What is the recommended method for reducing the risk of sexually transmitted infections (STIs) during oral sex, particularly for individuals with a history of STIs or those in high-risk groups?

Dental Dams for Oral Sex: Evidence-Based Recommendations

The CDC recommends using a dental dam or condom as a barrier during every act of oral-vaginal or oral-anal sex to prevent transmission of sexually transmitted infections, including HIV, herpes simplex virus, human papillomavirus, and other pathogens. 1

What Are Dental Dams and Why Use Them?

Dental dams are thin latex or polyurethane sheets that create a physical barrier between the mouth and genital or anal areas during oral sex. 2 Barrier methods must be used consistently and correctly throughout the entire sexual encounter to be effective. 1

Infections Prevented by Dental Dams

The primary infectious risks during oral-vaginal and oral-anal sex include:

• Viral infections: HIV, herpes simplex virus (HSV), human papillomavirus (HPV), and cytomegalovirus (CMV) 1
• Bacterial infections: Gonorrhea and chlamydia, which can infect both the genital tract and oropharynx 1
• Intestinal pathogens (particularly with oral-anal contact): Cryptosporidiosis, shigellosis, campylobacteriosis, amebiasis, giardiasis, and hepatitis A 1
• HPV transmission is particularly concerning, with a 7% point prevalence of oral HPV infection that can lead to oropharyngeal cancer 1

How to Use Dental Dams Correctly

Use a new barrier device for each sexual encounter and each body site—never reuse barriers. 1 The American Academy of Otolaryngology-Head and Neck Surgery recommends dental dams or condoms for all oral-vaginal contact to create a physical barrier against pathogen transmission. 1

Practical Application Steps:

• Handle carefully to avoid damaging with fingernails, teeth, or sharp objects 3
• Cover the entire area of genital or anal contact before beginning oral sex 1
• Hold the dam in place throughout the entire sexual act to maintain the barrier 1
• Use only water-based lubricants (K-Y Jelly, Astroglide, AquaLube, glycerin) with latex barriers, as oil-based lubricants (petroleum jelly, mineral oil, massage oils, body lotions, cooking oil) can weaken latex 3, 1

Alternative Barrier Methods:

If dental dams are unavailable, male latex condoms can be cut lengthwise to create a barrier sheet for oral sex. 3 Latex condoms offer greater protection against viral STDs than natural-membrane condoms. 1

High-Risk Populations Requiring Extra Vigilance

Individuals with History of STIs:

• HIV-infected persons face heightened risk of acquiring additional sexually transmitted pathogens through oral-vaginal contact 1
• Barrier method use reduces tubal infertility risk by 25% by preventing STI transmission that can lead to pelvic inflammatory disease 1
• Chlamydia infection from oral-genital transmission can ascend to cause salpingitis, a major cause of female infertility 1

Men Who Have Sex With Men:

• Men are 2-3 times more likely to develop oral HPV-related disease than women 1
• Oropharyngeal cancer risk increases with number of oral sexual partners and oral HPV infection persistence 1
• Hepatitis A vaccination is specifically recommended for homosexual or bisexual men 3

Immunocompromised Patients:

• Cancer patients receiving chemotherapy have medications present in vaginal fluids and saliva, and should abstain from sexual activity for 48-72 hours after chemotherapy administration 1
• Patients with low blood counts (thrombocytopenia or neutropenia) face increased bleeding risk and infection susceptibility, making mucosal trauma from any sexual activity particularly dangerous 1

Additional Risk Reduction Strategies

Vaccination:

• HPV vaccination should be offered to all eligible individuals to prevent infection with high-risk HPV strains that cause both genital and oropharyngeal cancers 1
• Hepatitis A and B vaccination is recommended for sexually active individuals, particularly those engaging in oral-genital contact 1

Hygiene Measures:

• Hand washing with warm soapy water before and after sexual activity reduces pathogen transmission risk 1
• Avoid activities that could introduce fecal material to the mouth, as latex barriers alone may not prevent transmission of enteric pathogens with low infectious doses 1

Oral Health Considerations:

A cut in the mouth, bleeding gums, lip sores, or broken skin increases chances of infection. 4, 5 The lesions or unhealthy periodontal status of the oral cavity accelerates transmission of infections into the circulation. 4, 5

Critical Clinical Pitfalls

Common Misperceptions:

Research reveals that many patients, particularly women who have sex with women, conflate dental dams with female condoms and describe their use hypothetically rather than actually using them. 6 Healthcare providers should not assume patients have accurate information about barrier methods. 6

Low Utilization Rates:

Among women who had oral sex with women in the previous 6 months, only 9.7% had used a dental dam and only 2.1% used one "often." 7 This underutilization stems from lack of awareness, perceived barriers to procurement, and unfamiliarity among health educators. 2

Counseling Requirements:

Sexual health services should include an accurate description of what barrier methods are, how to distinguish them from barrier methods used during heterosexual sex (female and male condoms), and how to use them correctly. 6 Providers must give specific instructions rather than assuming patients understand proper use. 6

Long-Term Health Consequences of Unprotected Oral Sex

• Tubal infertility occurs in 14% of cases due to STI-related pelvic inflammatory disease causing tubal scarring and occlusion 1
• Adolescents and young adults with cancer history are more likely than age-matched peers to develop a second cancer from HPV, a sexually transmitted infection 1
• Oral HPV infection demonstrates a bimodal age distribution, with the largest peak occurring between 55 and 64 years of age 3