Can I catch an STI from oral sex?

June 28, 2013

Dear Cecil:

I have noticed a high positive correlation between muff diving and a sore throat. Within a few hours I develop throat pain and sometimes, like now, a full-blown flu. Am I correct in assuming this must be from ingesting streptococcus or staphylococcus bacteria in mass quantities? Is there any way to sanitize the organ in question — say, a bath in Lysol or hydrogen peroxide? And how would one go about asking one's partner to do it?

Cecil replies:

Uh, Justin. Lysol? Hydrogen peroxide? I assume these are attempts at humor. Just the same, understand that in the perfect world of the future, you’ll have to wear a sign saying, “CALLS IT ‘MUFF DIVING.’ DO NOT HAVE SEX WITH THIS MAN.”

On to your question. Before we talk prevention, we need to figure out what you’ve got. Even if diagnosis over the Internet were a good idea, you haven't provided enough detail. Do you have one oral-sex partner, or several? Has the alleged high positive correlation been statistically demonstrated, or did you have a sore throat the other day and the flu now, and from this you conclude that cunnilingus = world of woe?

Whatever the facts are, we run into issues. If you have one partner and she’s also monogamous, you may get what she’s got, but then you’ve got it — you’re not going to get it multiple times. If, alternatively, you’re into frequent one-off sex with partners who are similarly disposed, thereby exposing yourself to every bug variant on earth, I suppose you could get repeated infections marked by sore throats, but probably you’d also exhibit numerous other symptoms you don’t mention.

So what follows is, of necessity, speculation. First we need to distinguish infections transmitted while having sex from sexually transmitted infections. You can pick up all sort of germs from mere physical contact or proximity, including the rhinoviruses that might cause a sore throat. STIs, however, are transmitted primarily through sexual activity. We’ll discuss only the latter here:

  • Chlamydia can be spread by oral sex and cause tonsillitis. So there’s a maybe.
  • Meningitis can be spread by oral sex, although the proven route is fellatio, and it generally causes headaches, not sore throat. We’ll cross this off the list.
  • Syphilis, which if untreated can lead to cancer, brain damage, and death, is typically spread by direct contact with a syphilis sore. One imagines you’d notice this. We’ll rule syphilis out too.
  • Candida infections can be spread from mouth to vagina, but evidently not the other way, and sore throats aren’t a symptom. Another no.
  • Bacterial vaginosis, some researchers think, can readily be spread by oral sex. The most noticeable symptom is a rotten-fish smell in the vagina of the recipient. The other party presumably carries the responsible bacteria in his or her mouth, but evidently they don’t cause sore throat.
  • HIV transmission via oral sex is, for the record, rare.
  • Other diseases spreadable by oral sex include herpes, urethritis, and varieties of hepatitis. Herpes often manifests as cold sores in and around the mouth, but not, so far as I know, sore throat.
  • Then there’s gonorrhea. Here we must linger. Transmitted bacterially, gonorrhea is especially amenable to oral sex. Symptoms appear four to six days after contact and commonly include mouth infections. Fellatio is the most common route for these infections, which often afflict gay men. However, cunnilingus is also up there. One study found parties ministering orally to women were four times as likely to contract an oral gonorrhea infection.

Now for the really bad part. Gonorrhea can infect your tonsils as a result of oral sex, and when it does can be tricky to cure: a study of Danish patients suffering from tonsillar gonorrhea found 11 of 13 had recently engaged in oral sex, and half the cases needed several courses of antibiotics.

We’re not done yet. Human papillomavirus (HPV) infection is commonly associated with genital warts, but also has a more sinister effect — it has become the chief cause of a type of throat cancer that’s showing up more often in American men. Between 1988 and 2004, the rate of HPV-caused throat cancers increased by 225 percent. Largely for this reason, after a steady decline in throat cancer since the 1980s, the trend reversed itself in the 2000s.

Those who have ever performed oral sex have more than double the risk of HPV infection. One high-profile case may be actor Michael Douglas, who blames his stage-IV throat cancer on cunnilingus, although without more information about his use of tobacco and alcohol, such factors can’t be ruled out.

Getting back to you, Justin, you probably don’t have any of the above, although if that sore throat or other symptoms linger, see a doctor. As for how you might persuade your partners to disinfect their genitals, I have no idea. But I’d love to hear you try.

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References

Ballini, Andrea, et al. "Transmission of nonviral sexually transmitted infections and oral sex." The Journal of Sexual Medicine 9.2 (2012): 372-384.

Balmelli, C., and H. F. Günthard. "Gonococcal Tonsillar Infection—A Case Report and Literature Review." Infection 31.5 (2003): 362-365.

Barlow, David. “The diagnosis of oropharyngeal gonorrhea” Genitourin Med 73 (1997): 16-17.

Bro-Jorgensen, Anne and Jensen, Tage. “Gonococcal Tonsillar Infections” British Medical Journal 11 (1971): 660-661.

Gillison, Maura L., et al. "Prevalence of oral HPV infection in the United States, 2009-2010." JAMA: The Journal of the American Medical Association 307.7 (2012): 693-703.

Osborne, Newton G., and Louis Grubin. "Colonization of the pharynx with Neisseria gonorrhoeae: experience in a clinic for sexually transmitted diseases." Sexually Transmitted Diseases 6.4 (1979): 253-255.

Öztürk, Özmen, and Hüseyin Seven. "Chlamydia Trachomatis Tonsillopharyngitis." Case reports in otolaryngology 2012 (2012).

Sackel, Stephen G., et al. "Orogenital contact and the isolation of Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum from the pharynx." Sexually transmitted diseases 6.2 (1979): 64-68.

Saini, Rajiv, Santosh Saini, and Sugandha Sharma. "Oral sex, oral health and orogenital infections." Journal of global infectious diseases 2.1 (2010): 57.

Scully, C., and S. Porter. "HIV topic update: oro‐genital transmission of HIV." Oral diseases 6.2 (2000): 92-98.

Simard, Edgar P., et al. "Cancers with increasing incidence trends in the United States: 1999 through 2008." CA: a cancer journal for clinicians 62.2 (2012): 118-128.

Willmott, F.E. “Transfer of gonococcal pharyngitis by kissing?” Brit. J. vener. Dis. 50 (1974): 317-318.

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