Recently, my husband endured a mild case of COVID—a cough, a sore throat, some aches and fatigue. Fortunately, he is vaccinated and boosted, and he recovered quickly. On day 10 after infection, he produced a negative rapid antigen test. Cool! So when can we have sex?
This, it turns out, is a more complicated question than it might appear. And although Omicron appears to be loosening its grip on the U.S., the virus is nowhere near done with us, meaning plenty of people will be asking the same question in the weeks and months to come.
We know that SARS-CoV-2, the coronavirus that causes COVID, is spread mostly through the air—that is, by people breathing in infectious aerosols or respiratory droplets that are produced when someone speaks, coughs, sneezes or breathes (or breathes heavily).
Close contact could get tricky pretty fast for those hoping to resume their sex lives immediately after a COVID bout. The close contact that comes with intimacy or kissing can place you at higher risk of catching the virus if your significant other is infected—even if they are asymptomatic. The coronavirus can spread with close heavy breathing or contact with saliva. This much is understood. But in terms of intercourse itself, what do we really know?
First, there is no evidence that COVID-19 is a sexually transmitted disease (STD). While the coronavirus is primarily spread through respiratory fluids, STDs are mostly spread through contact with other body fluids: semen, vaginal secretions, blood, et cetera.
Bits of the viral genome have been detected in semen from small groups of COVID-19 patients in studies using polymerase chain reaction (PCR) assays. Further methods to identify whether infectious virus is present—growing it in the lab or seeing if the virus is trying to copy itself—have so far yielded negative results, says A.J. te Velthuis, a virology and molecular biology expert at Princeton University. “So, overall, it seems that no active virus is present in the testes/prostate. The same is true for vaginal excretions.”
Two small studies of women with severe COVID-19 did not find the virus detectable in vaginal fluids, and another study of 12 pregnant women with confirmed COVID infection did not either. Nelson Bennett, a urologist at Northwestern University School of Medicine, and Justin Dubin, a urology fellow specializing in male sexual medicine and infertility at Northwestern University School of Medicine, both say that while they hope to see more research in this area, the risk of transmitting COVID via sexual activity is “very low.”
The virus has been detected in stool samples of patients with COVID-19, and more studies are needed to determine whether one might spread the virus during anal sex or such sexual activities as rimming (placing the mouth on the anus).
Even after 10 days and even after vaccination, “there is some risk of viral transmission via air or saliva,” te Velthuis says. But if you’ve tested negative after a lateral flow assay—a rapid antigen test—that risk is limited, and “sexual activity should then also be no problem,” he adds.
Now, keep in mind some common sense: Safe sex is certainly recommended. The Centers for Disease Control and Prevention cautions that a negative antigen test “does not necessarily indicate the absence of transmissible virus.”
If your partner or you are in isolation, have a known exposure or are experiencing typical COVID symptoms, you shouldn’t have sex. If someone has just had COVID-19, Bennett suggests taking a rapid test, while Dubin adds, “It isn’t the sex that will get you COVID but everything else that leads up to it. Sharing smaller closed spaces, being in close contact, kissing—these are all much more risky behaviors for COVID infection than the sex itself.”
According to NASTAD, the National Coalition of STD Directors, you should make sure three things have happened after you have recovered from COVID before you resume sexual activity with a household partner: no fever for three days without the use of fever-reducing medications; improvement of other symptoms; and the passage of 10 days since your symptoms began.
Michael Mina, an expert on rapid tests and chief science officer at EMed, says that if you had COVID but then posted two negative rapid tests 24 hours apart, you’re “very, very unlikely” to pass the virus either through kissing or by having sex. “I’d argue it is not even necessary to wait the full 10 days,” Mina says.
Amid the uncertainty, the safest partner is you. Masturbation does not spread COVID-19 and thus is very safe. And rates of masturbation have increased during the pandemic, according to Susan Milstein, co-author of Human Sexuality: Making Informed Decisions. If you’re having sex with someone who does not live with you, you may not know what precautions that person has been taking, and asymptomatic spread can occur. For obvious reasons, intimacy with multiple partners can contribute to the spread of COVID.
Video dates, sexting, erotic phone conversations and online chat rooms are all noncontact options. With respect to physical contact outside the home, it’s all about precautions. “Sex is sex. It’s going to happen,” says Dianne Rosenberg, a retired ob-gyn physician. “Have a glass of wine together while checking a rapid test and wear a condom.”
While some recommendations may seem impractical, experts have suggested measures that will likely reduce your risk of contracting COVID or sexually transmitted infections during sex. Using condoms, avoiding or limiting kissing, continuing masking, washing sex toys before and after use—these may all make a difference. So may reducing the number of sexual partners, choosing positions that limit face-to-face contact, keeping windows open and improving ventilation. Prior to and after sex, washing your hands and body with soap and water is a good idea.
And of course, getting vaccinated and boosted, as well as masking in public spaces, remain priorities. Not only do they help control the pandemic, but they are safe-sex precautions in their own right.
People who have weakened immune systems or are at high risk of severe COVID-19—those with diabetes, cancer or lung disease, for example—might consider abstaining from sex with people outside their household, taking extra precautions and checking with their physicians.
Safe sex during a pandemic means considering what your partner’s vaccination status is, what changes work best for both of you and what you each need from sex—and sharing that information with each other. Like so many facets of COVID, we still have much to learn. But even for those who’ve contracted the virus, it’s mostly good news.
And it is needed. “Sexual health is just as important as a functioning heart, mental health and all other aspects of physical health,” says Jessica Kingston, an obstetrics and gynecology physician at UC San Diego Health. In the midst of a global pandemic, anything that brings us such pleasure or joy is well worth a few precautions.