Group Sex and STDs
Inevitably, people inquire as to whether individuals who have group sex are at increased risk for sexuality transmitted diseases (STDs) or sexually transmitted infections (STIs, the abbreviation used here). This question always arises when I talk about nonmonogamy, although it rarely does so when I speak about infidelity or sexuality more generally. There are thus two important issues to address—the factual question and the underlying assumptions about people who have group sex.
Rates of STIs differ around the world, as does the quality of the data collected. The following information is from the United States; readers with an interest in a specific country or population are encouraged to consult the appropriate databases.
Given that we don’t force STI testing on the general population in the United States, the only way we know how many individuals contract STIs each year and how they do so is from data collected from clinics or self-report data provided to researchers—both of which are limited sources. Physicians treating STIs usually do not collect detailed information about their patients’ sex lives that would allow us to ascertain whether those individuals participated in group sex or not—and even if they did collect such information, it would not be readily available to researchers. Further, many people infected with STIs are asymptomatic. People reporting to a clinic are not representative of all those who have STIs, but only those who seek treatment. (As a man in the lifestyle told me of his commitment to regular testing, “People who like having sex do what it takes to keep themselves in the game.”) People with alternative sexual lifestyles, including those who have group sex, may be more likely to notice the physical changes accompanying an STI and therefore more likely to seek medical attention (or to suggest it to someone else). Thus, while one high-profile study conducted in the Netherlands found “swingers” reporting to a clinic with higher STI rates than other heterosexuals, these individuals may have been more likely to visit a clinic in the first place.[1] Self-report data is problematic for the same reasons. Some groups of people are asked frequently about their sex lives and about STIs—gay men who use bathhouses or college students, for example—but it is difficult to make meaningful comparisons with the general public based on this data because questions remain about how many people even realize they are infected with various STIs.
Still, sex is a risk factor for sexually transmitted infections (even though some are transmitted in other ways as well). Studies have shown that anyone with more than one sexual partner in a given time period is more at risk for STIs than those who abstain from sex altogether or are 100 percent sexually exclusive with a partner and have tested negative. People who have group sex might have more partners than the “average” adult in any given year. They might, however, have fewer partners than the “average” college student or philanderer. Either way, anyone with more than one sexual partner has an increased risk of catching an STI. Having concurrent sex partners in rapid succession can theoretically promote the spread of STIs if even one individual is careless.
According to a 2013 CDC report, young people (ages fifteen to twenty-four) account for 50 percent of new STI infections, although they represent only 25 percent of the sexually active population.[2] Untreated STIs can increase one’s chances of contracting HIV, create problems during pregnancy, and cause other complications. Treatment for most STIs is readily available, however, and effective if the infection is detected early. HPV, a virus that includes more than one hundred “types,” and genital herpes (herpes simplex virus 2, or HSV-2) are viruses that cannot technically be “cured” but can be managed or suppressed (whether HPV is cleared, latent, or a mix of the two remains unclear). HPV and HSV-2 are also quite prevalent and often asymptomatic. Certain HPV types cause cervical cancer in women everywhere, but most women who get HPV do not develop cervical cancer. Regular screening with Papanicolaou (“Pap”) tests is important; the FDA has also approved several vaccines to help protect against some of the more dangerous strains of HPV. The CDC claims that HPV is so common that at least 50 percent of sexually active men and women will acquire it at some point in their lives;[3] most will never even realize it, however, and in many cases, the body’s natural immune system clears HPV within two years. The CDC also reports that one in six people aged fourteen to forty-nine years in the United States has genital HSV-2, or genital herpes.[4] This means HSV-2 is about as common as food allergies, “odontophobia” (a fear of visiting the dentist), or being overweight as a child, although all of these conditions affect some groups more than others. HSV-1, or oral herpes, is also quite prevalent and can be transmitted to the genitals through oral sex; if statistics for both HSV-1 and HSV-2 are combined, the frequency of occurrence is greater than one in six. HIV, the virus that causes AIDS, is also more prevalent in some groups than in others. Outside of sub-Saharan Africa, the risk of HIV is primarily within high-risk groups such as men who have sex with men, injection-drug users, and heterosexuals with risky practices such as unprotected sex with multiple or anonymous partners. Once thought of as a “death sentence,” many medical professionals now recognize the possibility of managing HIV through the use of antiviral therapy, even though doing so is complicated, resulting in much longer life expectancy than in the earlier days of the AIDS epidemic. Despite warnings that HIV would sweep through the lifestyle population, very few cases have been reported among self-identified swingers. Gay men who have group sex in public venues or while “intensive sex partying” are still considered a high-risk group for HIV, although as discussed throughout this text, the sex practices of men who have sex with men can vary widely.
So are people who have group sex at a greater risk than other individuals who have more than one sexual partner in a given time period, such as those who are single and dating, sexually unfaithful, or consensually nonmonogamous? Not necessarily, as there are mitigating factors. Community norms influence sexual practices. Many people put themselves at risk, for example, because they believe that a careful choice of partner can protect against HIV and STIs. In many sex clubs for heterosexual swingers in the United States, however, condoms are mandatory and are expected with extradyadic partners (though not necessarily with committed couples). In the presence of witnesses, people may feel more pressure to conform to safety precautions—known “barebackers” can be stigmatized in many lifestyle enclaves. People are also more likely to engage in unsafe sex under the influence of drugs or alcohol. College students—who frequently report more than one sexual partner in a year and admit to the use of intoxicants before and during “hookups”—suffer high rates of STIs/STDs. The claim that as many as “an estimated one in four college students has a sexually transmitted disease”[5] is widely repeated; some experts believe this estimate to be low. While some group sex participants drink alcohol or use drugs before engaging in such activities, many venues and events discourage intoxication. Being part of a community can combat shame and promote discussion of sexual health. People with alternative sexual practices may also be more at ease negotiating for safe sex if they are more at ease with sex in general. A recent study comparing sexually unfaithful individuals and those in open relationships found that people who were secretly cheating were less likely to practice safe sex both in their primary relationship and in outside encounters. They were also less likely to be tested for STIs or to discuss safe sex with their partners.[6]
Educating about STI prevention is essential across the population regardless of sexual practices, as is regular screening for individuals who are sexually active.
1. Kate Kelland, “Disease Risk Higher for Swingers Than Prostitutes,” Reuters, June 23, 2010, http://www.reuters.com/article/2010/06/23/us-sex-diseases-swingers-idUSTRE65M6NX20100623.
2. “Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States,” CDC Fact Sheet, February 13, 2013, http://www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf.
3. An HPV epidemiologist I consulted suggested that due to the limitations of existing studies, this is an underestimation.
4. “Genital Herpes,” CDC Fact Sheet, www.cdc.gov/std/herpes/stdfact-herpes.htm (last updated February 11, 2013).
5. “Sexually Transmitted Infections,” Be Well: Health Education Services, Georgetown University, http://be.georgetown.edu/48377.html.
6. Terri D. Conley et al., “Unfaithful Individuals Are Less Likely to Practice Safer Sex Than Openly Nonmonogamous Individuals,” Journal of Sexual Medicine 9, no. 6 (2012): 1559–65.