| By
Elizabeth
Boskey, Ph.D., M.P.H., C.H.E.S.
No
matter what former president William Jefferson Clinton might
like you to believe, for any meaningful definition of the
word, oral sex is still sex. It may not be able to get you
pregnant, but it can both get you off and get you a sexually
transmitted disease.
A
lot of people think of oral sex as the safe alternative to
anal sex or intercourse. Although it is undeniably a safer
option, it is far from being a risk free activity. Oral sex
is capable of transmitting most common sexually transmitted
diseases. In general, the partner who is performing the oral
sex is at greater risk, particularly if they are performing
oral sex on a man, but neither partner is completely safe.
Different
sexually transmitted diseases have different relative risks
for transmission during oral sex. As you may remember from
national news coverage several years ago, there has been a
large up turn in the number of throat infections caused by
gonorrhea, which was initially noticed in teenagers. Gonorrhea
causes a throat infection that is relatively difficult to
eradicate, at least in comparison to genital infection with
the same bacteria, and recently antibiotic resistant cases
have been on the rise. Gonorrhea is far more easily transmitted
during fellatio, oral sex on a man, than it is during cunnilingus,
oral sex on a woman, because the site of infection in women,
the cervix, is not easily accessible during oral sex. Chlamydia,
an infection that behaves in an analogous way to gonorrhea,
has a similar risk of transmission during oral sex.
Oral
sex is a relatively low risk activity for passing on HIV,
the virus that causes AIDS, but it is by no means safe. The
risk is primarily for the person who is performing the oral
sex, since unless they have a lot of blood in their mouth
they are unlikely to expose their partner to significant amounts
of HIV. Risk of transmission is increased for people with
cuts or open sores in their mouth, if the person who oral
sex is being performed on comes in their mouth, or if person
receiving oral sex has other sexually transmitted diseases.
Concurrent infection with other sexually transmitted diseases
often increases the amount of virus present in both semen
and vaginal secretions.
HPV,
the virus that causes cervical cancer, has been in the news
a lot lately. Not only because of controversies over the HPV
vaccine but because of other cancers that the virus is associated
with. Recent news reports have linked HPV acquired through
unprotected oral sex with throat and oral cancers. It seems
to be a major cause of these cancers in individuals who do
not smoke.
Herpes
is also easy to transmit via oral sex. Although HSV-1 is normally
associated with cold sores and HSV-2 is normally associated
with genital herpes, either virus can actually infect at either
site. Even when a person has no symptoms, they can still transmit
the herpes virus. In fact, the vast majority of herpes transmissions
occur when no symptoms are present. This is why the viruses
are so common. More than half of all Americans are infected
with HSV-1, and 20-25% are infected with HSV-2. Therefore,
a person with cold sores can pass on an HSV-1 infection to
their partner's genitals, and a person with genital herpes
can pass on an HSV-2 infection to their partner's mouth.
Syphilis
has been in the news a lot lately, since it has been on the
rise across the United States. Some scientists think that
a large proportion of the increase in syphilis cases may actually
be due to transmission during oral sex. Many people do not
realize that oral sex is a risk factor for syphilis, and therefore
do not worry about being safe. Since syphilis can only be
passed on when symptoms are present, you would think there
wouldn't much risk of passing it on during oral sex, but the
small painless sores are very easy to miss.
Rimming,
or oral-anal sex, has its own particular risks. Specifically,
it can put individuals at risk of acquiring hepatitis A, which
is not normally considered to be a sexually transmitted disease
but spreads by the fecal oral route. Data is lacking as to
whether hepatitis B, which is more often thought of as the
sexually transmitted type of hepatitis, can be spread this
way, but it's probably better to be safe than sorry. Fortunately,
there are safe and effective vaccines for both hepatitis A
and hepatitis B, which all adults should consider getting
if they have not already been vaccinated.
There
is good news, however, for people who enjoy either performing
or receiving oral sex. It is possible to make it safer. Using
a condom when performing oral sex on a man will greatly reduce
the risk of transmission of most sexually transmitted diseases,
although not all of them since some can be transmitted by
contact with infected skin that may not be covered by the
latex barrier. When performing oral sex on a woman, or oral-anal
sex, using a latex dental dam can reduce your risk. Dental
dams can be purchased at many stores, but you can also make
them by cutting the tip off of a condom and then cutting it
down one side to make a latex rectangle. It may also be possible
to use plastic wrap to reduce the risk of sexually transmitted
disease transmission, but there is no peer-reviewed data on
its effectiveness. Still, it is a technique recommended by
many safer-sex educators and, even if it is not as good as
a latex dam, plastic wrap is certainly a better barrier than
nothing.
Condoms
and dental dams are most effective at preventing the spread
of diseases, such as HIV, gonorrhea, and chlamydia that are
transmitted through infected fluids. Sexually transmitted
diseases that are passed from skin to skin, such as HPV, herpes,
and syphilis, are more difficult to protect against. However,
consistent use of latex barriers during oral sex will greatly
reduce your risk of acquiring even them.
Sources:
"Can I get HIV from oral sex? from the CDC. Accessed
2/15/07.
Edwards
S. and Carne C."Oral sex and the transmission of viral
STIs" Sex. Transm. Inf. 1998;74;6-10.
Edwards
S. and Carne C."Oral sex and the transmission of non
- viral STIs" Sex. Transm. Inf. 1998;74;95-100.
Kent
C.K. et al. "Prevalence of Rectal, Urethral, and Pharyngeal
Chlamydia and Gonorrhea Detected in 2 Clinical Settings among
Men Who Have Sex with Men: San Francisco, California, 2003"
Clin. Infect. Dis. 2005; 41:67–74.
Kreimer
A.R. et al. "Oral Human Papillomavirus Infection in Adults
Is Associated with Sexual Behavior and HIV Serostatus"
J. Infect. Dis. 2004;189:686–98.
Lafferty,
W.E. et al. "Herpes Simplex Virus Type 1 as a Cause of
Genital Herpes: Impact on Surveillance and Prevention"
J. Infect. Dis. 2000; 181:1454–7
Papp
J.R. et al. "The use and performance of oral–throat
rinses to detect pharyngeal Neisseria gonorrhoeae and Chlamydia
trachomatis infections" Diag. Micro. Infect. Dis 2007;
59:259–264.
Petermana
T.A. and Furnessa, B.W. "The resurgence of syphilis among
men who have sex with men" Curr Opin Infect Dis 20:54–59.
"Transmission
of Primary and Secondary Syphilis by Oral Sex --- Chicago,
Illinois, 1998-2002" MMWR 53(41):966-968 Accessed 2/17/07.
Xu,
F. et al. (2006) "Trends in Herpes Simplex Virus Type
1 and Type 2 Seroprevalence in the United States" JAMA,
296:964-973
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