Health Risks Associated with Oral-Genital and Oral-Anal Sexual Practices
Oral-genital (cunnilingus) and oral-anal (anilingus) sexual practices carry significant risk for transmission of various sexually transmitted infections and should be practiced with appropriate protective barriers to prevent disease transmission.
Infection Risks
Oral-Anal Contact (Anilingus)
- Patients should avoid sexual practices that might result in oral exposure to feces (e.g., oral-anal contact) to reduce the risk for intestinal infections including cryptosporidiosis, shigellosis, campylobacteriosis, amebiasis, giardiasis, and hepatitis A 1
- Oral-anal sexual contact can transmit enteric pathogens including protozoan parasites (Entamoeba histolytica, Giardia lamblia) and bacterial pathogens (Shigella, Campylobacter) 2, 3
- Anilingus can lead to proctocolitis and enteritis, which may present with diarrhea, abdominal cramping, and inflammation of the colonic mucosa 1
Oral-Genital Contact (Cunnilingus)
- Oral-genital contact can transmit herpes simplex virus, human papillomavirus, and other sexually transmitted pathogens 1
- Oropharyngeal infections with Neisseria gonorrhoeae or Chlamydia trachomatis can occur through oral-genital contact, often presenting asymptomatically but sometimes causing pharyngitis and tonsillitis 4
- Oral health directly impacts transmission risk; cuts in the mouth, bleeding gums, lip sores, or broken skin significantly increase the chances of infection transmission 5
HIV Transmission Risk
- While HIV transmission through oral sex carries lower risk than vaginal or anal intercourse, the presence of oral lesions, bleeding gums, or genital sores increases this risk 1
- The per-act risk for HIV transmission from oral sex is substantially lower than vaginal intercourse (0.1%-0.2%) or receptive anal intercourse (0.5%-3%) 1
- Specific circumstances such as bleeding in the mouth can increase the risk for HIV transmission during oral-genital or oral-anal contact 1
Prevention Strategies
Barrier Methods
- Persons wishing to reduce their risk should consider using dental dams or similar barrier methods for oral-anal and oral-genital contact 1
- Latex condoms should be used during every act of sexual intercourse to reduce the risk for acquiring cytomegalovirus, herpes simplex virus, and human papillomavirus 1
- For oral-anal contact, changing condoms after anal intercourse and wearing latex gloves during digital-anal contact can reduce transmission risk 1
Hygiene Practices
- Frequent washing of hands and genitals with warm soapy water during and after activities that might bring these body parts in contact with feces might further reduce risk for illness 1
- Proper oral hygiene is paramount as unhealthy periodontium or ulcerations in the mouth can accelerate the transmission of infections into the circulation 5
Vaccination
- Hepatitis A vaccination is recommended for all susceptible men who have sex with men, as well as others with indications for hepatitis A virus vaccine 1
- Hepatitis B vaccination is recommended for all susceptible HIV-infected patients 1
Special Considerations
Higher Risk Populations
- Persons particularly at risk of being infected by or transmitting HIV (including bisexual men, injecting drug users, female sex workers, and serodiscordant couples) are more likely to practice anal sex, which carries higher transmission risks 6
- HIV-infected individuals should be especially cautious as they may be more susceptible to acquiring additional infections or transmitting HIV to partners 1
Asymptomatic Infections
- Many oral STIs can be asymptomatic, creating an important but frequently overlooked reservoir for new infections 4
- Regular screening for STIs is important for sexually active individuals engaging in these practices, even in the absence of symptoms 1
By understanding these risks and implementing appropriate preventive measures, individuals can reduce their chances of acquiring or transmitting infections during oral-genital and oral-anal sexual activities.