You know how to prevent STIs, but how do you stop the flu and COVID during a hookup?

How likely are you to get COVID-19 or the flu while having sex?

COVID-19 and the flu aren't sexually transmitted infections, but being up close and personal with someone who could be contagious is still a concern.

“There are a handful of small, limited studies examining transmission of respiratory viruses during sex but there is not a reliable percentage for catching COVID or flu during sex,” says Dr. Andi Toufexis, a family medicine physician and founder of the sexual health education platform Your Doctor Bestie. “In general, close contact with someone who has respiratory symptoms increases the risk of catching COVID or flu.”

Basically, you can’t social distance when you’re having in-person sex, so your risk increases because you're breathing so close to another person.

“I think there is certainly an increased risk of transmission because of the type of contact,” says Dr. Josefina Batista, the pediatric medical director at Midwest Express Clinic. “You know, you’re kissing, breathing heavily, you’re close to someone’s face for an extended period of time, sometimes the ventilation is poor.”

If you eat in restaurants, go to indoor concerts or movies, or work in an office, you risk contracting COVID-19 or the flu. But the risk is even higher during sex, a fact that means coitus with multiple people in a closed room increases your likelihood of getting sick even more.

“If one person has either infection and the other doesn’t, sex is a high-risk activity,” says Dr. James J. Chao, a board-certified plastic surgeon and cofounder of VedaNu Wellness. “If neither of you has symptoms and neither of you recently had exposure, the risk is very low. That hour you spend sitting close together in a closed bedroom is about as high-risk a scenario as it gets. Riskier than dinner. Arguably riskier than a packed bar.”

Paying attention to your symptoms and saying no to hookups when you’re sick can help stop the spread of respiratory infections and illness, but being in close proximity to another person tends to be risky because you can be contagious before symptoms even pop up.

“That window of infectiousness before symptoms is a concern with flu and COVID,” Chao says. “Flu can spread one day before you know you’re sick, COVID one to two days. So there is something to be concerned about, but it isn’t sex specifically.”

What COVID-19 and flu precautions should you take during a hookup?

Protecting yourself from COVID-19 and the flu means a whole new set of precautions beyond the STI-prevention ones you’re probably used to. “You might be focused on what happens between the sheets, but exposure can happen before sex begins and after it ends because both people need to share the same air at close range for an extended period of time,” says Chao. “Condoms are great for preventing some infections, but COVID and flu aren’t STIs, and keeping them out of the bedroom requires different precautions.”

You can't completely prevent yourself from getting sick, but staying up to date on your COVID-19 and flu vaccines should be the foundation of your prevention plan.

“The most important interventions occur before anyone undresses,” Chao says. “Vaccines first, which require advance planning since flu shots take approximately two weeks for immunity to develop. Updated COVID vaccines are no different.”

After you’ve gotten vaccinated, it’s time to consider other risk factors. “Next is timing. Unless symptoms are present, when you hook up is far more important than how,” he says. “Days before you have sex with someone, ensure that person wasn’t exposed to either illness. For COVID, test if you have access to reliable home tests. Otherwise, use online check-in and careful monitoring of symptoms for one another. Wait until both parties confirm no symptoms in the last 48 hours before proceeding. Wash hands for at least 20 seconds immediately before sex. Open a window if you can. That’s it.”

Toufexis agrees and says that being honest with your sexual partner if you get sick and staying away until you’re better is the key to avoiding spreading the illness.

“When it comes to staying safe during this virus season, the most important advice I give my patients is to stay home and away from others if you are sick,” she says. “You can go back to your normal activities — including sex — when, for at least 24 hours, your symptoms start improving and you have not had a fever (and are not using fever-reducing medications). Some people may be able to spread a virus that made them sick even if they begin feeling better but are less likely to be contagious after symptoms fully resolve.”

You can also lower your risk factor with a few key steps, according to Batista: “Healthy diet, exercise, staying away from people if you know that they’re sick, hand washing, not sharing drinks."

Do you have to wear a mask during sex?

Wearing a mask to avoid catching or spreading COVID-19 or the flu is a tried-and-true recommendation that has been proven to significantly reduce your risk. “The current guidelines focus on layers of protection, rather than masking alone,” Toufexis says. “Choosing to wear a mask during sex is a personal choice. Masks can reduce the risk of spreading a respiratory virus as well as vaccinations, cleaner air, hygiene, and testing.”

But unless it’s a gimp mask or sexy pup mask, you probably don’t want to wear one during sex. Chao knows that the reality is that no one is going to put on an N95 mask for a hookup, so it’s more important to focus on the other ways to protect yourself.

“Let’s lean into the reality that no one wants to wear a mask during sex,” Chao says. “Plenty of folks won’t be able to muster that type of consistency anyway. Don’t let that stop you from taking precautions. Masks are just one layer. Vaccination reduces the risk of severe disease; testing reduces the chances you arrive infected. Add ventilation on top of that and you’re good. At-home flu and COVID rapid tests are easy to find for around $10 to $15 and deliver results in 15 minutes. Avoiding sex when someone has symptoms can prevent an exposure that masking alone can’t.”

Being cautious during flu and COVID-19 season is normal, but the doctors warn against taking things a step too far and avoiding sex altogether.

“I think the goal is we shouldn’t scare people away from intimacy,” says Batista, who urges everyone to be “a responsible sexual partner” and tell a hookup if you’re having symptoms or have been sick recently so that you “give people enough information so that they can make an informed decision for themselves.”

Should you talk about COVID-19 and the flu before a hookup?

Talking with your hookup or sex partner beforehand is one of the key ways to avoid getting sick. This goes for COVID-19 and the flu just like it does for STIs.

“Most queer folks already have ‘The STI Talk’ with potential partners,” Chao says. “This is that same conversation with two extra questions at the bottom: Anyone sick in your house? Anyone had any symptoms in the last couple of days? Send a quick text before meeting up and see where things stand. I wouldn’t ask to see anyone’s vaccine card, though. It’s about honesty. Hiding a cough to keep a date sounds like the same person who would lie about other stuff.”

This should be a quick, easy, judgment-free conversation that takes only a couple of minutes, but can help you stay healthy during the part of the year when it seems like everyone around you is coughing.

“You may not ask everyone at a social gathering whether they've had recent respiratory symptoms or exposures, but that can be a reasonable conversation with someone you're going to be intimate with,” Toufexis says. “It can fit naturally into the conversation about STI testing and protection before a hookup.”

Once you’ve had the conversation and been honest about your vaccine history, any recent exposures, and whether or not you're having any symptoms, it’s up to you and your partner to decide if the risk is worth it.

“From a sexual health perspective, being a responsible sexual partner, I think there’s two pillars to that,” Batista says. “The first pillar is at their own risk. The second pillar is at your own risk.”