Oral Sex with Non-Group A Streptococcal Infection During Pregnancy
Oral sex during pregnancy when a partner has a non-Group A streptococcal infection is generally safe, as non-Group A streptococci (including Group B Streptococcus) are not sexually transmitted diseases and oral transmission does not pose a risk to pregnancy outcomes.
Understanding Non-Group A Streptococcal Colonization
The evidence provided focuses exclusively on Group B Streptococcus (GBS), which is the most clinically relevant non-Group A streptococcus in pregnancy:
GBS is not a sexually transmitted infection. GBS commonly colonizes the gastrointestinal tract and vagina in 10-30% of pregnant women and is not transmitted through sexual contact, including oral sex 1, 2.
GBS colonization is common even in adults who have never been sexually active, confirming it is not acquired through sexual transmission 1.
The gastrointestinal tract serves as the natural reservoir for GBS, with vaginal colonization occurring through ascending spread from the bowel, not through sexual contact 3.
Transmission Routes That Matter in Pregnancy
The only clinically significant transmission routes for GBS in pregnancy are:
Vertical transmission from mother to infant during labor and delivery through the birth canal 3.
Ascending infection from the vagina to the uterus during pregnancy, which can cause chorioamnionitis, preterm birth, or stillbirth 3, 2.
Oral sex does not contribute to either of these transmission pathways.
What Actually Requires Treatment
The guidelines are clear about when GBS matters in pregnancy:
Intrapartum antibiotic prophylaxis during labor is the only intervention that prevents neonatal disease, not avoidance of sexual contact 3, 4, 5.
Oral antimicrobial agents should not be used to treat asymptomatic GBS colonization during pregnancy, as this is ineffective and does not prevent neonatal disease 3, 4.
Treatment is only indicated for GBS urinary tract infections (symptomatic or asymptomatic bacteriuria) and for intrapartum prophylaxis during active labor 4.
Clinical Bottom Line
There is no evidence-based reason to avoid oral sex when a partner has non-Group A streptococcal colonization during pregnancy. The focus should instead be on:
Appropriate prenatal GBS screening at 35-37 weeks gestation with vaginal-rectal cultures 3.
Administration of intravenous penicillin G or ampicillin during labor if GBS-positive 3, 5.
Treatment of any GBS urinary tract infection if detected during pregnancy 4.
The concern about streptococcal infections in pregnancy relates entirely to vertical transmission during delivery and ascending infection from the genital tract, neither of which is influenced by oral sexual contact 3, 1.