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Orally contracted sexually transmitted diseases

Written by Dr Ikhisemojie
~Punch, Nigeria. Sunday, April 24, 2016

There is a notion that oral sex somehow protects people from contracting and suffering from Sexually Transmitted Diseases. It is a false one. Among various age groups around the world today, and increasingly in our own country, many teenagers and young adults are engaging in oral sex not because they necessary think it is safer but because they think it is now fashionable to do so. Some others have enough knowledge to determine that it may be safer to do so from a health perspective. Others see it as an escape from having to cope with unwanted pregnancies. That may be all that they can protect themselves against.

It is important to note from the outset that diseases such as gonorrhoea, syphilis, chlamydia and HIV are infections that can be acquired from performing oral sex. So, it must be seen in the proper context that oral sex is not the same thing as safe sex. Safe sex only exists in a make-believe kind of life. The only way to guarantee safe sex is to have only one partner or to abstain from it. As a result, most doctors would not consider oral sex or other sexual practices to be safe unless certain precautions have been taken to reduce or prevent such unwanted consequences from occurring.

Oral sex is the way of getting off a genital stimulation using the mouth and tongue. It does carry a substantial risk of leading to an infection particularly when there are cuts, sores and bruises around the mouth and tongue. It is now one of the most common ways in which sexually transmitted infections are passed on. The incidence of these infections around the world is increasing. And in addition to the four different diseases named above, others like herpes simplex, hepatitis A, B and C, and genital warts can also be transmitted. The precise incidence of this new and growing problem is unknown at the present time. What is clear is that the risk of getting sexually transmitted infections through oral sex is perhaps lower than in vaginal or anal sex. However, the risk exists. The risk is dampened significantly by using a condom or a dental dam. It is not clear why it is called a dental dam because it has been used from the very beginning as a barrier method of preventing pregnancies in non-penetrative sex. It is used to cover either the vagina or the anus. Only of recent has it been adapted to oral usage. When you do not have a dam, you can make an emergency one out of a condom.

As for gonorrhoea, there is now a distinct classification for it with associated features that can also help to diagnose it. It is thus called oral gonorrhoea, more specifically pharyngeal gonorrhoea. It is a sexually transmitted disease caused by direct contact between a person who is secreting the typically yellowish fluid and the throat of another individual. These features may be different in both men and women because of the different ways in which they are acquired, but certain common signs are present in both sexes. These are a sore-throat, a rash within the mouth, a fever and difficulty with swallowing. Most of the time, a person's natural immunity is sufficient to cure an attack of oral gonorrhoea so that it may pass without much trouble. At other times, however, such persons may have a sore in the mouth with yellowish or whitish specs and some discharge of the same colour. Women who perform oral sex are more likely than men to have oral gonorrhoea. Men, by contrast, who perform oral vaginal sex are not as likely to have the disease.

The symptoms as a whole are less obvious than those for anal, vaginal or penile gonorrhoea. The incubation period is usually from seven to 21 days. The disease is not commonly transmitted from the mouth of someone with the condition to another during kissing for example, but it may be possible to do so with the aid of the fingers to other parts of the body, such as the eyes. The occurrence with chlamydia is very similar to gonorrhoea but with hepatitis and HIV, the course of the disease is similar to those who get it by other forms of sex. The features are essentially the same and they can thus pass it on to others once there is contact between both parties across mucous membranes around the eyes, mouth, anus, vagina or penis. This is far more likely where there has been a breach in the mucosa and the inner layer of the affected surface is exposed to invasion by these organisms.

When a person suffers from any status that has already depressed their immune status, the progression of any of these diseases is much more rapid. Therefore, people who suffer from chronic kidney or liver disease are much more at risk. So also are those who are on treatment for cancer or are already living with HIV/AIDS. For the latter group, the likelihood of passing on an infection gets worse when there has been an ejaculation of semen. Therefore, practitioners of oral sex need to be acutely aware of these risks and work accordingly to diminish their exposure to them if they must continue to do what they are engaged in.

Although the use of condoms does not guarantee 100 per cent protection against these organisms, it does prevent the direct contact between the mucous lining of the mouth and that of the genitalia. The mucous secretions from these surfaces are the vehicles that facilitate the transfer of the organisms. As a result, preventing such transfer of bacteria and viruses guarantees the prevention of the associated disease condition. That means, of course, that all sexual contact will be with the latex material of the barrier object and once one surface has been placed so that it prevents such contact, it should not be alternated with the opposite surface. Finally, these materials are disposable and should never be recycled.
It is important to conclude here that in making these decisions, every individual has a choice. Even if you had the inclination to toe that path, an awareness of the possible health risks, the possibility of enduring a lifetime of disease and medications should help dissuade some from the risks of engaging in these practices.

Ask The Doctor

Dear doctor, I appreciate your article on "The adolescent years," which was published in SUNDAY PUNCH on March 8, 2015. Aside from the natural impact of youthful anxiety, neurosis to experiment in every laboratory and peer pressure, the next major adolescent destabiliser is mass childhood poverty, which is highly prevalent everywhere. No young man or woman takes time to listen to anybody. If they are not provided with the minimum of Abraham Maslow's physiological needs: food, clothing and housing, it gets worse. Boko Haram was devastating because of mass poverty and illiteracy in the north of Nigeria. The panaceas are adult education and gainful employment. God bless you.

Thank you very much for your comments and your contribution. A good education invariably promotes good health. Its absence reinforces the dangerous cycle of ignorance, poverty and disease.
Dear doctor, thanks for always being there. To the couple in need of a child, please know that there is need for prayers too. I waited for 13 years and today my first child is in Dubai, the second is in Australia, while my only son just graduated from university here in Nigeria. God will do it when we trust and wait on Him. God bless you. 

God bless you too. Surely, prayers are important but should not be the only effort or the main one. Patients should see their doctors and follow the instructions given as faithfully as possible. Having done so, your efforts should then be backed up with prayers.

Dear doctor, my sister is 41 years old and has three children. During pregnancy, she always develops diabetes which disappears after the baby is born. But 10 months after the birth of the last baby, she developed a deep cough which seems to have defied all medications. As she coughs, she emaciates and at a time she almost developed a partial stroke which left her mouth twisted. What type of sickness is this? Even as we have started regulating her blood sugar and blood pressure and controlling her diet, she is still very lean and cannot walk well. Please help us. Thanks.

I believe you should take your sister to a specialist centre, that is, a large public hospital where she can avail herself of the opportunity to be treated properly by physicians, gynaecologists and physiotherapists, all working together as one team to nurture her back to good health. The range of problems such as you have enumerated are far beyond what you should manage at home all by yourself. A teaching hospital or a large general hospital would be my advice.

Dear doctor, can a pregnancy of four months be aborted?

It can be done from a strictly medical point of view. The process is not as simple as that which you may be familiar with. However, it is also advisable that you go to a proper expert to have it done for you. The only snag is that induced abortion is illegal in Nigeria and you do need to be aware of that.

Dear doctor, since 2012 I have been struggling with my chest. It has always been heavy for me. Then, it connected with my left shoulder and arm. I am always weak especially when not wearing a shirt, because of exposure to air so I always wear a shirt at all times. Then the elbow and hand followed. On two occasions, I pushed a broken down vehicle which made my right arm to follow suit (shoulder, elbow, wrist, fingers). Throughout this period, I have been struggling with my day to day activities. I have been to hospitals and done x-rays. Nothing was seen. I have been given drugs without a permanent solution. Some say I have toxic emotions because of psychological problems since I was born. I am now in my 20s. Others say it is proximal myopathy (I don't know the meaning). Please what do I do? This is killing me.

I agree with those who say you may be suffering from some deep psychological problems. You need a proper assessment for that so that you can get the kind of treatment that should get you out of your misery. It does not seem to me to be a case of proximal myopathy which is a disease of muscles that is characterised by muscle weakness and the loss of muscle bulk. These features are significantly different from what your present complaints are. So first, you ought to see a physician who will examine you in full and determine what direction your treatment ought to take.
Dear doctor, I have taken these drugs; Arthemeter 20mg and Lumefantrine 120mg tablets. Lumartem weight 35kg of two packets with 24 tablets each. I used to take four tablets in the morning and four in the evening. I have taken two packets, which is 48 tablets, but my mouth is still a bit bitter and tasteless. Please sir, should I take more to feel better? I am 20 years old.

You've taken all those drugs without sufficient reason to do so. This is drug abuse. You must not take any more until you have conducted the relevant tests in a diagnostic laboratory to determine whether you indeed have malaria. That is the only way your treatment and eventual cure will have meaning.

Dear doctor, I am 21 years old. I don't have breasts and have never seen my period even once as a lady. What do I do now sir? God bless you.

There are so many questions I would have loved to ask you in order to clarify your question. However, as things stand now, you must first see a doctor for a full examination. He will then determine if you are indeed a woman. That is very important and he will conduct relevant tests to confirm this. Whatever is the result will determine what will be done to deal with your condition. Many people are biologically female but are brought up as males and vice versa. It is thus important to make that distinction because everything else regarding your treatment will depend on this information.

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