Anal Fisting and STIs: Risks, Protection and Testing

HIV and hepatitis usually get all the attention in the safer-fisting conversation, rightly so. But there’s a whole range of other sexually transmitted infections (STIs) that play a role in fisting and in the context of anal sexual practices. Some of them are barely discussed, although they’re more common than HIV. This article gives you a clear overview: which STIs are relevant, how they’re transmitted, how you protect yourself and when a test is due. Fact-based and without drama.

1.1 Which STIs are relevant in fisting?

In fisting and in the wider context of anal practices, these infections are above all relevant. They differ greatly in transmission route, frequency and treatment:

HIV and hepatitis we cover in detail in their own articles: Fisting & HIV and Fisting & Hepatitis.

1.2 Why fisting is its own STI topic

Two things make fisting STI-relevant. First, the small mucosal injuries that serve as entry points for pathogens. Second, and often underestimated, the faecal-oral path: in fisting, hands come into contact with bowel content, and what happens with those hands afterwards (mouth, shared lube, toys) decides whether pathogens like shigella are transmitted. Group settings with partner switching amplify both.

2.1 Shigella: diarrhoea after fisting

If heavy, sometimes bloody-mucousy diarrhoea sets in a day or two after a fisting session, shigellosis is a possibility to take seriously. Shigella are bacteria transmitted faecal-orally, and that’s exactly the route present in fisting and anal practices. Even a very small amount of pathogens is enough for an infection.

Important to know: several major cities have repeatedly seen shigella outbreaks among men who have sex with men, some with antibiotic-resistant pathogens. A severe diarrhoeal illness within about three days of anal sex contacts is a clear signal to see a doctor promptly and have a stool test done. Recognised in time, shigellosis is well treatable; untreated, the diarrhoea can last longer and in extreme cases lead to dangerous dehydration.

Protection comes above all from consistent hygiene: thorough handwashing after the session, no hand-to-mouth contact in between, an individual lube container and glove changes. More on this under Hygiene & Preparation.

2.2 Syphilis

Syphilis has become markedly more common in recent years, especially among MSM. It’s transmitted via skin and mucosa contact, often through small, painless ulcers that are easily overlooked. The tricky part: the early symptoms disappear on their own, but the infection persists and, untreated, can cause severe organ damage after years.

The good news: syphilis is well curable with penicillin, especially in the early stage. Because it often runs inconspicuously, regular testing is the only reliable way to detect it early.

2.3 Gonorrhoea and chlamydia

Gonorrhoea and chlamydia are two of the most common bacterial STIs and can settle in the rectum, often without clear symptoms. A particular variant of chlamydia, lymphogranuloma venereum (LGV), occurs mainly among MSM and can lead to painful inflammation in the anal area.

Both are in principle well treatable with antibiotics. With gonorrhoea, however, there’s a worrying development: the pathogens are becoming increasingly resistant to common antibiotics, and cases of extensively drug-resistant gonococci have been recorded in the UK and elsewhere. That’s no reason for panic, but a good reason to always have gonorrhoea treated medically and according to guidelines, not with leftovers from the bathroom cabinet.

2.4 HPV and herpes

HPV (human papillomaviruses) are transmitted via skin and mucosa contact and are extremely widespread. Certain types can cause genital warts, others raise the long-term risk of anal cancer. There’s a vaccine against the most important HPV types, ideally given before the first sexual contacts, but it can still be sensible later.

Herpes (HSV) causes recurring blisters and isn’t curable, but it’s well controllable with antiviral medication. During an active outbreak the risk of transmission is highest, in that phase a pause is the most sensible decision.

2.5 Mpox

Mpox is transmitted above all via close skin-to-skin contact and has spread increasingly in sexual networks in recent years, particularly among MSM. The illness is mostly self-limiting but can be very unpleasant and painful.

There’s a vaccine, recommended for MSM with frequently changing partners as well as for PrEP users and people with HIV. Anyone in this group should discuss vaccination protection with their doctor.

3.1 Protective measures in fisting

The good news: the same measures that protect against HIV and hepatitis also clearly lower the STI risk:

• Gloves, fresh per partner and body opening.
• Individual lube container per person, no shared pot.
• Consistent hand hygiene, especially against faecal-orally transmitted pathogens like shigella, no hand-to-mouth contact during the session.
• Cover toys with a condom and change between partners or clean.
• Take up vaccinations: hepatitis A and B, HPV, Mpox.
• Pause with symptoms or active outbreaks.

One limitation, to be honest: unlike with HIV, gloves offer only limited protection against pathogens that run via pure skin or mucosa contact (syphilis, HPV, herpes). Here vaccinations, regular testing and pausing with visible symptoms count for more.

3.2 Doxy-PEP: antibiotic prophylaxis?

In recent years so-called doxy-PEP has been discussed: taking the antibiotic doxycycline after a risk contact to prevent bacterial STIs. Studies show that taking it within 24 to 72 hours after sex can clearly lower the risk of syphilis and chlamydia among MSM, by about two thirds.

Important context: doxy-PEP is not a blanket recommendation in the UK but a case-by-case medical decision with clear criteria. It doesn’t work reliably against gonorrhoea (resistance), doesn’t protect against viruses like HIV or hepatitis, and broad antibiotic use raises resistance questions. Put differently: doxy-PEP is no free pass and replaces neither condoms nor regular testing. Anyone considering it should discuss it with an HIV or sexual health clinic.

4.1 Testing: what, where and how often

Because many STIs run without symptoms, regular testing is the single most important measure. For sexually active MSM with changing partners, a syphilis test twice a year is recommended, more often with high risk. Important here: a complete check also includes swabs from the rectum and throat, not just a urine sample, many anal and oral infections are otherwise missed.

You can get tests at NHS sexual health (GUM) clinics, in many places free and anonymous; Terrence Higgins Trust is a long-standing, stigma-free contact familiar with the subject. A regular all-round check isn’t a weakness but part of responsible sexuality, roughly like an MOT, just for topics people talk about less often.

5.1 Myths about STIs and fisting

About the authors

This guide was put together by the editorial team at fist.club, the online magazine and knowledge portal of Fist Club Europe e.V., an association based in Berlin. The content is based on practical experience from our workshops, exchanges with workshop leaders and community members, and on medical literature and the recommendations of UK health authorities (UKHSA), sexual-health bodies (BASHH) and sexual-health organisations. This article is no substitute for medical advice.

More about us: The Association · Workshops & Seminars · Become a member

This guide is no substitute for medical advice. With symptoms or for vaccinations, turn to your doctor or a sexual health clinic. Further articles: Safer Fisting, Fisting & HIV, Fisting & Hepatitis, Hygiene & Preparation, Fisting for Beginners, Glossary.