At risk of HIV? Get tested now

If you're worried you could have HIV, get tested now. The sooner you're diagnosed, the quicker you can access treatment, so you can lead a full and healthy life. Find out why and how to get an HIV test.

Getting tested for HIV means that, if you do have HIV, you can start your treatment before the infection damages your body and health. This is known as an early diagnosis.

Why you should get tested for HIV early

It's important to get tested for HIV early because, although you might look and feel healthy, the infection will be damaging your health. Left undiagnosed, you will also be at risk of passing HIV on to others.

Mandy Tyson, executive director for services, clinical and new business at HIV charity the Terrence Higgins Trust (THT), says: "If the infection is diagnosed early, when a person is fit and well, and they get treatment and care, we're looking at normal life expectancy. But they've got to be getting treatment and care, and it's got to start early."

It's estimated that 103,700 people in the UK have HIV. Around 17% of these – 18,100 in total – don't know they have it and are at risk of passing the virus on to others. They're also unable to benefit from effective treatments.

HIV is passed on through bodily fluids (such as blood, semen or vaginal fluid) through, for example, sex without a condom or through sharing needles to inject drugs.

Read about the causes of HIV.

Where to get an HIV test

The only way to know whether you have HIV is to have an HIV test. You shouldn't feel worried about getting tested, because if you do have HIV, the sooner you find out, the better.

You can get tested by going to:

• sexual health clinics or genitourinary medicine (GUM) clinics at hospitals or in the community – find sexual health services near you
• your GP surgery – ask your doctor or practice nurse whether your surgery offers HIV testing
• some contraception and young people's clinics
• Rapid testing clinics run by the THT
• a private clinic
• an antenatal clinic – if you're pregnant
• local drugs agencies – if you're an injecting drug user

People at increased risk of HIV, including men who have sex with men and black African communities, can also get a free HIV self-sampling test, which can be done at home.

It's up to you where you feel most comfortable being tested.

Why early diagnosis and treatment of HIV matters

Once HIV is in a person's body, the virus infects and destroys cells called CD4 cells in the blood. CD4 cells are responsible for fighting infection and are vital to your immune system.

A healthy adult who doesn't have HIV will normally have a CD4 count of 600 to 1,200.

If you have HIV, doctors will regularly test your blood to see how your immune system is doing. The tests measure the number of CD4 cells in your blood (your CD4 count) and the amount of HIV in your blood (the viral load).

Your doctor will know when it's best for you to start HIV treatment, which is usually given as a combination of tablets. Starting treatment can raise your CD4 count and lower your viral load.

"The latest research shows the benefits of starting treatment as soon as possible," says Tyson. "When the CD4 gets down to 200, opportunistic infections can start, such as tuberculosis, oral thrush, Kaposi's sarcoma and pneumonia.

"Starting treatment early means that HIV won't continue to damage the immune system, and people won't be at risk of these opportunistic infections."

Why late HIV diagnosis is serious

If HIV isn't treated, it will eventually damage your immune system so much that you're likely to develop a serious, life-threatening condition, such as pneumonia. It typically takes about 5 to 10 years for the virus to damage the immune system in this way.

If you're diagnosed with HIV at this stage – known as late diagnosis – antiretroviral drug treatment will work. However, the overall outlook for your health may be affected. In 2013, 42% of adults diagnosed with HIV in the UK were diagnosed late.

"The vast majority of people who die from HIV are those who are diagnosed late," says Tyson. "When people aren't diagnosed with HIV until they present late, at A&E or their GP with symptoms of a serious infection, it can affect their prognosis."

Preventing HIV

You can protect yourself against HIV by using a condom every time you have vaginal, anal or oral sex. This will also help to prevent you passing on the infection, if you have it.

If you're living with HIV, being on successful treatment and having an undetectable viral load will also make it unlikely that you will pass on the virus to any sexual partners. However, it is still important to practise safe sex.

If you're worried you have been exposed to HIV, there is a course of treatment called post-exposure prophylaxis (PEP). This can help to prevent an HIV infection developing after the virus has entered the body, if you take it soon enough.

You need to take PEP as soon as possible after the exposure risk – ideally within 24 hours, but no later than 72 hours. You can get PEP from any A&E department or sexual health or GUM clinics.

Find out more about:

• coping with a HIV-positive diagnosis
• living with HIV
• HIV symptoms
• HIV testing
• HIV treatment

Can oral sex give you cancer?

Some types of oral cancer are linked to human papilloma virus (HPV) infection in the mouth and throat. Find out the possible risks of this infection from oral sex, and how to protect yourself.

In England, around 5,400 people were diagnosed with oral cancer in 2011.

Oral cancers are sometimes called head and neck cancers, and include cancers of the mouth, lip and tongue, as well as cancers of the tonsils, oesophagus, larynx (voice box), nasopharynx (the area that connects the nose and throat) and the thyroid gland.

What causes oral cancer?

Experts have known for years that the main risk factors for oral cancer are drinking alcohol and smoking or chewing tobacco. But there is growing evidence that infection in the mouth with HPV is a major cause of oral cancer.

Around 25% of mouth and 35% of throat cancers are HPV-related, but the exact figures vary between different studies, possibly due to different ways of testing for the virus, or varying levels of smoking and other risk factors.

Detecting the HPV virus in a sample of people who have oral cancer does not mean that HPV caused the cancer. The virus becomes part of the genetic material of the cancer cells, triggering them to grow.

How do you get HPV in the mouth?

There are more than 100 types of HPV, and around 15 are associated with cancers. These 15 are known as high-risk HPV types.

The types of HPV found in the mouth are almost entirely sexually transmitted, so it's likely that oral sex is the primary route of getting them. The high-risk HPV types are also passed on through vaginal and anal sex, and are linked to:

• cervical cancer
• vulval and vaginal cancer
• anal cancer
• penile cancer
• laryngeal cancer
• tonsil cancer

Some can be passed on through skin-to-skin contact and cause warts, including genital warts. The types of HPV that cause visible warts are low-risk and are not the same types that cause cancer.

Most sexually active people (about 90%) will have been exposed to either high- or low-risk genital HPV types by the age of 25, but only 2-3% of these people develop visible genital warts. So most of us have been infected, but few are affected.

It's not known how common HPV infection in the mouth is. A study carried out in 2009-10 concluded that the prevalence of oral HPV infection in American men was 10%, and in women 3.6%. Risk factors for oral HPV identified by this study included:

• age: prevalence peaked in the 30-34 and 60-64 age groups
• number of sexual partners: 20% of people with more than 20 partners had an oral HPV infection
• current number of cigarettes smoked per day

There is good evidence suggesting that, for some oral cancers, risk factors may be linked to sexual behaviour. These risk factors include:

• ever having oral sex
• having oral sex with four or more people in your lifetime
• among men, first having sex at an earlier age (under 18)

Currently, there is very little research that has looked at the possible risks from giving oral sex to a man compared to giving oral sex to a woman. But we do know that HPV-related oropharyngeal cancer is twice as common in men than women, and is most common in heterosexual men in their 40s and 50s (compared to the rates in homosexual men).

This indicates that performing cunnilingus (oral sex on a woman) is more risky that performing fellatio (oral sex on a man). This seems counterintuitive, but the concentration of HPV in the thinner, moist skin of the vulva is much higher than the amounts of virus shed from the thicker, dry skin of the penis, and this affects how easy it is to pass the virus on. Other research indicates that HPV can be present in semen and passed on at ejaculation.

What is definitely known is that other infections are spread via oral sex, including herpes, chlamydia, syphilis and gonorrhoea, so it makes sense to protect yourself and your sexual partner by practising safer oral sex.

How does HPV cause cancer?

HPV does not directly give you cancer, but it causes changes in the cells it has infected (for example, in the throat or cervix), and these cells can then become cancerous.

Very few people infected with HPV will develop cancer. In 90% of cases, the infection is cleared naturally by the body within two years.

However, people who smoke are much less likely to clear the virus from their body. This is because smoking damages special protective cells in the skin called immune surveillance cells, allowing the virus to persist. Cervical and vulval cancer is rare in women who don't smoke, unless they have some other cause of immunosuppression (a weakened immune system).

If cell changes do happen, it can take a long time – even decades. HPV-related oral cancers seem to respond better to treatment than non-HPV-related oral cancers.

Could an HPV vaccine help men as well as women?

Yes. In the UK, girls aged 12 and 13 are routinely given the HPV vaccine. This is because it is known that nearly all cervical cancers are HPV-related and that the vaccine offers protection in women. The vaccine also protects women from HPV-related vulval and vaginal cancers.

In addition, it will probably protect them from anal and oral cancer. There is currently no conclusive proof that the vaccine will protect against oral cancer, but it's thought likely, because HPV causes mouth, throat and anal cancer in the same way that it causes cervical cancer.

In time, as the HPV vaccine reduces the number of cases of HPV infection in women, HPV will become less common in the general population – therefore, it will affect fewer men as well as fewer women. This has already happend in Australia, where cases of genital warts have fallen dramatically in women and heterosexual men under 21 within four years of the start of the vaccination campaign.

However, a vaccination given only to girls and women will not benefit men who have sex with men.

Boys and men are not routinely given the HPV vaccine in the UK. This is because they do not need to be protected against cervical cancer. Emerging evidence on the impact of HPV vaccination on other cancers is being reviewed by the Joint Committee on Vaccination and Immunisation.

Men who have sex with men may have an increased risk of anal cancer, linked to HPV infection, and made worse by co-infection with HIV. There is evidence that the HPV vaccination may protect against HPV-related anal cancer, and recurrence of anal pre-cancer after treatment.

If you are worried

If you're worried about oral cancer, see your GP. When mouth cancer is established, it has fairly clear symptoms, and your GP should be able to see them by looking in your mouth. If oral cancer is diagnosed early, it is easier to treat, but about half of these cancers are diagnosed when the disease has already spread within the neck.

The symptoms of oral cancer include:

• red – or red and white – patches on your tongue or the lining of your mouth
• one or more mouth ulcers that do not heal after three weeks
• a swelling in your mouth that lasts for more than three weeks
• pain when swallowing
• a feeling as though something is stuck in your throat

Read about the symptoms of oral cancer.

Safer oral sex

According to the third National Survey of Sexual Attitudes and Lifestyles, carried out in 2010-12, just over 75% of men and women aged 16-44 had heterosexual oral sex in the previous year.

You can make oral sex safer by using a condom on a man’s penis, because it acts as a barrier between the mouth and the penis. A dam (a square of very thin, soft plastic) across a woman’s genitals can protect against infection.

Find out more about STIs and safer sex.

Coping with a positive HIV test

Hearing that you have HIV can be shocking, but people with HIV can live a long and healthy life. Find out how to cope with a positive test result and where to go for support.

Read the information below or go straight to the advice on:

• your emotions
• getting the test result
• getting up-to-date information
• learning to cope
• telling people you're HIV positive
• if you're feeling depressed
• diagnosis during pregnancy

HIV is a manageable long-term condition but being tested early is essential to getting appropriate healthcare and treatment.

Your emotions

You may feel a range of emotions when you get your test results. This could include shock, numbness, denial, anger, sadness and frustration. It's perfectly normal and understandable to feel any of these. Some people might also feel relief that they finally know the truth.

You may also feel isolated and alone, even if you have family and friends around you. Whatever you feel, you don't have to go through it alone, and there are ways you can help yourself cope better.

Getting the test result

You will usually be told your results in person. The doctor, nurse or health adviser will do another HIV test to confirm the result, assess your current health and refer you to specialist HIV services.

They will also talk to you about how you feel and help you think about where you can get support.

The doctor, nurse or health adviser will also talk about safer sex and the importance of using a condom for vaginal, anal and oral sex to avoid passing the virus on to a sexual partner.

Find out more about preventing transmission of HIV.

'False positive' HIV test results

HIV tests have been developed to be especially sensitive and sometimes an HIV test will give a positive result even when there are no HIV antibodies in the blood. This is known as a "false positive".

Because of this, all positive results must be confirmed by another test method.

Getting up-to-date information

It's not unusual to feel shocked and unable to take everything in.

Don't feel you have to remember everything straight away. You should be given written information, and you can always ask questions of your medical team, a helpline or one of the sources of support listed on this page.

Find out as much as you can about HIV, and its treatments and their side effects. It will help you understand the information you are told about your condition, and help you ask the right questions of the team who provide your care.

Don't rely on information you've heard in the past. Up-to-date, accurate information is available from national services such as:

• Terrence Higgins Trust
• your local HIV services
• HIV information from NHS Choices
• NAM Aidsmap

Learning to cope

Accepting that you're HIV positive can be the first step in getting on with your life. "Be honest with yourself," advises Angela Reynolds from the Terrence Higgins Trust (THT). "You will have this for the rest of your life. But remember that although HIV is not curable, it is treatable."

HIV treatments have improved, and this means that HIV is now a manageable long-term condition.

You might imagine that you'll be ill all the time and will have to stop work, but this isn't necessarily the case. "Most people carry on working and don't have to give up sex and relationships forever," says Reynolds.

"After the first shock of diagnosis, most people cope over time. There's a lot of support to help you."

Try not to keep your feelings to yourself. If you don't feel you can talk to friends or family, try talking to your doctor, nurse or a counsellor, or call a helpline such as:

• THT: 0808 802 1221
• The Sexual Healthline: 0300 123 7123

Websites such as NAM and healthtalk can guide you through the first few weeks and months after your diagnosis. They can also give you an insight into how other people have coped with an HIV diagnosis and how it has affected their lives.

You can find HIV support services near you.

Your strengths

Reynolds suggests learning from a time in the past when you dealt with a difficult situation. "Everyone has different ways of coping," she says.

"If you look back at how you have coped in the past, you might be able to identify what helped you cope before. This can give you confidence that you'll be able to cope with this new situation.

"If you feel you could have coped better, think what you could do differently now. For example, if you didn't talk to anyone the last time you had a problem in your life, you could talk to a health adviser this time. Work out in advance what your coping strategy will be."

Telling people you are HIV positive

Talking about what you're going through can help, but think carefully about who you tell about your diagnosis.

Work out why you want to tell them and think of the potential consequences, for example if they tell someone else. If you decide to tell them, work out how you will answer any questions they might ask, such as 'How did you get it?'"

Find out more about telling people you're HIV positive in the living with HIV section. If your family or partner would like support to help them cope with your diagnosis, they can also contact HIV organisations.

You might also want to meet other people with HIV. Finding out how other people have coped with a positive diagnosis, and hearing about their experiences of living with HIV, can be helpful for some people.

There are support groups for people who have recently found out they're HIV positive. Your HIV clinic, GP or a helpline can let you know what's available in your area.

There are also support groups for specific people, such as young people, women, gay people, people from Africa and people who are HIV negative and have a partner who is HIV positive.

The website healthtalk has videos and articles about people's experiences of living with HIV, including getting an HIV diagnosis.

If you're feeling depressed

It's normal to feel as though you're not coping at times, to stop enjoying being with friends and family, or to feel sad or have trouble sleeping.

However, if these feelings last a long time or you continue to feel overwhelmed by them, you may have depression. Get help as soon as possible as you may need treatment.

Your HIV clinic, local mental health services or GP can all help you.

Diagnosis during pregnancy

Pregnant women in the UK are offered an HIV test as part of routine antenatal care. Finding out you're HIV positive when you're pregnant can be very difficult for you and your partner.

Your midwife and HIV services will support you and help reduce the risk to your baby. It's possible to give birth to a healthy baby who is HIV negative. Find out more about HIV, pregnancy and women's health on the i-Base website.

For more information, go to:

• NAM: healthy living with HIV
• NAM: having a relationship with an HIV-negative partner
• NAM: just found out you're HIV positive

You can also find HIV information in lots of different languages at NAM: translations.

STI symptoms that need checking

Many people with sexually transmitted infections (STIs) don't get symptoms, so it's worth getting tested even if you feel fine. If you think you have an STI, the earlier you're tested, the sooner treatment can be given if it's needed.

Watch a video on genital herpes

An STI can be passed from one person to another through sexual contact, including vaginal, anal and oral sex. You can get or pass on an STI whoever you're having sex with.

STIs can pass between men and women, and from women to women and men to men. For more specific sexual health advice, read women who have sex with women and sexual health for men who have sex with men.

Many STIs can be cured with antibiotics. Some, such as HIV, have no cure, but can be treated to prevent them getting worse.

You can't tell by looking at someone (including yourself) whether they've got an infection, so it's important to get a check-up if you've had unprotected sex or think you might be at risk.

Symptoms

Many people don't notice symptoms when they have an STI, including most women with chlamydia. If it's left untreated, chlamydia can affect your ability to get pregnant.

Gonorrhoea can also affect fertility. Around 50% of women and 10% of men with gonorrhoea don't have symptoms.

Left untreated, STIs can affect your health. If you have any of the symptoms listed below, get tested.

In women and men:

• pain when you pass urine (pee)
• itching, burning or tingling around the genitals
• blisters, sores, spots or lumps around the genitals or anus
• black powder or tiny white dots in your underwear – this could be droppings or eggs from pubic lice

In women:

• yellow or green vaginal discharge
• discharge that smells
• bleeding between periods or after sex
• pain during sex
• lower abdominal pain

In men:

• discharge from the penis
• irritation of the urethra (the tube urine comes out of)

These symptoms don't necessarily mean you have an STI, but it's worth seeing a doctor so you can find out what's causing the symptoms and get treatment.

For example, it's possible to get thrush without having sex, but it can cause STI-like symptoms, such as soreness, itching and discharge. Thrush is easily treated – find out more about treatment for thrush.

Where can I get tested for STIs?

You can get tested at:

• a sexual health clinic or genitourinary medicine (GUM) clinic – find STI services near you
• some community contraceptive clinics – find contraceptive services near you
• some sexual health services – call the national sexual health line on 0300 123 7123 or Worth Talking About (for under-18s) on 0300 123 2930
• some GP surgeries

Some pharmacies can also test for chlamydia.

Find out where you can get a free chlamydia test through the National Chlamydia Screening Programme (under-25s only).

Have safer sex

Always use condoms to help protect yourself from catching or passing on an STI. Buy condoms that have the CE mark or BSI kite mark on the packet.

This means they've been tested to high safety standards. Condoms that don't have the CE mark or BSI kite mark won't meet these standards, so don't use them.

Find out what happens when you visit a sexual health clinic.

Visiting an STI clinic

Getting tested and treated for sexually transmitted infections (STIs) is straightforward and confidential. Most infections can be cured.

A sexual health or genitourinary medicine (GUM) clinic specialises in sexual health, and can provide tests and treatment for many STIs.

Visiting an STI clinic

You can make an appointment to go to an STI clinic, or sometimes there's a drop-in clinic, which means you can just turn up without the need for an appointment.

You might feel embarrassed, but there's no need – the staff at these clinics are used to testing for all kinds of infections. It's their job and they won't judge you. They should do their best to explain everything to you and make you feel at ease.

You can go to a sexual health clinic whether you're male or female, whatever your age, regardless of whether or not you have STI symptoms. If you're under 16, the service is still confidential and the clinic won't tell your parents.

If they suspect you or another young person is at risk of harm, they might need to tell other healthcare services, but they will talk to you before they do this.

Find sexual health services near you, including sexual health and GUM clinics.

Your name and details

When you go to a sexual health clinic, you'll be asked for your name and some contact details.

You don't have to give your real name if you don't want to. If you do, it will be kept confidential. Your GP won't be told about your visit without your permission.

If you have tests and the results aren't available during your visit, the clinic will need to contact you later, so give them the correct contact details.

The clinic will ask how you want to receive your results. They can usually be given to you over the phone, by text, or in an unmarked letter.

Answering some questions

You will see a doctor or a nurse, who will ask you about your medical and sexual history.

Be prepared to answer questions about your sex life, including:

• when you last had sex
• whether you've had unprotected sex
• whether you have any symptoms
• why you think you might have an infection

You can ask to see a female or male doctor or nurse if you prefer, but you might have to wait longer than usual for one to become available.

Having STI tests

The doctor or nurse will tell you what tests they think you need. They should explain what is going on and why they are suggesting these tests. If you're not sure about anything, ask them to explain.

The tests might involve:

• a urine (pee) sample
• a blood sample
• swabs from the urethra (the tube urine comes out of)
• an examination of your genitals
• if you're female, swabs from the vagina, which you can usually do yourself

Testing for chlamydia and gonorrhoea usually requires only a urine sample or a self-taken swab for a woman. Testing for HIV and syphilis needs a blood sample.

Tests for herpes aren't usually done unless you have sores on your genitals or anus. In this case, a swab will be taken from a sore. This will be uncomfortable for a moment.

Find out more about:

• chlamydia testing
• herpes testing
• syphilis testing
• gonorrhoea testing
• HIV testing

Getting your test results

With some tests, you can get the results – and treatment, if you need it – on the same day. For others, you might have to wait for a week or two. If this is the case, the clinic will check how you would prefer to receive your results.

If you test positive for an STI, you will be asked to go back to the clinic to talk about your results and the treatment you need.

Many STIs can be cured with antibiotics. Some infections, such as HIV, have no cure, but there are treatments available. The clinic can advise you on these and put you in touch with a counsellor.

If possible, tell your sexual partner and any ex-partners so they can get tested and treated as well.

If you don't want to do this, the clinic can usually do it for you – it's called partner notification and the clinic won't reveal who you are.

Using condoms to protect against STIs

The best way to protect yourself from getting or passing on an infection is to use a condom every time you have sex. The clinic can give you some condoms so you can practice safer sex.

Always buy condoms that have the CE mark or BSI kite mark on the packet. This means they've been tested to high safety standards.

Condoms that don't have the CE mark or BSI kite mark won't meet these standards, so don't use them. Get tips on using condoms properly.

Bear in mind that having had an STI once doesn't make you immune to it – you can get the same infection again.

Other places to go for help

Sexual health and GUM clinics have the greatest expertise in testing and treatments for STIs, but you can also go to:

• your GP
• a young people's sexual health service – call the national sexual health line on 0300 123 7123
• a community contraception clinic
• a pharmacy

They may be able to offer tests for some infections and advise you on where to go for further help.

Further information

Does anal sex have any health risks?

How long before STI symptoms appear?

What infections can I catch through oral sex?

Sex activities and risk

Find out about the risks of getting a sexually transmitted infection (STI) from different sexual activities.

In nearly every case, condoms will help protect you against this risk.

Learn about the risks associated with the following sexual activities:

Vaginal penetrative sex
Anal penetrative sex
Oral sex
Fingering
Sex toys
Urine and faeces
Cutting

Vaginal penetrative sex

This is when a man's penis enters a woman's vagina.

If a condom is not used, there's a risk of pregnancy and getting or passing on STIs, including:

• chlamydia
• genital herpes
• genital warts
• gonorrhoea
• HIV
• syphilis

Infections can be passed on even if the penis doesn't fully enter the vagina or the man doesn't ejaculate (come). This is because infections can be present in pre-ejaculate fluid (pre-come).

Even shallow insertion of the penis into the vagina (sometimes called dipping) carries risks for both partners. Using a condom can help protect against infections.

Preventing pregnancy

There are many methods of contraception to prevent pregnancy, including the contraceptive injection, contraceptive patch, contraceptive implant and combined pill.

Bear in mind condoms are the only method of contraception that protects against both pregnancy and STIs, so always use a condom as well as your chosen method of contraception.

Find out about the 15 methods of contraception.

Anal penetrative sex

This is when a man's penis enters (penetrates) his partner's anus. Some people choose to do this as part of their sex life, and others don't. Men and women can choose to have anal sex whether they're gay or straight.

According to the third National Survey of Sexual Attitudes and Lifestyles, published in 2013, 17% of men and 15.1% of women had anal sex in the past year.

Anal sex has a higher risk of spreading STIs than many other types of sexual activity. This is because the lining of the anus is thin and can easily be damaged, which makes it more vulnerable to infection.

STIs that can be passed on during anal sex include:

• chlamydia
• genital herpes
• genital warts
• gonorrhoea
• HIV
• syphilis

Using condoms helps protect against STIs when you have anal sex.

If you use lubricants, only use water-based ones, which are available from pharmacies. Oil-based lubricants such as lotion and moisturiser can cause condoms to break or fail.

Get tips on using condoms properly.

Oral sex

Oral sex involves sucking or licking the vagina, penis or anus. Some men and women (gay and straight) choose to do this as part of their sex life, and others don't.

According to the third National Survey of Sexual Attitudes and Lifestyles, published in 2013, more than 77% of men and 75% of women had oral sex in the last year.

There's a risk of getting or passing on STIs if you're giving or receiving oral sex. The risk increases if either of you has sores or cuts around the mouth, genitals or anus.

This is because viruses and bacteria, which may be present in semen, vaginal fluid or blood, can travel more easily into a partner's body through breaks in the skin.

Generally, the risk of infection is lower when you receive oral sex than when you give someone oral sex. However, it is still possible for STIs to be passed on.

STIs that can be passed on through oral sex include:

• chlamydia
• herpes – type 1 and type 2, which can cause cold sores around the mouth and on the genitals or anus
• genital warts
• gonorrhoea
• hepatitis A, hepatitis B and hepatitis C
• HIV
• syphilis

If you have a cold sore and you give your partner oral sex, you can infect them with the herpes virus. Similarly, herpes can pass from the genitals to the mouth.

The risk of passing on or getting HIV during oral sex is lower than anal or vaginal sex without a condom. However, the risk is increased if there are any cuts or sores in or around the mouth, genitals or anus.

You can make oral sex safer by using a condom as it acts as a barrier between the mouth and the penis.

You can use any kind of condom during oral sex. Make sure it has the CE mark or BSI kite mark, which means the condom meets high safety standards.

Fingering

This is when someone inserts one or more fingers into their partner's vagina or anus. It's not common for fingering to spread STIs, but there are still risks.

If there are any cuts or sores on the fingers, no matter how small, the risk of passing on or getting HIV or other blood-borne infections such as hepatitis B or C increases.

Some people gradually insert the whole hand into a partner's vagina or anus, this is called fisting. Not everyone chooses to do this.

Again, the risk of infection is higher if either person has any cuts or broken skin that come into contact with their partner. You can lower the risk by wearing surgical gloves.

Sex toys

This covers a wide range of items, including vibrators and sex dolls. Any object used in sex can be called a sex toy, whether it's designed for this use or not.

It's important to keep sex toys clean. If you're sharing sex toys, make sure you wash them between each use and always use a new condom each time.

Sharing sex toys has risks, including getting and passing on infections such as chlamydia, syphilis and herpes. If there are any cuts or sores around the vagina, anus or penis and there's blood, there's an increased risk of passing on hepatitis B, hepatitis C and HIV.

Urine and faeces

Some people choose to urinate on a partner as part of their sex life, and others don't. There's a risk of passing on an infection if the person who's being urinated on has broken skin.

Faeces (poo) carries more of a risk. This is because it contains organisms that can cause illness or infection, for example shigella. This is a bacterial infection of the intestine that causes severe diarrhoea and is often mistaken for food poisoning. It can be caught during oral-anal sex and giving oral sex after anal sex when even a tiny amount of infected poo can get into the mouth and cause infection.

Although faeces doesn't usually contain HIV, it can contain the hepatitis A virus. There's a chance of infection when faeces comes into contact with broken skin, the mouth or the eyes.

Cutting

Cutting the skin – called scarification – as part of sex carries risks. Infections such as HIV, hepatitis B and hepatitis C can pass from person to person through broken skin.

No sexual contact is needed. Simply getting blood on a partner is enough to transmit these infections.

To lower the chances of infection, cutting and piercing equipment should be sterilised and not shared.

Further information

Are sex toys safe?

How soon do STI symptoms appear?

What should I do if I think I've got an STI?

Could I be pregnant?

If you’re a girl and you have unprotected sex (without contraception) with a boy, you could get pregnant. Find out the signs of pregnancy and where to go for support.

Pregnancy is a real possibility when you have sex, and there are lots of rumours about when and where you can get pregnant.

You can read this whole article, or go straight to the relevant bit for you:

• When can I get pregnant?
• What's emergency contraception and where can I get it from?
• What are the signs of pregnancy?
• When can I take a pregnancy test?
• What if I'm pregnant?

When can I get pregnant?

Don’t believe everything you hear. The truth is that it's possible for you to get pregnant:

• if it’s the first time you're having sex
• at any time of the month, including during your period
• even if the boy pulls his penis out before he comes (ejaculates)
• even if you haven't started your periods
• no matter what position you have sex in, including standing up
• even if you stand up, wash or jump up and down immediately after sex
• if you don’t have an orgasm
• even if the boy says he’ll be careful (boys can't stop themselves from leaking sperm before they come)

Read more facts about sex.

Pregnancy can also happen if your usual contraception hasn’t worked – for example, if you’re on the pill, but you've vomited, had diarrhoea or forgotten to take the pill. Contraception only works if it's used correctly and consistently. Find out:

• the 15 methods of contraception
• what to do if you're on the pill and you're sick or have diarrhoea

What's emergency contraception?

If you have unprotected sex, or if you think your contraception has failed, you can avoid an unplanned pregnancy by using emergency contraception. This should only be used in an emergency and is not a replacement for regular contraception. Emergency contraception does not protect against sexually transmitted infections (STIs).

There are two types:

• The emergency contraceptive pill (sometimes called the "morning-after" pill). There are two kinds of emergency contraceptive pill. Levonelle has to be taken within 72 hours of sex; ellaOne has to be taken within 120 hours of sex. Both are more effective the sooner they are taken.
• The intrauterine device (IUD), which can be put into your uterus up to five days after unprotected sex.

You can get free emergency contraception from GPs, community contraceptive clinics, Brook services (if you’re under 25), some sexual health and genitourinary medicine (GUM) clinics, clinics for young people and some pharmacies. Find sexual health services, including contraceptive clinics, near you.

You can get emergency contraception, whatever your age. If you're over 16, you can buy the emergency contraceptive pill from pharmacies.

What are the signs of pregnancy?

The first sign of pregnancy that most girls and women notice is a missed period, but to know for sure, you'll need to take a pregnancy test. Find out about doing a pregnancy test.

Free and confidential tests are available at some GP surgeries, Brook services (if you’re under 25), contraceptive clinics or young people’s clinics. They won’t tell your parents, even if you're under 16. You can also buy pregnancy testing kits from a pharmacy or supermarket.

Other signs and symptoms of pregnancy include:

• sore breasts
• feeling sick or vomiting at any time of the day or night
• feeling very tired
• needing to pee often

If you’re worried that you might be pregnant, go to a clinic or GP as soon as possible to find out for sure. Whatever the results of your test, they can offer you help and support. If you are pregnant, a doctor or nurse will explain your options and where to get advice and independent counselling.

If you're not pregnant, you can get advice on effective contraception to avoid the risk of an unplanned pregnancy in the future.

When can I take a pregnancy test?

You can take a test the day your period is due. If you’re not sure when your period is due, do the test 21 days (three weeks) after either:

• you had unprotected sex
• the time you may have forgotten to take the pill
• think there may have been a problem with your contraception

What if I'm pregnant?

If the test is positive, you're pregnant and you need to decide what to do next. Talk to a doctor or nurse at the clinic, or to your GP, about your options. It might also help to talk to someone close to you.

Get all the information you need as soon as possible, so you can make a decision about the pregnancy that’s right for you. Don't delay your decision, and don’t pretend the pregnancy isn’t real, as it won’t go away.

If you decide to continue the pregnancy, you will need to start your antenatal (pregnancy) care as soon as possible.

An unplanned pregnancy can be stressful and you may feel unable to continue with it. You should discuss this with your GP, who will explain your options, including the possibility of an abortion.

Abortion is safer and easier the earlier it is carried out in pregnancy. Most abortions in England and Wales are done in the first 13 weeks (three months). All women requesting an abortion should be offered the chance to discuss their options with a trained counsellor.

Getting medical care as a student

It's important to look after your health when moving away from home for the first time. This includes registering with a new GP and finding your local sexual health service.

Here are our five health tips for new students.

1. Register with a local GP

If, like most students, you spend more weeks of the year at your college address than your family's address, you need to register with a GP near your college as soon as possible.

That way you can receive emergency care if you need it, and access health services quickly and easily while you're at college.

This is especially important if you have an ongoing health condition, particularly one that needs medication, such as asthma, diabetes or epilepsy.

You can choose to register with any local GP. The health centre attached to your college or university is likely to be the most convenient, and the doctors working there will be experienced in the health needs of students.

Find your local GP surgery.

Other health services available

Many college health centres have good links with specialists, such as psychiatrists, sports physicians, psychotherapists, counsellors and physiotherapists.

Having trouble getting an appointment? You can also always ask your local pharmacist for medical advice and support.

They may not be at the pharmacy counter when you go in, so ask the person at the counter (who may not be qualified to give medical advice) if you can speak to the pharmacist.

Getting ill during the holidays

If you become unwell or need other medical treatment when you're at home or not staying near your university GP, you can contact your nearest practice to ask for treatment.

You can receive emergency treatment for 14 days. After that you will have to register as a temporary resident or permanent patient.

Find out how to register as a temporary resident with a GP.

You can also visit an NHS walk-in centre or minor injuries unit. These can provide treatment for minor injuries or illnesses such as cuts, bruises and rashes.

However, they are not designed for treating long-term conditions or immediately life-threatening problems. You don't need to be registered and you don't need an appointment.

2. Register with a dentist

Dental problems can't be dealt with by doctors, so make sure you register with a local dentist.

Not all treatment is free, even under the NHS. You may be able to apply for help with health costs, including prescriptions and dental care.

Find an NHS dentist.

Get help with dental costs.

3. Check your vaccinations

Men ACWY vaccination

Students are now routinely offered a vaccination to prevent meningitis W disease.

The Men ACWY vaccine protects against four different causes of meningitis and septicaemia: meningococcal (Men) A, C, W and Y diseases. It replaces the separate Men C vaccine.

All 17- and 18-year-olds in school year 13 and first-time university students up to the age of 25 are eligible as part of the NHS vaccination programme.

GP practices will automatically send letters inviting 17-and 18-year-olds in school year 13 to have the Men ACWY vaccine.

But if you're a student going away to university or college for the first time, contact the GP you're registered with to ask for the Men ACWY vaccine, ideally before the start of the academic year.

This is because you'll be at particularly high risk in the first weeks of term, when you're likely to come into contact with many new people of a similar age.

Mumps vaccination

Universities and colleges also advise students to be immunised against mumps before starting their studies.

The MMR vaccine (for mumps, measles and rubella) is part of the routine NHS childhood immunisation schedule. This means most young people who've grown up in England will have had two doses of it in childhood.

If you're not sure you've had two doses of the MMR vaccination, ask your GP for a catch-up vaccination.

Flu jab

Get an annual flu vaccination if you have asthma and take inhaled steroids. You should also get a flu vaccination if you have a serious long-term condition such as kidney disease.

4. Get contraception

Even if you don't plan to be sexually active while you're a student, it's good to be prepared.

Contraception and condoms are free to both men and women from any GP – it doesn't have to be your own – or family planning clinic.

Find your local sexual health service.

5. Rest and eat healthy food

Prevention is better than cure, as the saying goes, so you'll greatly increase your chances of avoiding your GP's waiting room by taking care of yourself in the first place.

Student life may not be renowned for early nights and healthy eating, but getting enough sleep and eating well will mean you have a better chance of staying healthy.

You'll feel more energetic and be better equipped to cope with studying and exams.

Remember to:

• eat five portions of fruit and vegetables a day
• buy wholemeal bread and pasta instead of white
• keep fast food to a minimum

Eating well doesn't have to cost a lot and is often cheaper than takeaways. Taking the time to cook simple meals instead of eating out or buying ready meals is also healthier.

Buy a student cookbook for affordable healthy recipe ideas. You might also want to try downloading the free One You Easy Meals app.

Read more about healthy eating on a budget.

Disabled Students' Allowance (DSA)

As a higher education student living in England, you can apply for a Disabled Students' Allowance (DSA) if you have a:

• disability
• long-term health condition
• mental health condition
• specific learning difficulty, such as dyslexia

The support you get depends on your individual needs and not on income.

Sexual health FAQs

Dr Patrick French (pictured) is a sexual health adviser and genitourinary medicine (GUM) consultant at the Mortimer Market Centre in London. He answers some common questions about sex.

• Watery discharge
• Spots on my penis
• Can I get HIV through condoms?
• I need emergency contraception
• Pains after anal sex
• Itchy penis
• Vaginal discharge
• Could I have an STI from years ago?
• Could I be infertile from a previous infection?
• Do I need to tell my partner about my STI history?
• Can you carry an infection and not actually get it?
• If my partner has an STI, do I need treatment too?
• Should I get checked out for STIs?
• How long is treatment?
• What happens when they test for infections?
• Can I see a woman doctor?
• Can I get HIV without having sex?
• Can I catch an STI in the bath?
• I have more sexual health questions. Who can I talk to?

Watery discharge

I've got a watery discharge, which smells really unpleasant and fishy. I'm scared of going to my doctor because he knows my mum. What could it be? Could it go away on its own?

Dr French says:

"I don't think that this will be anything particularly serious, but it's very important that you get this checked out. The most likely cause of this sort of problem is an extremely common infection called bacterial vaginosis (BV).

"It isn't sexually transmitted, and it's easy to diagnose and cure. Go to your local sexual health or GUM clinic, which can tell you at your first visit exactly what's going on and give you treatment. You can refer yourself to these clinics. They're free and completely confidential.

"Although your GP knows your mum, he or she has a duty to respect your right to confidentiality if you ever go to them for advice or treatment."

Spots on my penis

I have small spots on the testicles and some on the penis. Should I be worried?

Dr French says:

"I wouldn't worry if I were you. There are lots of normal hair follicles and glands on the testicles and penis, which all men have, and don't cause any problems. But I can't be completely certain, because there are a number of skin problems that start as small spots and need treatment.

"I'm thinking particularly of genital warts, which start as pinkish lumps on the genitals, and grow in size and number. To be extra sure, I would suggest that you make an appointment at your local sexual health or GUM clinic, where the staff can tell you there and then if there's anything to worry about."

Can HIV get through condoms?

I recently had sex for the first time with my boyfriend. We used a condom, but I'm not sure if it was enough protection against HIV. One of my friends says that HIV can get through the tiny holes in the rubber. Is she right?

Dr French says:

"As often happens with friends, she's wrong. If used properly, condoms are extremely good protection against HIV and many other sexually transmitted infections (STIs). They're also useful at preventing unintentional pregnancies, although many women use a more reliable form of contraception as well as condoms to ensure they're protected against both STIs and unwanted pregnancy. Condoms do not have tiny holes in them."

I need emergency contraception

Where can I get the morning after pill? I had sex with my boyfriend last night and we didn't use a condom. Can I get the pill today, because I don't want to leave it too late?

Dr French says:

"Yes, you should be able to get it today without any problem. You can get the emergency hormonal pill free from GP surgeries, community contraceptive clinics, some sexual health clinics, NHS walk-in centres, some accident and emergency (A&E) departments, and some pharmacies. You can buy the emergency pill from pharmacies if you're over 16.

"There are two types of emergency contraception pill (known as the morning after pill). Levonelle works for up to 72 hours after you've had unprotected sex, and ellaOne works for up to 120 hours. But the sooner you use it, the more effective it will be. You can also visit your doctor and have an IUD or coil fitted to protect you against pregnancy. This can be done up to five days after unprotected sex."

Pain after anal sex

I recently had anal sex with my boyfriend for the first time. Since then I have terrible pain in the end of my penis when urinating. We didn't use a condom. Do you think I've injured myself or caught an infection?

Dr French says:

"It's unlikely that you've injured yourself, but it's more likely that you've caught an infection. I would strongly suggest going to your local sexual heath (GUM) clinic for a sexual health check-up. If you have an infection, it's almost certainly easy to cure.

"Having unprotected sex with your boyfriend definitely puts you at risk of infections that are hard to treat, such as HIV and hepatitis B. When you go to the clinic, make sure that you get a hepatitis B vaccine. Take your boyfriend with you."

"The health adviser at the clinic can talk to both of you about safer sex, and how to avoid HIV and other infections."

You can find a clinic address in the phone book under "sexual health", or by calling the national sexual health line (0300 123 7123).

Itchy penis

My penis itches a lot each time I go to the toilet to pee. It's been like this for a long time, but has got worse recently. I've heard that yoghurt can treat this type of thing. I ate a big pot this morning, but it still itches.

Dr French says:

"Do you have a rash on the head of your penis, or is it sore when you pee? If you have a rash, you might have thrush. This is a common infection, which is caused by a fungus and isn't sexually transmitted. Clotrimazole cream from your pharmacy should sort out the problem. If this doesn't work, go to your local sexual health clinic for a check-up.

"If you have pain when you pee, you may well have an STI in the tube of your penis. Get this checked out and treated at your local sexual health (GUM) clinic, or see your GP.

"There's no evidence that yoghurt can clear up an infection. Some women find that it helps with symptoms of thrush, but only if applied to the affected area, not if you eat it."

Find out about thrush in women and thrush in men.

Vaginal discharge

Since last week I've noticed a light substance coming from my vagina. It doesn't smell bad, but it doesn't normally happen. Can you suggest a cream to get rid of it?

Dr French says:

"It's normal for women to have some fluid coming from the vagina (vaginal discharge), and it's quite likely that this "substance" is your normal vaginal fluid. However, if it's a new problem, you may have a vaginal infection.

"The most common infections that cause this problem aren't sexually transmitted, but I would suggest that you go to your local sexual health clinic for a check-up. The clinic is free, confidential and you can refer yourself. You should be able to find out there and then if you have an infection. Or you could see your GP."

Could I have an STI from years ago?

I had unprotected sex when I was in my early twenties. Could I be carrying an infection and not know it?

Dr French says:

"It's possible for infections such as HIV to take years before any symptoms show. About one in six people with HIV in the UK haven't been diagnosed. Chlamydia often has no symptoms, but it can affect your fertility if left untreated. If you're in any doubt, arrange for a check-up with your local GUM clinic."

Could I be infertile from a previous infection?

I had an infection when I was younger and had it treated. Now I'm thinking about starting a family. Which infections could stop me from having a baby?

Dr French says:

"Chlamydia and gonorrhoea can both lead to infertility if left untreated, although most people who have had these infections don't have any permanent problems.

"Chlamydia is easy to treat once it's detected, but many people with chlamydia have no symptoms and are unaware of their infection. If you think you might be at risk, go for a check-up and test. Testing for chlamydia is now quick, painless and easy to do, with most people just having a urine test or self-taken swab."

Find out about chlamydia symptoms.

Do I need to tell my partner about my STI history?

I had treatment for an infection a few years ago and it hasn't come back. Do I need to tell my new girlfriend about it?

Dr French says:

"It depends on which STI you had. Some can be completely cured with antibiotics, but others may recur or cause no symptoms.

"It's generally good to be open about your sexual history with a new partner and always practise safer sex by using a condom. If you're not sure, ask your local GP surgery or sexual health (GUM) clinic."

Find your nearest clinic, or you can look up a clinic address in the phone book under "sexual health".

Can you carry an STI but not actually get it?

I've heard that people can carry diseases without getting infected themselves. Are there any infections that are caught only by men or only by women?

Dr French says:

"No, it's not possible to carry a disease without being infected yourself. However, it's common to have an STI without any symptoms, but still pass it on to someone when you have sex with them. There are no STIs that are only caught by men or only caught by women. If you think that you may be at risk of an STI, the only way to find out is by having an STI check-up."

If my partner has an STI, do I need treatment too?

My girlfriend has got chlamydia and says I need to get treatment. But I've got no symptoms, so what's the point?

Dr French says:

"Your girlfriend is right. It's very important that you go for treatment even if you've got no symptoms, because most people who have chlamydia have no symptoms.

"If you don't get treatment, you'll pass this infection back to your girlfriend. Chlamydia can be a very serious problem, particularly for women, who can become infertile if it's not treated."

Should I get checked out for STIs?

Do you think I should have a regular check-up at a clinic? My last visit was two years ago, but I've had six or seven partners since then.

Dr French says:

"Yes, a check-up would be a good idea. A lot of STIs cause no symptoms, and having a check-up is very straightforward. If you've moved since your last clinic visit, you can find your nearest clinic here."

How long is treatment?

How long does a course of treatment for an STI usually last?

Dr French says:

"There's no average, because all STIs are different. Many STIs are treated with one-off doses. However, some courses of treatment last one week or can be longer."

What happens when they test for infections?

I've got a rash and I'm scared, but I'm also scared about what will happen if I go to a clinic. Will it hurt?

Dr French says:

"No, it won't hurt. Usually a doctor or nurse will ask about your sexual history and advise you which tests you'll need. Nowadays, many people who have an STI check-up no longer need an internal examination or any swabs, although women may be asked to take a vaginal swab.

"Usually, you'll only need to take a blood test for HIV and syphilis, and a urine test or self-taken swab for chlamydia and gonorrhoea. Some women need to have an internal vaginal examination with swabs. Some men may need to have a small swab taken from the tip of the penis.

"Staff will explain the procedure to you. You're in control, so tell them if you aren't happy with any test that they suggest."

Find out about visiting an STI clinic.

Can I see a woman doctor?

I don't want to discuss my business with a man because it's embarrassing. Can I ask to see a woman doctor?

Dr French says:

"Yes, absolutely. No-one can make you see a male or female doctor or nurse if you don't feel comfortable. Occasionally, you may have to wait a little longer until someone suitable becomes available."

Can I get HIV without having sex?

I've heard that HIV is a risk when we go abroad. Is there any risk of getting HIV if you don't sleep with someone on holiday, but do other sexual things instead?

Dr French says:

"Providing that you don't have unprotected (without a condom) vaginal or anal sex, it's very unlikely that you'll be at risk of HIV. There's no risk of getting HIV from kissing and touching.

"If you give a man oral sex, there's a small risk of getting HIV, particularly if he comes in your mouth. Some people use condoms (you can get flavoured condoms) for oral sex.

"There's no risk of HIV if a man gives you oral sex."

Read more about sex activities and risk.

Can I catch an STI from having a bath?

I am sharing a bathroom with students and have heard you should disinfect the tub before bathing, as you never know if any of the people who use the same tub have STIs. How likely am I to catch an STI from someone by sharing a tub? What about bathing together with someone who has an STI? Should I get tested?

Dr French says:

"I think it is a good idea to rinse out the bath with some water after someone has just used it – after all, you don't want to have a bath in someone else's dirt! But you don't need to disinfect the bath. This is not a way that STIs are passed on. For more information about STIs, call the national sexual health line (0300 123 7123)."

I have more sexual health questions. Who can I talk to?

You can find a clinic address in the phone book under "sexual health", or by calling the national sexual health line (0300 123 7123).