NYC health department offers new recommendations on safe sex during COVID

"Using protection" now may include wearing a mask.

When it comes to COVID-19 and sex, it's all about limiting your risk, according to the department. The safest sex is sex you have with yourself. If you want to have sex with another person, your safest bet is with someone who lives in your household.

However, if you venture out, try to limit your number of sexual partners, and try to have sex with people you trust and feel comfortable asking about their COVID-19 status.

And, especially if it's a one-night stand or group sex, try to avoid kissing, and try to wear a mask.

"Wearing masks during sexual intimacies may not be everyone's cup of tea, but does provide added protection," said Dr. William Schaffner, a professor of medicine in the Division of Infectious Disease at the Vanderbilt University School of Medicine.

Though it might be easy to scoff at such recommendations, Schaffner said New York City just might be ahead of the curve when it comes to safe-sex guidelines during COVID-19. After all, the city has been the epicenter of the U.S. epidemic, seeing nearly 15% of the nation's COVID deaths.

"These guidelines are ahead of data, but very proactive in public safety," Schaffner said. "They might prevent other infections while we're at it."

Schaffner, who said other jurisdictions may review and mimic New York City's guidelines, said it's not just about masks. The NYC guidelines also recommends not having sex if you feel sick, using condoms and washing up before and after sex, measures similar to helping prevent the spread of other diseases including HIV.

People infected with COVID-19 can spread the virus through saliva, mucus or their breath, even if they're asymptomatic. The virus has been found in semen and feces, but it isn't known if COVID-19 can be spread through vaginal or anal sex.

"Kissing is almost certainly a mode of transmission. If you want to do everything you can to prevent COVID but want to still be close to a person, then you may want to avoid kissing," said Dr. Todd Ellerin, chief of Infectious Diseases at South Shore Health.

The guidelines went further in recommending minimizing group sex and erring to a more intimate setting. But if a larger crowd is preferred, the health department advises wearing a face covering, avoiding kissing and face touching, and using an alcohol-based hand sanitizer.

The guidelines also take into consideration how to approach safe sex in an environment where "hooking up" as living alone are common. The biggest key? Honest communication.

You should ask potential partners if they've had any COVID symptoms -- fever, cough, sore throat -- in the last 14 days and whether they've been tested using a nasal swab or saliva test.

However, these recommendations come with a reminder that you can still be asymptomatic and have the disease, so even honest dialogue about symptoms may not always reveal whether one partner has COVID-19.

And as much as New York City's health department tries to normalize safe sex practices in a pandemic world, the guidance stresses that it's important not to expose others to COVID-19.

If you feel unwell, have symptoms or have been exposed to someone with COVID, it's best to skip kissing and sex altogether, especially if you or your partner have medical conditions -- moderate to severe asthma, diabetes, a weakened immune system -- that increase your risk of getting COVID.

"The recommendations are designed to prevent COVID-19 spread during sexual intimacies, both via specific sexual practices as well as by being close to another person," Schaffner said. "To date, transmission of COVID-19 by specific sexual practices has not been demonstrated and needs further investigation

Schaffner acknowledged that as communities begin reopening and social distancing measures are relaxed, more people hooking up could lead to more virus spread.

"These recommendations," he added, "provide guidance to prevent COVID-19 transmission in the event that turns out to be the case."

Alexis E. Carrington, M.D., currently completing her internal medicine preliminary year at Elmhurst Hospital in New York City, is a contributor to the ABC News Medical Unit.