Is oral sex safe?
Many people, especially young teens, consider oral sex to be "safe" sex. "Safe sex" by many people is defined as having sexual gratification by means that reduces or eliminates the chance of producing a fetus (pregnancy). However, medical professionals include in the meaning of "safe sex," sex practices that prevent or significantly reduce the possibility of getting a disease from a sex partner (for examples, HIV, chlamydia, syphilis, or gonorrhea). Most doctors do not consider oral (and other) sexual practices "safe" unless precautions are taken to prevent or substantially reduce disease transmission between partners, or if the sex partners are uninfected. Consequently, oral sex (any male or female oral contact with a partner's genitalia; most clinicians also include genital/oral contact with any other body orifice such as the anus or rectum in the definition) is not, without precautions, considered inherently "safe sex" because sexually transmitted diseases (STD's) may be transferred by these practices.
What is oral gonorrhea?
Specifically, oral gonorrhea (also termed pharyngeal gonorrhea) is defined as an STD infection of the pharynx with Gram-negative coccal-shaped (round) bacteria named Neisseria gonorrhoeae. Infection is acquired through direct contact with white/yellowish pus-like fluid (also termed discharge or exudates) containing N. gonorrhoeae bacteria from one sex partner. This discharge is caused by N. gonorrhoeae bacterium inflaming the local tissue. It mixes with a person's vaginal fluids, seminal fluids, or mucus membranes near the anus and rectum that come in contact with another person's oral mucus membranes. The exudate may not always be easy to see. The bacterial infection then establishes itself in the pharynx and may be asymptomatic (cause no symptoms), but can cause symptoms of sore throat and discomfort when swallowing food. The affected throat resembles a strep throat with redness and occasionally may have some white spots or whitish/yellow discharge. People who perform fellatio (oral contact with a penis) are more likely to get oral gonorrhea than those who do cunnilingus (oral contact with the vagina, clitoris). Men who have sex with other men are the most likely to develop oral gonorrhea (about 10% to 25%).
Although oral gonorrhea can be cured by the body (ranges from about a week to three months), not all people will be able to self-cure and this could lead to spread of the disease throughout the body (disseminated gonorrhea).
What does oral gonorrhea look like?
Picture of the throat in a person with oral gonorrhea
(photo courtesy of CDC)
What are the symptoms of oral gohorrhea?
The main symptom of oral gonorrhea is a sore throat but up to 90% of individuals infected may have little or no symptoms.
These symptoms of oral gonorrhea are the same for men or women and usually occur a few days after oral contact (about 7 to 21 days )with a partner's genitals or anal area when the partner is infected with N. gonorrhoeae. People with oral gonorrhea usually do not transmit the disease to others, but it can occur in some instances. Most investigators state that kissing does not transmit the disease as the bacteria apparently do not infect the tongue or mouth. However, it is possible to transmit the disease if the bacteria in the pharynx are transmitted to other objects by direct contact (for examples, fingers, penis, or sex toys) and then the objects touch other body areas such as genitals, anal/rectal areas, or the eyes. This type of oral transfer of bacteria occurs infrequently. In general, symptoms of oral gonorrhea are either mild or not present and are markedly different from vaginal, penile, anal, and eye or disseminated gonorrhea.
How is oral gonorrhea diagnosed?
Definitive diagnosis usually depends on isolating N. gonorrhoeae from the throat; however, most doctors consider a positive rapid throat swab, designed to detect N. gonorrhoeae, a good recommended presumptive diagnosis of the disease. Doctors usually will treat the patient with antibiotics that are effective on the locally occurring N. gonorrhoeae strains. Currently, the CDC recommends the following treatment for gonorrhea: ceftriaxone, 250mg IM plus a single dose of azithromycin, 1 g, orally. Furthermore, if possible, the patient's sex partners from the past 60 days should be evaluated and similarly treated (the CDC terms this Expedited Partner Therapy or EPT).
On the bright side of this disease, many people that develop oral gonorrhea never develop symptoms and spontaneously clear the infection without antibiotics. Those individuals that develop symptoms may also clear the infection, but many are treated with antibiotics. Because a large number of N. gonorrhoeae bacterial strains are resistant to some antibiotics, the treating health care practitioner usually will choose one or more antibiotics that are known to be effective against the strains that are predominant in the patient's local geographic region.
On the darker side of this oral infection, is the rare instance in an immunocompromised individual when the person could develop systemic (throughout the body) spread of the disease.
How can I prevent contracting oral gonorrhea?
Prevention of oral gonorrhea is tricky. The presence of the bacteria on mucus membranes or in discharges in seminal or vaginal fluids facilitates transfer of N. gonorrhoeae bacteria, so preventing contact with these will prevent disease transfer. Condoms, although not 100% effective, afford significant protection from these secretions. This is true for both male and female condoms. The use of condoms during oral sex is not to allow the mouth to come in contact with these secretions, only with the condom material. If you are new to these situations, do not be hesitant to ask for help or instructions from reliable sources (for example, doctors or sex educators) because the information may help protect your health.
Of note, N. gonorrhoeae is not a lonely pathogen. The bacteria frequently are associated with two other organisms, Treponema pallidum (that causes syphilis) and chlamydia trachomatis (that causes chlamydia infections). Most doctors treat the patient with antibiotics that will kill N. gonorrhoeae, but also will kill these other two STD organisms (Treponema, the cause of syphilis and chlamydia) at the same time. Consequently, it is possible (but infrequent) to get infected with all three from one sexual encounter; more often only two are transferred, but doctors rarely know which two, so they treat for all three STD infections.
For uninfected partners, oral sex is relatively safe (except for the occasional gastrointestinal pathogen that may contaminate the genital or anal/rectal areas). For all others, many doctors think that the risks of oral sex outweigh the advantages unless sexual partners agree to protection methods, especially if the partners are new to each other. Even then there is still some risk of accidental infection if the condom or barrier leaks.
For the new kids on the sexual block, don't believe anyone that says oral sex is safe without protection. Protect yourself and your partner(s). If there is any evidence of gonorrhea that you can see (whitish or light yellowish discharge from a partner's penis, vagina, or anal/rectal area), the best choice is not to have oral or any other kind of sex until the person is disease-free. Yep, for first timers and those that might buy or sell oral sex, it might be a good practice to turn on the light and take a look at where your mouth (or any other anatomical part) is headed!
Medically reviewed by Robert Cox, MD; American Board of Internal Medicine with subspecialty in Infectious Disease
PHOTO: CDC.gov, Public Health Image Library item #3805