You can get condoms, dams and lube for free from many gay pubs and clubs - and usually from your local sexual health clinic.

Information on sexually transmitted infections is always changing, as both new treatments and new infections appear. Therefore, no matter what the scenario, please use protection, whether it is a latex dam, latex glove or condom.

Safer sex for lesbians and bisexual women is a way to protect yourself from contracting or transmitting sexually transmitted diseases including HIV and AIDS. But what exactly is safer sex? And how can you be sure you’re protected?

First the disclaimer. If you’re sexually active, there is no 100 percent protection against contracting a sexually transmitted infection. But there are some things you can do to make your play safer.

The best way to protect yourself from contracting a sexually transmitted disease is to keep your partner’s body fluids out of your body. These fluids include vaginal fluids, blood, menstrual blood, breast milk, and semen.

Information on Safe Sex for Lesbians

Lesbians are not considered at high risk for contracting AIDS unless they share needles for intravenous (IV) drugs or have sexual contact with people who are in high-risk groups. Keep in mind that bisexual woman are at significantly higher risk of catching and spreading STI's through unprotected sex with both men and women.

According to the Women's AIDS Network of San Francisco lesbians who may be at risk for AIDS and should consider being tested for the virus include:

• Women who share needles or any other paraphernalia if using IV drugs. This is the single most important risk category for lesbians.
• Women who have used semen for donor insemination from a donor in a high-risk group who is known to be antibody positive, or whose risk status is unknown.
• Women who have received blood transfusions or blood products between 1979 and 1985.
• Women who have had sexual contact with people who use IV drugs
• Men who have had gay sex since 1979
• People of either sex whose sexual histories are unknown.

Lesbians are not at high risk of contracting or transmitting the AIDS virus at this time unless they use IV drugs or have unsafe sexual contact with people who are in high risk groups - such as bisexual men or women or men or women who use drugs.

Thus far, only a few cases of AIDS are thought to have been transmitted through female-to-female contact. If you have a new sexual partner, learn about her history and share your own. If either of you has a history that suggests the possibility of exposure to the virus, it's best to be tested before engaging in sexual activity.

Here are some low-risk activities:

• Masturbation (only touching yourself)
• Cybersex
• Nipple and breast stimulation when not lactating
• Erotic massage
• Body rubbing
• Kissing
• Using a sex toy with a condom (be sure to use a new condom if sharing sex toys)
• Cunnilingus (oral sex) with a barrier, such as a glove, dental dam or non-microwaveable plastic wrap /cling film
• Vaginal or anal contact with a latex glove

The following activities are Risky:

• Unprotected cunnilingus, especially when a woman is bleeding
• Unprotected rimming
• Sharing sex toys without a condom
• Sharing needles
• Unprotected fellatio
• Unprotected penis/vaginal intercourse
• Unprotected penis/anal intercourse

More information below for Lesbian and Bisexual women about other common and new STDs/STIs.

Sometimes referred to as 'chemical vaginitis,' this condition is a great mimicker. Because it often affects not only the vagina itself but external tissues (the vulva), it is often mistaken for a yeast infection, or even new onset genital herpes. It's due to genital contact with an irritant, the most common offending agents being latex or components of spermicides, lubricants, a new detergent/soap/bath gel, silicone sex toys, or 'feminine' deodorants. Anything that can cause an allergic skin reaction (like a rash) can cause a similar reaction on mucous membranes, including genital tissues.

Symptoms

Symptoms include red, painful or irritated or itching vulva; increased vaginal discharge. The vulva may have whitish or grayish striations or hue, along with some scaly skin.

Treatment

If you can figure out the offending substance, discontinue use. Antihistamines may help relieve symptoms. Low-dose (0.5%) cortisone cream is also effective, but consult the local NHS GUM clinic, or GP or NHS 24 before applying any steroid cream to the genital area.

BV is basically an imbalance of the normal bacteria that live in the vagina, most specifically in association with loss of the normal protective lactobacilli that normally live there in abundance. It is not clear what precisely causes BV; some researchers think women sex partners may actually transmit some undefined factor that causes it. Research continues on this question. We do know douching is a risk factor for BV (and douching is a bad idea in general).

Symptoms

Symptoms include grey to yellowish homogeneous discharge, sometimes with a fishy odour, sometimes causing vulvae and/or vaginal irritation.

Transmission

While it's not clear how women develop BV and there is ongoing research, one research article called BV an "STD among lesbians" suggest it is a “Lesbian unique” STD. This has yet to be proven, and research is under-way to look at this more closely. Whether or not partners should be evaluated or treated is not yet known.

Treatment

Antibiotic vaginal cream or oral medication. Over the counter lactobacilli supplements do not contain the specific kind of bacteria needed to replenish the vagina's natural balance.

HPV is probably the most common STD (some estimates say ~70% of all adults have evidence of previous infection), with most infected people never evidencing its two major effects: genital warts, and cervical neoplasia (pre cancerous or cancerous changes, detected as an abnormal Pap smear). It is an STD caused by skin or mucous membrane contact with an infected person. Different strains of HPV cause genital warts and cervical cancer.

Transmission WTW

Very likely occurs, probably through direct contact of genital skin, or contamination of hands/fingers. The role of insertive sex toys is not known for sure, but it's possible that HPV could be transmitted on shared toys not thoroughly cleansed between use in one (infected) partner and the next.

Treatment

If warts are present, the most common treatment is freezing using liquid nitrogen; more than one treatment may be required. There is no cure for the virus itself. Pap smears can detect HPV and cervical changes; yearly exams are essential for all sexually active women, regardless of the gender of partners. Research has shown that lesbians may be less likely to get Pap smears as frequently as they should. Get routine screening (every 1-2 years, depending on your Pap smear history) regardless of whether you have sex with men, or bisexual women.

Chlamydia is caused by bacteria transmitted to the vagina or rectum by contact with infected genital fluids. Chlamydia can infect the cervix, rectum or urethra (the passage through which urine exits the body) in women. You can also contract Chlamydia conjunctivitis, a painful eye infection that can cause blindness.

Symptoms

Most women experience no symptoms. Sometimes slightly increased vaginal discharge, spotting, burning with urination, abnormal bleeding (especially after penetration).

Transmission WTW

Theoretically possible but not yet studied. However engaging in anal or vaginal play with vibrators or fingers with a bisexual woman who is infected can increase risk of contracting anal, oral or vaginal Chlamydia.

Treatment

Oral antibiotics. All partners should be treated.

Gonorrhoea is caused by bacteria transmitted to the vagina, throat or rectum by exchanging infected genital fluids during sex.

Symptoms

Often none. Occasionally, vaginal discharge—often yellow or yellow-green—and painful urination can occur, as can abnormal bleeding, especially after penetration.

Transmission WTW

Theoretically possible but not yet studied. However engaging in anal or vaginal play with vibrators or fingers with a bisexual woman who is infected can increase risk of contracting anal, oral or vaginal Gonorrhoea.

Treatment

Antibiotics. Persons infected with gonorrhoea are also treated for chlamydia. All partners should be treated.

"Trich", a tiny protozoa, can present like BV, but unlike BV, "trich" is definitely an STD. It lives in the moist areas of the genitals of infected people (e.g. vaginal fluid, genital glands).

Symptoms

Often causes foamy discharge with foul odour, but symptoms may be absent. Painful urination, itching or irritation are sometimes present. If symptoms occur, they usually occur 4 - 20 days after infection but can begin much later.

Transmission WTW

Clearly documented, and probably underestimated. Partners should absolutely be evaluated and treated. Both partners should abstain from sexual activity until treated.

Treatment

Oral antibiotics. Partners should be treated.

Pelvic Inflammatory Disease (PID) is an infection of the uterus, fallopian tubes and ovaries. PID is caused by many kinds of bacteria, but chlamydia and gonorrhoea are the most common causes. It can also occur after childbirth, abortion, or surgery on the female organs. The infection usually starts 2 to 21 days after having sex with an infected person, but some infections do not start until several months later. PID can cause scar tissue that can block fallopian tubes causing infertility (after 1 PID infection 10% of women become infertile; 75% are infertile after 3 infections), tubal pregnancies (a woman is 7 times more likely to have a tubal pregnancy after PID), and abscesses. Some women continue to have lower abdominal pain for several months after PID.

Symptoms

Mild to severe abdominal pain, back pain, may have fever, nausea, bleeding between periods, pain with sex, vaginal discharge. Some women have no symptoms.

Transmission WTW

Transmission of the bacteria that cause PID is theoretically possible though not studied. A recent report did discuss PID occurring in two lesbians, in whom the diagnosis was initially missed because they were thought to be at 'low risk' for STD.

Treatment

Mild PID is treated with a shot of antibiotics in addition to oral antibiotics. Severe PID is treated in the hospital with IV antibiotics. Routine treatment of sex partners.

Hepatitis is an inflammation of the liver. Many potential causes, including drugs, toxins and viruses. Hepatitis A, B, and C are the three major viruses that cause hepatitis.

Symptoms

Often none. If symptoms do occur may include yellowing of skin and eyes, loss of appetite, nausea, stomach pain, extreme tiredness.

Transmission WTW

• Hepatitis A is transmitted by faecal matter either in contaminated food or by oral-anal contact. Transmission between female partners has been reported.
• Hepatitis B is transmitted by exchanging blood or body fluids. Touching an infected person's open sore or cut if you yourself have any skin breaks, or sharing a razor, toothbrush or nail clipper, can permit transmission. Even small amounts of blood or other body fluids can spread the virus if direct contact occurs. *Hepatitis A is preventable by vaccination: ask your health provider!
• Hepatitis B is not spread by food, water or casual contact. Transmission between female partners has not been studied, but has occurred. *Hepatitis B is preventable by vaccination: GP or local NHS GUM Clinic*
• Hepatitis C is transmitted primarily through contact with infected blood. Sexual transmission between men and women is relatively uncommon; WTW has not been studied.

Treatment

A complex issue. See your GP or local NHS GUM Clinic for more information.

Herpes infections are caused by the herpes simplex viruses (HSV-2 and HSV-1). Transmission can occur even when lesions are not present (in fact, probably most transmission actually occurs in the absence of skin ulcers or breakdown, which is why 90% of persons infected with HSV-2 don't know they're infected).

Symptoms

Small blisters on the vulva, often painful, are classic, but at least 90% of people infected with HSV-2, which causes the majority of genital herpes, do not know they are infected. Itching is a common symptom. In the initial episode of HSV, symptoms can include painful/difficult urination, fever, swollen lymph nodes, and flu-like symptoms.

Treatment

Three antiviral medications are now available and all work equally well. Antivirals are also recommended for recurrences and suppression when there are more than six recurrences a year. Antivirals help the symptoms of HSV and speed healing; they do not cure the virus. They also reduce the likelihood that HSV is shed in the absence of outbreaks.

Transmission WTW

Most agree it does occur, but data on specific prevalence and risks is very limited. In particular, oral-genital contact (oral sex) can transmit HSV-1 from the mouth to the genital area, especially when one partner has a cold sore.

Precautions

Because transmission can occur even when no lesions are present, any genital-genital contact should involve latex barriers 100% of the time; couples should abstain from sex during outbreaks, until the skin is fully healed.

AIDS is caused by the HIV virus. It is spread through direct contact with blood, semen, vaginal fluids, or breast milk, usually during sex, birth, or sharing needles. The HIV virus slowly attacks white blood cells which constitute a major part of the body's immune system. White blood cells fight infections. When the immune system is weak, harmful germs and infections take over, and AIDS (acquired immunodeficiency syndrome) becomes evident.

Transmission WTW

While there is little research or documentation on this topic, the medical literature does have case reports of WTW sexual transmission of HIV. The most likely sources for transmission are menstrual blood, vaginal discharge when there is vaginitis (there are more white blood cells containing HIV present then), and traumatic sex practices. However, more research is urgently needed in this area; none of these mechanisms, or their relative risk, have been directly studied yet.

Treatment

There are numerous drug therapies to help the immune system and fight the HIV virus, though at this time there is no cure. Treatments are constantly changing so for the most up to date we suggest you visit the NHS EQIP site for more information.

Syphilis is a bacteria which is passed on from warm moist parts of the body such as in your arse, mouth/throat and cock. It's easy to pick up and spread. The condition used to be relatively common in the UK until the end of the Second World War. Then the widespread availability of antibiotics meant that condition became quite rare.

However, in recent years, the number of people with the condition has increased. There were 2,766 reported cases in the UK during 2006.

Catching Syphilis increases your chances of catching HIV. Also, HIV will alter the typical course of Syphilis, increasing the chances of it progressing to tertiary Syphilis.

Transmission

Having unprotected vaginal, anal or oral sex, through genital contact, contact with syphilitic sores, rashes, lesions and blood-to-blood contact.

Symptoms

Syphilis is often known as the ‘great imitator’ due to its ability to produce symptoms that mimic a variety of other infections. The signs and symptoms of Syphilis can be difficult to recognise and some people may not even notice them. Syphilis can develop in three stages:

Primary Syphilis - The symptoms for primary syphilis can take up to 12 weeks to develop. One or more painless, red sores (chancre) may appear on the vagina, cervix, mouth, throat or arse. These sores may take between two to six weeks to heal, and this stage may also be accompanied by swelling of the glands closest to the site of infection.>

Secondary Syphilis - The secondary phase can develop four to ten weeks after the appearance of the chancre. This stage has many symptoms, and therefore can be confused with other infections. The most frequently reported symptoms include: A whole-body rash (common on soles of feet and palms of hands), fever, headaches, patchy hair loss and swollen lymph nodes. These signs and symptoms will clear up with or without treatment. However, without treatment, the infection will develop into the tertiary stage.

Tertiary Syphilis - When the symptoms of secondary Syphilis have subsided, the infection enters this stage. This means that although the person will have no symptoms, they are still infected. Left untreated, syphilis can cause serious damage to the heart, nervous system and brain. This internal damage may turn up many years later, and the time frame for this progression is very variable; varying from three to ten years.

Syphilitic ulcers can also facilitate the transmission of HIV infection, and therefore increase the likelihood of contracting the virus. This is because the ulcers provide a route for the infection to get into the blood system.

Research has also been carried out which reports that Syphilis infection can cause the viral load of people who are HIV positive to rise. Although syphilis is treatable, people living with HIV may experience more problems in curing a syphilis infection due having a weakened immune system. Therefore, treatment for Syphilis in people living with HIV may be longer compared with someone who is HIV negative.

Treatment

A simple blood test is also carried out to detect the presence of the infection. If sores are present, a swab is taken and examined.

Antibiotics are given to treat the infection for up to two weeks. A second blood test is then taken after the antibiotic course to check if the infection has cleared up fully. It’s also important for your sexual partners to get checked too.