks and lessen the symptoms.
Most anal HPV infections have no symptoms. Many people will never know they had HPV because their body clears the infection on its own. Some people, however, will get anal warts and others may get anal cancer.
Some types of HPV can cause warts on the genitals or anus. Both men and women can get anal warts. The warts are small soft bumps. Warts are most often painless, but they can cause itching, bleeding, or discharge from the anus. Some people who have internal anal warts may feel like there’s something stuck in their rectum or anus.
Other types of HPV can cause anal cancer. Symptoms of anal cancer include bleeding from the anus or rectum, blood in feces (poop), pain in the anus, a mass or growth in the anal canal, anal itching, and having to go to the bathroom (poop) more often.
Testing: Providers can diagnose HPV by doing a visual examination of the warts or using an anal Pap test or anal HPV test. If the warts are internal, the provider may want to use a small instrument to look inside your rectum. They might also want to take a biopsy (a sample of the wart or infected skin that is looked at in a lab).
Anal sex can spread HIV because the virus is transmitted through blood, semen, and vaginal fluid. If transmitted, the virus infects the whole body. There are no specific anal symptoms.
Testing: You can test for HIV using a sample of blood or saliva. There are many places that offer free HIV testing and many options for at-home tests. There is also a self-test that will give you results in 20 minutes.
Treatment: It is important that people diagnosed with HIV see a provider right away to discuss treatment options. With anti-retroviral therapy (ART), many people living with HIV have no detectable virus in their bodies. When the virus is undetectable, you can’t transmit it to a partner.
This infection, caused by the Shigella bacteria, is not solely sexually transmitted. It is passed through feces (poop) and can be transmitted in many non-sexual ways including contaminated food, drinking water, swimming pools, and even a handshake with someone who didn’t wash their hands thoroughly.
Many cases, however, are linked to sexual activities in which someone’s mouth comes in contact with an anus, hand, penis, or sex toy that has not been fully cleaned (even microscopic amounts of infected poop can make someone sick). In recent years there have been a number of shigellosis outbreaks among men who have sex with men.
The primary symptom of this infection is watery diarrhea. Many people mistake it for a stomach bug.
Testing: Shigellosis is diagnosed using a stool (poop) sample.
Treatment: Most people don’t need treatment other than rest and lots of fluid. Severe cases may require an antibiotic.
Should I get screened/tested for anal STIs?
Anyone who has any rectal symptoms should see a health care provider. Be honest with the about your experience with anal sex (how many partners, when was the last time, etc.) so your provider can decide if you should be tested.
The Centers for Disease Control and Prevention (CDC) recommends that men who have sex with men get tested for rectal chlamydia and gonorrhea at least every year if not more often. It does not recommend regular anal testing for women or men who have sex with women. The agency also says there is not enough evidence to support the value of regular anal pap tests or HPV tests.
Still, if you’re having anal sex—especially condomless anal sex—it is a good idea to talk to your health care provider about anal testing. If you’re honest about your sexual history, the provider can help you determine what screening tests might work and how often.
People should also get tested as soon as possible if they have any rectal symptoms.
How can I prevent anal STIs?
If you’re engaging in anal sex, there are ways to be safer. Some of these include:
- Using condoms every time you have sex
- Using a dental dam any time you perform rimming
- Wash your hands frequently and wash all sex toys you use.
- Talking with your partner(s) about safer sex precautions, including condoms and STI testing
- Considering doxy PEP if you’re eligible
- Getting tested regularly for STIs (of the penis or vagina), and making sure your partner(s) are screened if needed
- Talking to your provider about what tests they would recommend.
With anal sex, it is also very important to use a lot of lube. Unlike the vagina, the anus does not produce and lubrication of its own. If you don’t add extra lube, anal sex can be uncomfortable and cause small tears or cuts in and around the anus. These tears can make it easier to get an STI.