When thinking about STDs (sexually transmitted diseases), people usually think of trips to the gynecologist or urologist for treatment and “protected” sexual intercourse. What doesn’t often come to mind? Dentists or oral surgeons finding lesions during routine exams or protection in the form of dental dams. While sexually transmitted diseases are commonly associated with intercourse and the genitals, many STDs can, in fact, follow a genito-oral route of transmission. Disseminating information and increasing public awareness can help reduce the rates of transmission.
The STD most commonly associated with oral infections is Herpes. While Herpes Simplex Virus-1 is normally associated with childhood (and adult) cold sores and Herpes Simplex Virus-2 is traditionally thought of as sexually transmitted, cross infections are increasingly common, with infections being passed both ways on the genito-oral route. Transmission is most likely when the disease, which often goes latent for long periods, becomes active. Symptoms usually include blisters on the lips or tongue which become open, painful sores, though blisters/sores can affect the upper throat in some. Initial outbreaks are often more severe than subsequent recurrences, and symptoms usually subside on their own within 2 weeks. There is no cure for Herpes, though flare-ups tend to strike with decreasing frequency and severity. According to the Mayo Clinic, those with more frequent or severe outbreaks can benefit from prescription anti-viral treatments such as valacyclovir (Valtrex). acyclovir (Zovirax), and famciclovir (Famvir). Prevention includes abstaining from contact with infected individuals and using condoms or dental dams.
Hepatitis B, while not as often transmitted orally, can cause far greater health problems than Herpes. Hepatitis B is transmitted via bodily fluids, including blood, semen, and saliva that contains trace amounts of blood. The majority of adults infected with Hepatitis B are able to defeat the infection and are considered cured. However, about 10% of infected adults develop chronic Hepatitis B, which never does go away. While some become “chronic carriers” who show no symptoms but are contagious, others develop “active” Hepatitis B, which can cause devastating liver damage in the form of cirrhosis, liver cancer, or liver failure. Liver failure can only be “treated” through organ transplantation. Symptoms of Hepatitis B can take up to four months from the time of transmission to develop, and include fever, jaundice, abdominal pain, discolored urine, fatigue, and pale-colored stool. While there is no cure or preventative treatment to stop already-contracted Hepatitis B from becoming chronic, the National Institutes of Health recommend a prophylactic in the form of a readily available vaccine. Abstinence, dental dams, and condoms represent the best forms of protection.
Gonorrhea, which can cause myriad fertility issues in both men and women when transmitted through intercourse and left untreated, is a fairly benign beast when contracted orally. Oral Gonorrhea, which has an incubation period of one day to two weeks, usually affects the throat rather than the mouth. While most cases of oral/pharyngeal Gonorrhea show mild (or no) symptoms and resolve without treatment, antibiotic therapy is still advisable to prevent possible transmission from oral to genital through fellatio. Evidence for oral-genital transmission through cunnilingus is scant, though a slight risk may exist. Prevention, aside from avoiding contact, is best accomplished via condom and dental dam use.
Gonorrhea’s frequent partner in crime is Chlamydia, the most common sexually transmitted disease in the United States. Often, Chlamydia and Gonorrhea are found together. While oral Chlamydia is not common and is, like genital and rectal Chlamydia, often symptomless, it can cause sore throat, tonsillitis-like infection, and fever. If symptoms do appear, they usually manifest within three weeks of contracting the disease. According to Planned Parenthood, treatment involves antibiotics; often a single dose, though some antibiotic treatments require a week’s regimen. Prevention is best accomplished through abstaining from contact with infected individuals or using condoms and/or latex dental dams.
HPV, or Human Papilloma Virus, is the organism responsible for genital warts. While HPV is widely recognized as the leading cause of cervical cancer in women, many do not realize that, according to the Oral Cancer Foundation and others, it is also a leading cause of oral cancers in men, winning out over smoking and alcohol consumption. Competing with Chlamydia for the number one spot, HPV is widespread and easily transmitted via oral, genital, or rectal contact. Oral HPV signs can include warts on the lips, gums, tongue, palate, and throat, though there are often no outward symptoms. Because HPV is not passed through bodily fluids, skin-to-skin contact with HPV warts is enough to transmit the disease to a partner. While HPV warts can be removed, there is no effective anti-viral treatment/cure. While the vaccine Gardisil has been found to prevent (but not treat) some forms of HPV, it is not yet known whether or not it can serve as an effective protection against oral HPV. As a result, the only effective preventative is abstaining from sexual/oral contact with infected individuals.
Syphilis, the classic STD throughout the ages, is believed to be transmitted orally in approximately 4% of cases (though some research brings that number up to 14%). However, unlike Gonorrhea, oral Syphilis does not resolve itself, though to the untrained eye it might seem so. Primary oral Syphilis manifests at 2-6 weeks post exposure as a single sore (or chancre) on the lip or mouth area, though some do develop multiple sores. These sores are usually small, round, and painless, and resolve themselves in 3-6 weeks without treatment. However, the resolution of the chancre does not indicate the eradication of the disease. Without treatment, oral Syphilis enters the secondary stage, which can begin as the primary chancre is healing or weeks after. Secondary Syphilis is characterized by mucosal lesions and body rashes. The rashes can be intense, accompanied by swollen lymph nodes, fever, sore throat, hair loss, and fatigue, but in many cases, the rashes are barely noticeable and aren’t accompanied by any obvious symptoms. Syphilis must be treated (with simple antibiotic injections) in the first year to stave off possible late-stage/Tertiary Syphilis. Late stage/Tertiary Syphilis affects approximately 15% of those with untreated Syphilis, and symptoms ranging from blood vessel and organ damage to dementia and blindness can strike 10-20 years after initial infection. Condoms and latex dental dams provide a good measure of protection from oral transmission.
While some of the STDs discussed here are rather readily transmitted orally, HIV (Human Immunodeficiency Virus) does not tend to lend itself to easy oral transmission, which makes contracting HIV through oral sex less common than through vaginal or anal intercourse. Less commonl or no, it can be transmitted orally, and is therefore included. HIV is most likely to be orally transmitted through fellatio when there are open sores/lesions or cuts in the mouth/throat or on the lips. Mouth to mouth contact can transmit HIV if there are mouth sores or cuts, which leads the Centers for Disease Control to recommend against deep or “French” kissing if a partner has HIV. Incubation can last anywhere from six months to years, and during that time the individual is contagious, even though there may be no symptoms. While there are treatments for HIV, there is no cure, and the best prevention is abstaining from sexual contact with infected partners. Condoms and dental dams used during oral sex can offer effective protection with proper use.
While rarely talked about, many of our more common STDs can be and are transmitted orally. Because the issue of oral transmission of STDs is not widely publicized, many are unaware of both the risks and the steps that can be taken to prevent or treat these diseases. With increased awareness comes better understanding, more proactive preventative measures, and more timely treatment.