I know that casual sex and the hookup culture are often considered the norm in college, and many students don’t consider negative consequences beyond pregnancy.
Unfortunately, nearly half (48.2%) of the 2.4 million reported cases of chlamydia, gonorrhea and syphilis (all stages) in the United States in the most recent year surveyed were among adolescents and young adults ages 15 to 24 years, according to the Sexually Transmitted Infections Surveillance, 2023 from the US Centers for Disease Control and Prevention.
What I’ve seen in my clinical experience is that teens and young adults often overlook the need for protection against infections, especially when they are using birth control pills or IUDs to prevent pregnancy. In fact, the Spring 2024 National College Health Assessment data shows that only half (50.2%) of the students who used any method of contraception reported using a male condom the last time they had vaginal intercourse.
As a college health doctor, I’m aware that many college students are having sex, and that is clearly their choice. But I’ve seen firsthand how emotionally and physically devastating these diagnoses can be, with tears flooding the exam room from students diagnosed with herpes, chlamydia, gonorrhea, genital warts or HIV.
Whether the disease is curable or chronic, the emotional toll is often greater than the physical symptoms — especially since many of these sexually transmitted infections could have been prevented.
That’s why I want you to know what’s really going on in college and what you can do to keep yourself safe and healthy. This is the no-judgment, real-world talk that everyone deserves to hear before swiping right in college — or anywhere.
Is everyone else having sex?
First, don’t believe everything you hear in your dorm, at the dining hall or at keg-fueled parties. While students will hear that “everyone” is hooking up, that’s not true.
Nearly 52% percent of college students reported having vaginal intercourse within the last year, according to the 2024 American College Health Association National College Health Assessment. That means 48% did not.
And it’s not all consensual sex. True consent is clear, enthusiastic, ongoing, verbalised, freely given and able to be withdrawn at any time. Students often feel pressured to be more physically intimate to fit in.
Thirteen per cent of undergrads report “nonconsensual sexual contact by physical force or inability to consent,” according to the Association of American Universities. Intoxicated or high individuals cannot give consent, yet many hookups happen under the influence.
Many students have tearfully shared that they “just wanted to get it over with” or chose oral or anal sex to stay a “technical virgin.” Some feel guilt or regret, while others are fully comfortable with their physical intimacy but are shocked by an STI or pregnancy diagnosis.
You can’t tell who has an STI
When a student comes in concerned about a genital rash, blisters, discharge or pain with urination, STI testing is part of the workup. Students often are selective about which STI tests they want; they’re often fine with checking for chlamydia and gonorrhea but decline HIV testing, because their partner is “not that kind of person.”
While the myth persists that these diseases are passed around in other communities (not yours), sexually transmitted infections don’t discriminate. Your risk of an STI comes from behavioural choices, not anyone’s appearance, skin colour, culture, religion, values, wealth, sexual orientation or political persuasion.
Yes, some STIs are more common in certain populations. But check your bias anyway, especially with HIV. Heterosexual contact accounted for 22% of new HIV infections in the United States in 2022, and 13- to 24-year-olds made up 20% of new HIV diagnoses, according to HIV.gov, a federal website with information and resources related to HIV/AIDS from the US government. Additionally, young adults are increasingly more fluid in their sexuality, which includes having more bisexual experiences, whether or not they identify as gay or bisexual.
If you test positive for one STI, you need more testing. Sexually transmitted infections are mostly spread through body fluids, and some are simply shared through direct contact. If you’ve contracted one infection, you may have another, so you should be tested for them. Unfortunately, we frequently diagnose more than one at a time.
Oral sex is not risk-free
Did you know your partner’s cold sore can become your genital herpes? Cold sores are caused by herpes simplex virus type 1, or HSV-1, which is easily transmitted by direct contact from one person’s oral area to another person’s genitals. While herpes is probably the most common disease we see passed via oral sex, it’s not the only one.
Chlamydia, gonorrhea, syphilis, human papillomavirus (HPV), herpes and, less commonly, HIV can all be spread bidirectionally from oral-genital intimacy. That means STIs can also cause throat, genital and anal infections. Barriers such as condoms or dental dams can significantly reduce your risk. (This is why flavoured condoms exist.)
No sign of symptoms is no guarantee
Most STIs are silent, causing no, fleeting or minimal symptoms, yet capable of causing significant disease in you or your partner. Screening tests are critical to detect asymptomatic bacterial infections early, while they can still be easily treated.
Chlamydia is the most common bacterial STI in the world, according to the Pan American Health Organisation. Chlamydia is also the most common bacterial STI in the United States, with more than 1.5 million reported cases per year, and yet chlamydia causes no obvious symptoms in most women (75% of females and 50% of males, according to Scripps Health). Left untreated, 10% to 15% of women will develop pelvic inflammatory disease, or PID, and roughly 10% of those women with PID develop infertility, according to the Cleveland Clinic.
Gonorrhea is the second most common bacterial STI, with more than 600.000 cases in the United States in 2023, according to the National Overview of STIs in 2023. Although gonorrhea can also cause PID, very often there is a coinfection with chlamydia, ranging from 10% to 40% in some National Institutes of Health studies. Gonorrhea’s biggest challenge is its growing resistance to antibiotics, making it increasingly difficult to treat.
PID is the most common preventable cause of female infertility in the United States, affecting an estimated 100,000 women per year, the Cleveland Clinic noted. Sexually active young women should proactively get tested for chlamydia and gonorrhea each year to protect their future fertility.
Human papillomavirus is the most common STI overall. Although most HPV infections will resolve spontaneously without problems, persistent infections can quickly cause genital warts or, years later, lead to cancer. Because HPV may be transmitted to a person performing oral sex, HPV also causes 60% to 70% of the roughly 60,000 oropharyngeal cancers (twice as common in men versus women) diagnosed annually in the United States, according to the American Cancer Society.
The emotional burden of STIs
Human papillomavirus genital warts are not lethal, but they will make you miserable. The treatment is painful, with repeated procedures and a high risk of recurrence. Patients are often scared, embarrassed and emotionally distraught, terrified that this incurable disease will make them undesirable to any future potential partners. I cannot emphasise enough how this emotional burden (which we see with herpes and HIV as well) critically affects students’ self-image, confidence and mental health.
Since the HPV vaccine rollout, HPV high-risk infections (including genital warts) have fallen by up to 88% among teen girls and young women, thanks to both direct immunisation and herd immunity, according to the CDC.
Patients with genital warts used to fill our college clinics, and now thankfully are significantly less common. The Human Papillomavirus Vaccine Impact Monitoring Project shows that cervical precancers dropped roughly 80% in women ages 20 to 24, and researchers predict HPV vaccination can prevent over 90% of all HPV-related cancers from ever developing, according to the CDC.
How to reduce your risk
If you’re going to have sex, be prepared before you have sex. Birth control pills are extremely effective when used correctly, but college life is filled with irregular schedules, late nights, road trip weekends and, for some people — vomiting. If pills are delayed, forgotten, missed or thrown up, the efficacy plummets.
Adding condoms not only decreases your risk of conception but also adds protection against STIs. Do not, however, double up on condoms. This myth is still perpetuated, but using two condoms at once can increase your risk of breakage and failure.
Numbers also matter. If you never drive or ride in a car, you’ll never have a car accident. The more you drive, the higher your cumulative risk. It’s math, not morality.
What you deserve
Teens and young adults deserve more than outdated, awkward and judgmental sex talks. They need to learn how to protect their health, their future fertility and their emotional well-being while learning to live life as adults. If more students knew this information, far fewer would end up blindsided in their college medical centre’s exam rooms.
Hookups may be part of college culture for many students, but let’s normalise being open, prepared and honest about the risks. Check with your university health centre to learn more about prevention, screening and treatment.
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