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Oral sex: it’s not all talk

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23rd Aug 2011
Dr Catriona Ooi   all articles by this author

The practice of oral sex and the attitude towards it across the generations.


Introduction
THERE is no doubt that society has become generally more permissive and open-minded when it comes to sex, and it is therefore not surprising that some individuals have also broadened their sexual repertoire, but the greatest changes are seen between generations.

Indeed, the sex lives of our parents and grandparents were probably different from the sex lives and experiences of younger generations. One of the most stark differences is oral sex.

The Australian study of health and relationships found that oral sex was first practised one year following sexual debut for women born between 1981 and 1986 compared with six years in those born between 1941 and 1950.

In fact, studies have found that oral sex is prevalent amongst young Australians, with more than 50% of surveyed uni students aged 17–25 reporting previous oral sex, and 13% of these having never had vaginal or anal sex.

Similarly 56% of young Brits 16–18 years had also had oral sex.

Oral sex is a low risk sexual activity compared to anal and vaginal sex and as a result safe sex precautions are less commonly employed, if at all.

While the self reported use of condoms for oral sex with both casual and regular partners generally increased over five years to 1994 for Melbourne-based university undergraduates, other groups rarely reported use.

So what are the risks?
Gonorrhoea
In Australia, homosexually active men are at greatest risk of pharyngeal gonorrhoea, and screening guidelines reflect this, recommending pharyngeal gonorrhoea PCR or culture as a component of the sexual screen at least annually.

Pharyngeal infection is mostly asymptomatic. Similar to genital infection, treatment is with 500 mg ceftriaxone IMI, and remember to organise contact tracing.

Herpes
Skin to skin contact occurs with oral sex and so herpes simplex virus (HSV) can be transmitted from mouth to genitals and vice versa. This more commonly occurs for HSV1 from orolabial infection to genitals, resulting in genital herpes from HSV1.

Most infections are in young people as they are more likely to be HSV1 antibody negative.

Like genital herpes, orolabial herpes may shed asymptomatically and transmission occur at this time. Genital herpes is managed with antivirals as determined by clinical presentation.

Human papillomavirus (HPV)
Rarely, condyloma acuminata can occur on the lips, tongue and palate as the result of infection with genital wart HPV types.

More recently, HPV-18 and 16, related to cervical cancers, have been associated with a subset of cancers of the oropharyngeal tract.

Chlamydia
Screening for chlamydia in the pharynx is not recommended.

Similar to pharyngeal gonorrhoea, pharyngeal chlamydia is usually asymptomatic. It is generally viewed as rare.

However, more recent studies indicate that occasional screening may be warranted in highrisk groups such as men who have sex with men, or sex workers at risk.

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