We’ve talked extensively about HIV and the various hepatitis viruses. But the world of sexually transmitted infections (STIs) has a few other players you should be aware of to be truly safe. Don’t worry – this isn’t about fear-mongering, but about expanding your shield of knowledge.

Here, we’ll focus on the “classic” bacterial STIs: syphilis, gonorrhea, and chlamydia. These infections are usually immediately associated with unprotected anal sex. But even with fisting – which is generally considered safer because there’s no direct genital contact – these bacteria can be transmitted under certain circumstances. This happens whenever infectious bodily fluids or secretions are involved. Let’s take a closer look so you know what to watch out for.

Syphilis (also called lues) is a true chameleon among sexually transmitted diseases. The causative bacterium (Treponema pallidum) can infect virtually any part of your body – and often there are no symptoms or only non-specific ones. In the early stage, a painless sore (the famous chancre) sometimes forms at the entry point, such as on the penis, lip, or in the anal area. Because this ulcer doesn’t hurt and disappears on its own, it often goes unnoticed – especially if it’s inside the rectum and can’t be seen. However, if left untreated, syphilis continues to slumber in the body and can severely damage organs and even the nervous system over several stages. Late consequences of untreated syphilis can include paralysis, blindness, deafness, or mental deterioration. In short: Syphilis is insidious and should not be underestimated.

How can syphilis be transmitted during fisting?

Transmission occurs through direct contact with syphilitic sores or infected mucous membranes. The tricky part is that a syphilis sore can also be unnoticed in the rectum. So, if you’re fisting someone who has such an invisible sore in the anal area, you could get infected – specifically, if the bacteria get onto your hand (or into tiny skin tears on it). Conversely (though less common), a syphilis sore on your hand could transmit the bacteria to your partner’s sensitive mucous membrane. Important to know: Fisting itself does not increase the risk of syphilis, but your hand can become a transmitter as soon as infectious fluids or lesions are involved.

Your shield against syphilis:

• Gloves are your best friend: Consistently wear latex or nitrile gloves when fisting. They provide the perfect barrier and prevent direct skin contact with any existing (often invisible) sores. Make sure to use oil-free lubricant, as oil can damage latex.

• Eyes open and hands off: If you or your partner notice unusual wounds, weeping areas, or rashes on your hands, penis, or in the anal area – don’t touch! In such a case, keep your hands off and see a doctor. Weeping skin areas or sores should generally not be touched.

• Get tested regularly: Syphilis is highly curable with antibiotics (usually penicillin injections over several weeks) – but only if you know about the infection. A blood test as part of a regular STI check gives you certainty and detects syphilis at any stage. Since the risk of infection is never completely zero despite all precautions, it’s better to get tested more often to treat it early if necessary.

• Important note for your syphilis test: If you’ve had syphilis before, the usual screening tests (rapid tests) are no longer conclusive – they would show positive for life, even if you’re long healthy. In this case, you should ask your doctor to perform specific laboratory tests (e.g., TPHA or TPPA test and an RPR titer) to distinguish between an old antibody reaction and a new, active infection. This is the only way to reliably detect a fresh syphilis flare-up. It’s also important: In people with immunodeficiency (e.g., untreated HIV infection), syphilis tests can rarely be false-negative. So, if in doubt, keep a watchful eye on possible symptoms and seek medical advice early.

Gonorrhea and chlamydia are bacteria that like to make themselves at home in our mucous membranes – including the rectum. The nasty thing about them: There, they often cause no symptoms at all, but are still highly contagious. It’s not for nothing that they are called “silent” or “invisible” infections. If left untreated, both can lead to chronic inflammation, which can have long-term health consequences – e.g., infertility, prostate or epididymitis in men, or salpingitis in women. Therefore, it is important to take them seriously even without symptoms.

Gonorrhea: Many people associate gonorrhea with pus discharge from the penis – and yes, in the urethra, a gonococcal infection usually leads to severe burning during urination and a milky-white, later yellowish, pus discharge after a few days. But: Gonorrhea bacteria (Neisseria gonorrhoeae) also thrive in the throat or rectum, often completely unnoticed. Anal gonorrhea remains asymptomatic in most cases; only rarely do slimy-purulent admixtures in the stool or pain during anal sex occur. Don’t be fooled: Even without symptoms, anal gonorrhea is highly contagious. If the infection spreads further, untreated gonorrhea can spread throughout the body and affect, for example, the prostate, epididymis, or even joints and the heart. Signs of an advanced infection can include dull pain in the perineum/pelvis, fever, or swelling. In short: Gonorrhea is annoyingly easy to transmit and should be treated quickly.

Chlamydia: Chlamydia trachomatis – the name of the pathogen – is among the most common STIs overall. Like gonorrhea, it is transmitted through all types of sex and preferentially infects the urethra, genital tract, rectum, and throat. Most of the time, you don’t feel anything. If symptoms do occur, they typically appear 1–3 weeks after infection: there may be clear discharge from the urethra, itching, burning during urination; sometimes also pain in the testicles or lower abdomen and a slight fever if the infection “ascends” (i.e., reaches the prostate, seminal ducts, or, in women, the uterus and fallopian tubes). Because chlamydia infections are so often silent, they frequently go undetected – and can then be unknowingly passed on or cause long-term consequences (e.g., adhesions of the fallopian tubes with the risk of infertility or ectopic pregnancies in women). So, here too: better to get tested one more time.

How can gonorrhea chlamydia be transmitted during fisting?

Mainly through cross-contamination. Imagine person A has an unnoticed chlamydia or gonorrhea infection in their rectum. You fist this person and get microscopic amounts of infectious rectal secretions on your glove or hand. If you then – with the same glove or unwashed fingers – fist person B or carelessly touch your own eye, the bacteria can spread and colonize the next mucous membrane. This is exactly how transmission happens during fisting: not through the fisting itself, but by infected bodily fluids moving from one person to another. Gonococci are particularly efficient – they are easily transmitted with every contact with infected mucous membranes, even through brief touches with fingers, shared toys, or mutual masturbation. While these bacteria don’t survive long outside the body, a little secretion is enough for direct mucous membrane-to-mucous membrane contact. That’s why hygiene is key here.

Your shield against gonorrhea chlamydia:

• Hygiene and fresh gloves: This is the be-all and end-all when fisting. Use a fresh glove for each person and each orifice – this prevents bacteria from traveling. So, change your glove (and possibly the condom on toys) before moving from partner A to partner B. Also, don’t all reach into the same lubricant pot to avoid spreading germs. After the action: Dispose of gloves correctly and wash your hands thoroughly (with soap!). This minimizes the risk of accidentally infecting yourself on mucous membranes (eyes, mouth, your own genitals) if germs have gotten onto your hands.

• Get targeted testing: Because gonorrhea and chlamydia often remain asymptomatic, especially in the throat and rectum, a urine test during your STI check isn’t always enough. If you are sexually very active, specifically ask for swabs from the rectum and throat during your check-up. Many public health offices or checkpoints offer such tests easily and anonymously. Remember to ideally get tested for gonorrhea and chlamydia at least once a year – more often if you have frequently changing partners or risky contacts. If detected early, both infections are easily curable with antibiotics.

• Watch for symptoms: If you experience burning, itching, an unusual smell, or discharge from the urethra, don’t hesitate: See a doctor! Pain during urination, anal sex, or unusual discharge from the penis/anus can also be warning signs. It’s better to get it checked out – gonorrhea and chlamydia are treatable with the right antibiotics, and the sooner, the better. Important: If an infection is confirmed, all recent sexual partners should be informed and treated to prevent re-infection (to avoid the “ping-pong” effect). During treatment (usually just a few days of antibiotics), also remember: no sex until the doctor gives the all-clear.

In addition to the three major bacterial STIs, there are a few other pathogens to keep in mind. These include herpes, HPV (Human Papillomaviruses, which cause genital warts), LGV (Lymphogranuloma venereum, an aggressive form of chlamydia infection), Shigella bacteria, and parasites like intestinal amoebas. In recent years, mycoplasmas (especially Mycoplasma genitalium) and ureaplasmas have also been increasingly discussed – small, cell wall-less bacteria that are sexually transmissible and often overlooked. Poor hygiene can promote the spread of all these pathogens.

• Herpes: The herpes simplex virus (types 1 and 2) causes painful blisters on the lips or in the genital/anal area. It is transmitted through direct skin or mucous membrane contact – unfortunately, even when there is no visible blister (the virus can be “silent”). So, theoretically, herpes can be transmitted during fisting, for example, if someone has an active sore on their anus and the other person touches it with their bare hand. A glove significantly reduces this risk, but does not provide 100% protection, as herpes can also affect surrounding skin areas. It’s best to avoid sexual contact as soon as a partner has visible herpes lesions.

• Symptoms: The first outbreak often brings fever and fatigue, along with painful blisters and open sores at the infection site. Later, local outbreaks may recur.

• Treatment: Herpes is not curable, as the virus remains in the body. But antiviral medications (e.g., acyclovir) can shorten outbreaks and alleviate symptoms. It’s important not to scratch yourself or others: Open herpes blisters are highly infectious, so keep your hands off and cover them well until everything has healed.

• HPV (Human Papillomaviruses): HPV is extremely common – most sexually active people get infected at some point. Fortunately, most HPV types cause no symptoms at all and often clear up on their own. However, some types cause genital warts (small, skin-colored warts on the penis, anus, perineum, etc.), while others can lead to cancer in the long term (e.g., anal cancer, cervical cancer). HPV is transmitted through skin contact. This means that even with a condom or glove, you can get infected in uncovered areas.

• Symptoms: Genital warts are visible and palpable, but they don’t hurt. High-risk HPV types are not noticed at all – cell changes may only appear years later.

• Treatment: Genital warts can be removed or frozen by a doctor, but they often recur because HPV remains in the skin. Fortunately, there is a vaccine against certain dangerous HPV types, which is highly recommended (preferably before first sexual contact at a young age). This vaccine protects against the most common wart and cancer-causing types and is an important preventive measure. In short: Gloves and condoms reduce the HPV risk, but the best protection is offered by vaccination in combination with regular check-ups.

• Mycoplasmas (M. genitalium) Ureaplasmas: These are tiny bacteria without a cell wall that can also be sexually transmitted. Mycoplasma genitalium has only recently been researched more intensively and is considered an “emerging” STI. It is most comparable to chlamydia: Most infections are asymptomatic, but there can be slight watery discharge, burning in the urethra, or itching. Mycoplasmas can also occur in the rectum or throat. Why are they on everyone’s lips? Because M. genitalium unfortunately quickly develops resistance to antibiotics. Classic broad-spectrum antibiotics (as used for gonorrhea/chlamydia) often don’t work, so specific reserve medications must be used for treatment. Experts are already warning of a “superbug”. The current recommendation: Test and treat mycoplasmas only if symptoms are present and other causes (gonorrhea, chlamydia) have been ruled out. If this is the case, detection is done via PCR swab in the laboratory and therapy according to current guidelines with specific antibiotics (possibly after resistance testing). Inform partners if you test positive so they can also be tested if they have symptoms.

• Ureaplasmas (e.g., Ureaplasma urealyticum) are close relatives of mycoplasmas. However, they are extremely common in healthy people’s mucous membranes. Over 80% of women and more than half of men have ureaplasmas as normal colonizers, usually without symptoms. In rare cases, U. urealyticum can cause urethritis – especially in men, and only if very many bacteria are present. Since in about 80% of cases, ureaplasma detection occurs without symptoms, doctors are very reluctant to treat ureaplasmas. Note: Not every lab finding is an infection requiring treatment. Only if clear symptoms are present and no other pathogens like gonococci, chlamydia, or mycoplasmas are responsible, is therapy against ureaplasmas considered. Otherwise, our body often lives peacefully with them. Good hygiene and safer sex naturally also reduce the risk of infection here.

• LGV (Lymphogranuloma venereum): This is a special variant of chlamydia (type L1-L3) that has increasingly appeared in the gay community in recent years. LGV causes significant inflammation in the rectum (proctitis) with severe pain, sometimes bloody-purulent discharge, and fever. LGV can be transmitted during fisting if secretions from an inflamed intestine are carried over. Diagnosis is made via a special chlamydia test that identifies the LGV type.

• Treatment: The normal chlamydia therapy (1 week of doxycycline) is not sufficient here – LGV usually needs to be treated with antibiotics (doxycycline) for 21 days. It is important to seek medical advice immediately if you experience corresponding symptoms (severe anal discomfort).

• Shigella Intestinal Parasites: During fisting, as with all practices involving possible contact with fecal germs, gastrointestinal infections can occur. Shigella bacteria, for example, cause a severe diarrheal disease (dysentery) and have been repeatedly registered in recent years in outbreaks among MSM in connection with sexual contacts. Even tiny traces of infectious stool, which get into the mouth or a wound via the hand, toys, or the penis, can be enough. The same applies to intestinal parasites such as amoebae (e.g., Entamoeba histolytica) or Giardia: they cause diarrhea, abdominal cramps, and nausea.

• Protection: In addition to gloves, careful hygiene and no oral contact after anal contact (i.e., do not lick someone or put the penis in the mouth unwashed after fisting, etc.) are particularly helpful here. Wash or change gloves, clean toys thoroughly, and use fresh lubricant when changing partners (not the same pot). This way, “unwanted cohabitants” in the intestine can be effectively kept away.

As you can see, the range of pathogens is diverse. Fortunately, most are treatable, and with a few simple measures, you can significantly reduce the risk.

Let’s summarize the best strategies to protect yourself from the entire STI spectrum while still having fun:

1. Barrier methods are non-negotiable: Always wear gloves when fisting. They protect not only against HIV and hepatitis but also against syphilis, gonorrhea co. by preventing direct contact with infectious material. The same applies to other types of play: use lubricant-compatible condoms on dildos/toys if they are used with multiple partners, and always for anal sex. In short: use barriers where they fit – they are your best defense blocker.

2. Hygiene and the right order: Change gloves and condoms regularly, especially when changing partners. Ideally, each person has their own lubricant pot – or you use single-use packs – so that nothing is spread. Wash your hands thoroughly before going from anal to oral or to the next partner. And make sure your fingernails are short and smooth when fisting to avoid micro-injuries. Cleanliness and caution are key to preventing unwelcome germs.

3. Regular testing: Knowledge is power – and protection. Get tested regularly for STIs, especially if you have frequently changing partners. A complete check for men who practice anal sex/fisting also includes throat and anal swabs (in addition to blood tests for syphilis, HIV, hepatitis). Many infections remain unnoticed for a long time; tests allow you to detect them early and treat them before complications occur or you unknowingly infect others. Make it a routine, e.g., schedule an STI check every 3 to 6 months, depending on your activity.

4. Open communication: Talk to your sex partners about safer sex. Sure, it can be unusual in the heat of the moment, but it builds trust. If everyone knows where they stand – e.g., whether someone recently had an infection, is undergoing treatment, or needs to pay special attention to something – you can minimize risks together. Don’t be afraid to ask for test results or offer your own. And if you are diagnosed with an STI yourself, inform your recent partners so they can also get tested and treated. Transparency ultimately protects everyone involved.

5. Listen to your body: You know your body best. If something seems unusual to you – be it tingling, burning, rash, discharge, unusual odor, or simply a “gut feeling” that something is wrong – take it seriously. If in doubt, refrain from sexual activity until you have it medically clarified. Many STI symptoms are initially mild (e.g., slight burning during urination), but they are warning signs. Almost every STI is treatable if detected early. However, if the signs are ignored, it can become complicated. So: Better to see a doctor once too often than once too little.

Yes, theoretically you can get syphilis, gonorrhea, or chlamydia from fisting. But the good news is: With simple protective measures – gloves, hygiene, and regular testing – you have the risks well under control. Almost all mentioned STIs are curable or at least treatable if detected early, and you don’t have to let their shadow drive you crazy. Stay up to date on new developments (e.g., new testing options, vaccinations like the HPV vaccine, or recommendations on mycoplasmas that we discussed above) – your knowledge is a strong shield. This way, you can make your sexual encounters conscious, safe, and enjoyable. Because ultimately, fisting – like any sexual activity – should primarily be fun, and with the right know-how, it remains so: carefree and sexy, but safe!