Oral sex

Today I tackle the topic of oral sex, and in particular safe oral sex. The areas I wanted to talk about are:

• Oral sex and the risks of HIV transmission
• Ways to have oral sex safely
• Certain conditions that can increase the risk of HIV transmission via oral sex
• Other sexually transmitted diseases associated with oral sex
• And, finally, an increase in wart virus-associated throat cancer and ways we may be able to avoid this.

Current research shows that the risk of HIV infection via oral sex is quite low. While it’s understood that there are some people who have become HIV positive after oral sex, there are three main mechanisms that reduce the risk of the virus entering via the mouth.

Saliva inhibits HIV.
Research has shown that saliva is able to inactivate the HIV virus. This reduces the chance of HIV infection from the virus that may be present in pre-cum or semen.

The lining of the mouth and throat is difficult for HIV to penetrate.
In the same way our skin is made of multiple thin layers much like the skin of an onion, so is the lining of our mouth and throat. These many layers make HIV transmission difficult as virus particles are not able to penetrate.

The mouth and throat have a low number of cells needed for HIV transmission.
For HIV transmission to occur, the virus needs to be able to connect with a particular immune system receptor called a CD4 receptor. In a similar way that a lock and key can open a door, HIV is able to enter cells after attaching to a CD4 receptor. In the case of the mouth, there are fewer cells with the CD4 receptor present in the mouth, which reduces the chance of HIV being able to infect cells.

What factors increase the chance of HIV infection via oral sex?
If you have any cuts, sores or ulcers, recent dental work or infection of the gums, there is an increased risk of HIV, as this may allow infection via the bloodstream.
Taking care of your teeth can reduce the chance of infections of the gums, however, it’s recommended to not brush or floss your teeth an hour or so before oral sex as this can lead to small cuts that can allow HIV to enter the bloodstream. If you have any ulcers, cold sores, or your gums are red and inflamed, it’s best to avoid oral sex or consider using a condom if you choose to give head.
Research has now shown that having throat infections like chlamydia and gonorrhoea increase the risk of HIV being able to enter the bloodstream.

It’s important as part of your regular sexual health check-ups to make sure you have a throat swab to check if these infections are present. A recent Melbourne study showed that around 4 percent of people attending sex clubs had either chlamydia or gonorrhoea in their throat and didn’t even know about it!

Current guidelines recommend avoiding getting cum in the mouth and, if you want to be 100 percent safe, use a condom when giving head.

Are there other risks associated with oral sex?
While the risk of HIV infection is low with oral sex there are other infections that are very easy to catch. Chlamydia, gonorrhoea, syphilis and herpes are very easily passed on via oral sex.
It’s possible to have infections with these diseases without having many symptoms. For this reason, it’s important to make sure you get checked for these as part of your regular sexual health check-ups.
Chlamydia and gonorrhoea can be checked with a simple swab of the back of the throat. Syphilis and herpes can be checked with a blood test. Herpes infection is fairly obvious due to the painful rash that can erupt when there is an outbreak. If you have a cold sore or outbreak of herpes on your penis, it’s best not to have oral sex as this is the time when herpes is most easily spread.

The wart virus and risk of throat cancer.
New research shows that there is an increase in throat cancer in gay men. On testing, 90 percent of these cancers have been shown to be associated with the human papilloma virus (HPV), also known as the wart virus. If you have had oral sex with a partner with genital warts, there is a chance that HPV infection in the mouth or throat can lead to oral cancers.
If you even notice an ulcer or sore in the mouth or throat that is not healing, see your doctor as soon as you can. Early detection makes treatment much easier.

There is a vaccine available in Australia that can help protect against four of the main wart viruses that are known to cause cancers. While primarily marketed to women to prevent cervical cancer, there is good evidence to suggest gay men should also consider vaccination. Unfortunately, vaccination does not help treat warts if they are already present. However, it will help prevent infection with other strains so I would highly recommend talking with your doctor to see if you may be eligible.

These injections are not cheap at just under $500 for all three injections but they are certainly worth considering if you can afford them. Be sure to have a chat with your doctor about this.

By DR GEORGE FORGAN-SMITH
General Practitioner

An excerpt of thehealthybear.com.au