Editing Safe sex (section)

==Practices==
A range of safe-sex practices are commonly recommended by Sexual Health Educators and Public Health Agencies. Many of these practices can reduce (but not eliminate) risk of transmitting or acquiring STIs.<ref>{{cite web |title=How You Can Prevent Sexually Transmitted Diseases |date=30 March 2020 |url=https://www.cdc.gov/std/prevention/default.htm |publisher=Centers for Disease Control |access-date=2 April 2021}}</ref>

===Phone sex/cybersex/sexting===
Sexual activities, such as phone sex, [[cybersex]], and [[sexting]], that do not include direct contact with the skin or bodily fluids of sexual partners, carry no STI risks and, thus, are forms of safe sex.<ref name=plannedparenthood>{{cite web |url = http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex/safer-sex-4263.htm |title = Safer Sex ("Safe Sex") |access-date = 23 September 2009 |archive-date = 29 March 2008 |archive-url = https://web.archive.org/web/20080329023107/http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex/safer-sex-4263.htm |url-status = dead }}</ref>

===Non-penetrative sex===
[[Image:PeterJohannNepomukGeigerEroticWatercolor04.jpg|thumb|right|[[Watercolor]] of [[Handjob|manual stimulation]] of the penis, [[Johann Nepomuk Geiger]], 1840]]

{{Main|Non-penetrative sex}}
A range of sex acts called "non-penetrative sex" or "outercourse" can significantly reduce STI risks. Non-penetrative sex includes practices such as kissing, mutual masturbation, manual sex, rubbing or stroking.<ref name="LaRosa">{{cite book | vauthors = LaRosa J, Bader H, Garfield S |title=New Dimensions In Women's Health |publisher=[[Jones & Bartlett Learning]] |year=2009 |page=91 |access-date=31 August 2013 |isbn=978-0763765927 |url=https://books.google.com/books?id=2X03PXd4JSoC&pg=PA91 |quote=Outercourse is the sharing of sexual intimacy with behaviors such as private part kissing, petting, and mutual masturbation. The advantages of outercourse include no risk of pregnancy without penile-vaginal penetration and the behaviors permit emotional bonding and closeness.}}</ref><ref name="White">{{Cite book | vauthors = White L, Duncan G, Baumle W |title=Medical Surgical Nursing: An Integrated Approach |edition=3rd |publisher=[[Cengage Learning]] |year=2011 |access-date=1 September 2013 |page=1161 |isbn=978-1133707141 |url=https://books.google.com/books?id=LWEJAAAAQBAJ&pg=PA1161|quote=Some people consider outercourse to mean sex play without vaginal intercourse, while others consider this to mean sex play with no penetration at all (vaginal, oral, or anal).}}</ref> According to the Health Department of Western Australia, this sexual practice may prevent pregnancy and most STIs. However, non-penetrative sex may not protect against infections that can be transmitted via skin-to-skin contact, such as [[herpes]] and [[HPV|human papilloma virus]].<ref>{{cite web|title=STDs (Sexually Transmitted Diseases) |url=http://www.mckinley.illinois.edu/handouts/sexually_transmitted_infections.html|access-date=23 January 2014|archive-date=2 February 2014|archive-url=https://web.archive.org/web/20140202144530/http://www.mckinley.illinois.edu/handouts/sexually_transmitted_infections.html|url-status=dead}}</ref> Mutual masturbation and manual sex carry some STI risk, especially if there is skin contact or shared bodily fluids with sexual partners, although the risks are significantly lower than other sexual activities.<ref name=plannedparenthood/>

===Condoms, dental dams, gloves===
{{anchor|Barrier protection}}
Barriers, such as condoms, dental dams, and medical gloves can prevent contact with body fluids (such as [[blood]], [[vaginal fluid]], [[semen]], rectal mucus), and other means of transmitting STIs (like skin, hair and shared objects) during sexual activity.<ref>{{cite journal | vauthors = Gil-Llario MD, Morell-Mengual V, García-Barba M, Nebot-García JE, Ballester-Arnal R | title = HIV and STI Prevention Among Spanish Women Who have Sex with Women: Factors Associated with Dental Dam and Condom Use | journal = AIDS and Behavior | volume = 27 | issue = 1 | pages = 161–170 | date = January 2023 | pmid = 35788924 | pmc = 9852118 | doi = 10.1007/s10461-022-03752-z }}</ref><ref>{{cite journal | vauthors = Claure I, Anderson D, Klapperich CM, Kuohung W, Wong JY | title = Biomaterials and Contraception: Promises and Pitfalls | journal = Annals of Biomedical Engineering | volume = 48 | issue = 7 | pages = 2113–2131 | date = July 2020 | pmid = 31701311 | doi = 10.1007/s10439-019-02402-1 | s2cid = 254185613 | pmc = 7202983 }}</ref>

[[File:How To Put on a Condom graphic.png|thumb|How to put a male condom on a penis]]
[[File:Safe sex.webm|thumb|Demonstration of penile-vaginal penetration with a condom, a safe sex practice]]
* External [[condom]]s can be used to cover the penis, hands, fingers, or other body parts during sexual penetration or [[oral sex]].<ref name="Corinna" /> They are most frequently made of [[latex]], and can also be made out of synthetic materials including [[polyurethane]] and [[polyisoprene]].
* Internal condoms (also called [[female condom]]s) are inserted into the [[vagina]] or [[Human anus|anus]] prior to sexual penetration. These condoms are made of either polyurethane or [[nitrile]]. If external and internal condoms are used at the same time, they may break due to friction between the materials during sexual activity.
* A [[dental dam]] (originally used in dentistry) is a sheet of latex typically used for protection between the mouth and the [[vulva]] or anus when engaging in oral sex. 
* [[Medical glove]]s and [[finger cot]]s made out of latex, vinyl, [[nitrile rubber|nitrile]], or polyurethane can cover hands or fingers during [[Non-penetrative sex#Manual sex|manual sex]] or may be used as a makeshift dental dam during oral sex.<ref name="Corinna">{{cite book |vauthors=Corinna H |title=S.E.X.: The All-You-Need-to-Know Sexuality Guide to Get You Through Your Teens and Twenties |date=2016 |publisher=Da Capo Lifelong Press |location=New York |isbn=978-0738218847}}</ref><ref name="Moon">{{cite book | vauthors = Moon A |title=Girl Sex 101 |date=2018 |publisher=Lunatic Ink |isbn=978-0983830900}}</ref>
* Condoms, dental dams, and gloves can also be used to cover [[sex toys]] such as [[dildo]]s during sexual stimulation or penetration.<ref name="Corinna" /><ref name="Moon" /> If a sex toy is to be used in more than one orifice or partner, a condom/dental dam/glove can be used over it and changed when the toy is moved.

Oil-based [[Personal lubricant|lubrication]] can break down the structure of latex condoms, dental dams or gloves, reducing their effectiveness for STI protection.<ref>{{cite book | vauthors = Corinna H |title=S.E.X.: The All-You-Need-to-Know Sexuality Guide to Get You Through Your Teens and Twenties |date=2016 |publisher=Da Capo Lifelong Press |location=New York |isbn=978-0738218847 |page=294 |edition=2nd}}</ref>

While use of external condoms can reduce STI risks during sexual activity, they are not 100% effective. One study has suggested condoms might reduce HIV transmission by 85% to 95%; effectiveness beyond 95% was deemed unlikely because of slippage, breakage, and incorrect use.<ref name="Varghese">{{cite journal |vauthors=Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW |title=Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use |journal=Sexually Transmitted Diseases |volume=29 |issue=1 |pages=38–43 |date=January 2002 |pmid=11773877 |doi=10.1097/00007435-200201000-00007 |s2cid=45262002 |url=http://ww2.aegis.org/files/AskDoc_refs/varghese2002-29-1.pdf |url-status=dead |archive-url=https://web.archive.org/web/20110724224853/http://ww2.aegis.org/files/AskDoc_refs/varghese2002-29-1.pdf |archive-date=24 July 2011}}</ref> It also said, "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".<ref name="Varghese"/><sup>p.&nbsp;40.</sup>

===Pre-exposure prophylaxis (PrEP)===
{{Main|Pre-exposure prophylaxis}}
[[Pre-exposure prophylaxis]] (often abbreviated as ''PrEP'') is the use of prescription drugs by those who do not have HIV to prevent HIV infection. PrEP drugs are taken ''prior'' to HIV exposure to prevent the transmission of the virus, usually between sexual partners. PrEP drugs do not prevent other STI infections or pregnancy.<ref>{{Cite journal |last1=Kumar |first1=Sagar |last2=Haderxhanaj |first2=Laura T. |last3=Spicknall |first3=Ian H. |date=June 2021 |title=Reviewing PrEP's Effect on STI Incidence Among Men Who Have sex with Men-Balancing Increased STI Screening and Potential Behavioral Sexual Risk Compensation |journal=AIDS and Behavior |volume=25 |issue=6 |pages=1810–1818 |doi=10.1007/s10461-020-03110-x |issn=1573-3254 |pmc=8085068 |pmid=33242186}}</ref>

As of 2018, the most-widely approved form of ''PrEP'' combines two drugs (tenofovir and emtricitabine) in one pill. That drug combination is sold under the brand name [[Truvada]] by Gilead Sciences. It is also sold in generic formulations worldwide. Other drugs and modalities are being studied for use as PrEP.<ref>{{Cite web |title=Pre-exposure Prophylaxis (PrEP) to Reduce HIV Risk | work = National Institute of Allergy and Infectious Diseases | date = 10 December 2020 |url=https://www.niaid.nih.gov/diseases-conditions/pre-exposure-prophylaxis-prep |access-date=2022-06-27 |language=en}}</ref><ref>{{cite journal | vauthors = Beymer MR, Holloway IW, Pulsipher C, Landovitz RJ | title = Current and Future PrEP Medications and Modalities: On-demand, Injectables, and Topicals | journal = Current HIV/AIDS Reports | volume = 16 | issue = 4 | pages = 349–358 | date = August 2019 | pmid = 31222499 | pmc = 6719717 | doi = 10.1007/s11904-019-00450-9 }}</ref>

Different countries have approved different protocols for using the tenofovir/emtricitabine-combination drug as ''PrEP''. That two-drug combination has been shown to prevent HIV infection in different populations when taken daily, intermittently, and on demand. Numerous studies have found the tenofovir/emtricitabine combination to be over 90% effective at preventing HIV transmission between sexual partners.<ref>{{cite web |url=https://www.cdc.gov/hiv/risk/prep/ |title=Pre-Exposure Prophylaxis (PrEP) |date=19 September 2016 |publisher=Centers for Disease Control and Prevention |access-date=14 March 2017}}</ref> AVAC has developed a tool to track trends in PrEP uptake across the globe.<ref>{{Cite web |title=PrEP {{!}} AVAC |url=https://avac.org/prevention-option/prep/ |access-date=2024-02-07 |website=avac.org}}</ref> 

===Treatment as prevention===
{{Main|Treatment as prevention}}
Treatment as Prevention (often abbreviated as ''TasP'') is the practice of testing for and treating HIV infection as a way to prevent further spread of the virus. Those having knowledge of their HIV-positive status can use safe-sex practices to protect themselves and their partners (such as using condoms, sero-sorting partners, or choosing less-risky sexual activities). And, because HIV-positive people with durably suppressed or undetectable amounts of HIV in their blood ''cannot transmit HIV to sexual partners'', sexual activity with HIV-positive partners on effective treatment is a form of safe sex (to prevent HIV infection). This fact has given rise to the concept of "U=U" ("Undetectable = Untransmittable").<ref>{{cite web |url=https://www.preventionaccess.org/ |title=U=U|date=2017|publisher=Prevention Access Campaign|access-date=11 September 2018}}</ref>

===Other forms of safe sex===
Other methods proven effective at reducing STI risks during sexual activity are:
* [[Immunization]] against certain sexually-transmitted viruses. The most common vaccines protect against [[Hepatitis B vaccine|hepatitis B]] and [[HPV vaccine|human papilloma virus (HPV)]], which can cause [[cervical cancer]], [[penile cancer]], [[oral cancer]], and [[genital warts]]. Immunization before initiation of sexual activity increases effectiveness of these vaccines. HPV vaccines are recommended for all teen girls and women as well as teen boys and men through age 26 and 21 respectively.<ref>{{Cite web|url=https://www.cdc.gov/std/prevention/default.htm|title=Prevention - STD Information from CDC|date=2019-05-28|website=www.cdc.gov|language=en-us|access-date=2019-08-05}}</ref>
* Limiting numbers of sexual partners, particularly casual sexual partners, or restricting sexual activity to those who know and share their STI status, can also reduce STI risks. [[Monogamy]] or [[polyfidelity]], practiced faithfully, is safe (as far as STIs are concerned) when all partners are non-infected. However, a number of monogamous people have been infected with sexually transmitted infections by partners who are [[Adultery|sexually unfaithful]], have used injection drugs, or were infected by previous sexual partners. The same risks apply to polyfidelitous people, who face higher risks depending on how many people are in the polyfidelitous group.
* [[Communication]] with sexual partners about sexual history and STI status, preferred safe sex practices, and acceptable risks for partnered sexual activities.
* Engaging in less-risky sexual activities. In general, solo sexual activities are less risky than partnered activities. Sexual penetration of orifices (mouth, vagina, anus) and sharing body fluids (such as semen, blood, vaginal fluids, and rectal mucus) between sexual partners carry the most risk for STIs.
* Regular STI testing and treatment, especially by those who are sexually active with more than one casual sexual partner.<ref name=Kahn>{{cite journal | vauthors = Kahn JO, Walker BD | title = Acute human immunodeficiency virus type 1 infection | journal = The New England Journal of Medicine | volume = 339 | issue = 1 | pages = 33–9 | date = July 1998 | pmid = 9647878 | doi = 10.1056/NEJM199807023390107 }}</ref><ref name="pmid11187417">{{cite journal | vauthors = Daar ES, Little S, Pitt J, Santangelo J, Ho P, Harawa N, Kerndt P, Glorgi JV, Bai J, Gaut P, Richman DD, Mandel S, Nichols S | display-authors = 6 | title = Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network | journal = Annals of Internal Medicine | volume = 134 | issue = 1 | pages = 25–9 | date = January 2001 | pmid = 11187417 | doi = 10.7326/0003-4819-134-1-200101020-00010 | s2cid = 34714025 | first14 = Network }}</ref> It is possible to attain and show proof of STD-free-verification through [[online dating services|online dating apps]] and websites.<ref>{{cite web| url = https://www.sheknows.com/health-and-wellness/articles/985207/app-for-finding-out-std-status/| title = Do you know his STD status? There's an app for that| date = 3 April 2013}}</ref><ref>{{cite web| url = https://medcitynews.com/2016/01/tinder-healthvana-std/| title = Tinder adds link to healthvana for STD-checking purposes| date = 22 January 2016}}</ref>
* [[Circumcision and HIV|Penile circumcision]]. Some research suggests that circumcising (removing) the foreskin of the penis can reduce the risk of contracting HIV.<ref>{{cite web | title = Circumcision (male) | publisher = Mayo Clinic | url = https://www.mayoclinic.org/tests-procedures/circumcision/about/pac-20393550 | access-date = 10 May 2020}}</ref><ref>{{cite news |url=http://news.bbc.co.uk/2/hi/health/6502855.stm |title=WHO agrees HIV circumcision plan  |access-date=12 July 2008 |work=BBC World News |publisher=BBC |date=3 March 2007 }}</ref> Some advocacy groups dispute these findings.<ref>{{cite web|url=http://www.circumstitions.com/HIV-SA.html|title=Circumcision and HIV - the Randomised Controlled Trials|website=www.circumstitions.com}}</ref><ref>{{cite web|url=http://mgmbill.org/aids.htm|title=Circumcision and AIDS<!-- Bot generated title -->|url-status=dead|archive-url=https://web.archive.org/web/20080723220755/http://mgmbill.org/aids.htm|archive-date=23 July 2008}}</ref>