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Sex positivity is in, sex shaming is out. More people are comfortable talking about what it means to have a healthy sexual relationship, and that’s a good thing.
But there’s one thing that many of us still feel awkward or downright avoid talking about: sexually transmitted infections (STIs).
You may know them as sexually transmitted diseases, or STDs, but the less-stigmatizing term that’s used more often now is STI.
Unfortunately, the risk is very real whether you talk about STIs or not. Consider this the STI 101 class you probably never got in high school.
STI rates are slowly declining — except for one
After increasing at somewhat alarming rates in the late 2010s, STIs are finally decreasing nationally and in Washington state. In 2019 in Washington, there were 37,641 cases of chlamydia and 11,848 cases of gonorrhea, the two most common STIs. By 2024, those numbers dropped to 26,183 and 9,470, respectively.
The latest numbers are still significant. Plus, the rate of one STI is still increasing, at least here in Washington: syphilis.
In 2019, there were 830 cases of primary and secondary syphilis, meaning the disease was still in its earlier, contagious stages. That number peaked in 2022 and declined slightly in 2024 to 1,083 cases. Meanwhile, nationally, syphilis is decreasing, like other STIs, so the difference in Washington is notable.
Syphilis can be spread from mother to baby
One type of syphilis that is increasing nationally, however, is congenital syphilis, which happens when a pregnant person with syphilis gives birth before receiving complete treatment, and the baby contracts syphilis during pregnancy or delivery. Throughout the U.S., there were 4,000 cases of congenital syphilis noted in 2024.
Since untreated syphilis can cause serious harm like brain and nerve damage, heart disease, seizures, and even blindness once it reaches later stages, public health officials are recommending that people, including pregnant people, start getting tested for syphilis more often and at younger ages if they’re sexually active and not reliably using protection.
“This is a completely preventable and curable infection, but it remains a substantial public health challenge,” says Chase Cannon, MD, MPH, medical director for the Sexual Health Clinic at Harborview Medical Center. “Our local and state public health authorities are committed to combating congenital syphilis.”
These efforts have included a recommendation implemented in 2022 that all women 45 and under be tested for syphilis; enhanced testing in jails and emergency rooms; and an improved turnaround time for testing in birthing hospitals.
The increase in syphilis is due to what public health officials call a syndemic, he says, which is the convergence of several social and health factors — in this case, systemic racism, living unhoused, using drugs or having substance use disorder, having a history of incarceration and having fewer socioeconomic opportunities.
“All of these things make people less likely or willing to access healthcare in a timely manner to be tested, receive a syphilis diagnosis, and be treated and cured before giving birth,” Cannon says.
Getting tested is one of the most important ways to prevent the spread of syphilis and other STIs. If you live in King County, there are many STI testing clinics to choose from, some of which offer free testing and resources to help if you test positive.
STIs often have no symptoms
You may think all STIs cause symptoms — things like a burning feeling while you pee, smelly discharge or pain in the affected area — but that’s simply not true.
“The majority of STIs (upward of 50-70%) do not cause symptoms and are only diagnosed with routine screening,” Cannon says. “This is the case for common STIs like gonorrhea, chlamydia, syphilis and HPV.”
Though anyone can be infected without having symptoms, cisgender women and people with vaginas are particularly at risk. This is a problem for two major reasons.
First, if someone doesn’t know they have an STI, they probably won’t get tested and treated — and untreated STIs can cause serious health problems.
Second, if someone doesn’t know they’re infected, they may pass on the infection to their next partner if they aren’t using protection during sex.
Throat STIs are a thing
STIs don’t just infect someone’s genitals; they can also infect someone’s throat. (Joy.) In this case, too, the person probably won’t have symptoms and thus won’t know they have an infection.
It’s become a big enough concern that there are extragenital tests (aka throat tests) for chlamydia and gonorrhea.
“Gonorrhea is the primary STI that we believe causes a true infection of the throat,” Cannon says. “Almost all of the gonorrhea infections we identify in the throat do not cause symptoms and are best treated with an injectable antibiotic that is given in a medical clinic.”
Those aren’t the only STIs that can spread through oral sex, though. Herpes, HPV and syphilis can all spread this way. (STIs can also spread through anal sex.)
The best way to protect against throat STIs is to use condoms or dental dams when you give or receive oral sex.
STI screening doesn’t test for everything
Say you go to your doctor’s office and ask to be screened for STIs. That means you’ll get tested for every STI under the sun, right?
Actually, no.
Different screenings involve different procedures. Screening for chlamydia and gonorrhea requires either a urine sample or a genital swab. For herpes, which is notoriously difficult to diagnose, doctors may get a tissue sample or do a blood test, but the test may not be accurate. A blood test is the best way to detect HIV or syphilis, however.
If you have a vagina, you can be tested for HPV via a Pap smear — or ask your doctor for an at-home HPV test. Testing is also available for people with penises, but it isn’t federally approved yet, so if you have a penis and are concerned about HPV, you need to bring that up.
Typically, doctors will screen you for what you’re most at risk for, depending on your sexual history: who you’ve had sex with recently and how you’ve had sex.
If you’re worried about a specific STI and want to be tested for it, you need to say so.
Some STIs are becoming antibiotic-resistant
Around the world, STIs are developing resistance to the antibiotics used to treat them. Though this isn’t yet a huge threat in the United States, researchers are worried it soon could be.
Though some common STIs, like chlamydia and syphilis, have shown occasional antibiotic resistance, currently, the biggest threat is antibiotic-resistant gonorrhea.
Gonorrhea bacteria have fairly quickly developed resistance to nearly every antibiotic used to kill them. There are still two antibiotics that can successfully treat this highly resistant type of gonorrhea, though. (Thankfully.)
Researchers are also trying to learn more about an STI called Mycoplasma genitalium (aka Mgen), which has been shown to easily acquire resistance to antibiotics — and is harder to treat. Mgen is becoming more common and is often associated with pelvic inflammatory disease, though there is still a lot scientists don’t know about it.
“As the population uses more antibiotics for various conditions, we have seen resistance increase over time in these two STIs,” Cannon says. “For gonorrhea, there are two new medications to treat it, but we need to be careful about how they are used to ensure they remain effective when we need them. For Mgen, researchers are looking into new possible combinations of older antibiotics, but unfortunately, there are currently few treatment options in the United States.”
Testing recommendations vary — a lot
Specific STI screening recommendations often depend on someone’s particular sexual behaviors and risk factors. There’s no one-size-fits-all approach.
For example, women who have sex with women are generally thought to have a lower STI risk overall, but could face unique issues, like a lessened but largely unrecognized HPV risk. (And since cancer from HPV is largely preventable, getting screened and getting the HPV vaccine, if you haven’t already, is a great way to protect yourself.)
Alternately, men who have sex with men, transgender and nonbinary people who have sex with men, and people who have penetrative anal sex are at increased risk for HIV and are encouraged to get tested at least annually and consider if HIV pre-exposure prophylaxis (PrEP) is right for them.
The best way to prevent STIs is a two-step process: practice safe sex by using condoms and dental dams, then get tested regularly so you can address any issues before you pass them along to someone else unknowingly.
So, what exactly does “regular” screening mean? If you’re sexually active but have a new sex partner or aren’t in a monogamous relationship, getting tested at least once a year is a good place to start. If you have multiple partners, getting tested more frequently might make sense.
If you want specific testing recommendations based on your unique risk factors, ask your doctor for advice. And yes, maybe it’s a little awkward to talk about, but better to feel a little awkward than have an untreated STI.
This article was originally published on February 17, 2020. It has been reviewed and updated with new info.
