All types of sexual activity carry some STD risk

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Sexual activity other than intercourse carries some risk of sexually transmitted disease, and doctors should make sure their patients understand that, according to the American College of Obstetricians and Gynecologists (ACOG).

Many people may engage in “noncoital” sexual activities such as oral sex, mutual masturbation and anal sex to prevent pregnancy and cut the risk of STDs. However, all of these sex acts come with some degree of STD risk, and it’s still important for people to protect themselves, according to an ACOG expert committee.

“Most people, including adolescents, are unlikely to use condoms during oral sex, which places them at risk for acquiring an STD,” Dr. Richard Guido, one of the report authors, said in an ACOG statement. “This unlikelihood is partly because of a greater perceived safety compared with intercourse.”

Writing in the journal Obstetrics & Gynecology, the panel advises doctors to ask patients—adults and teenagers—about all of their sexual activities, and to counsel them on how to reduce their STD risks. Although this “is a sensitive issue to address for both patients and physicians, it’s important to discuss sexuality frankly and without judgment so that we can help our patients fully protect themselves against STDs,” Guido added.

While oral sex is generally safer than vaginal or anal sex, the ACOG committee notes, it is not without risk. The viruses that cause genital herpes, genital warts and hepatitis can all be transmitted through oral sex. The same is true of the bacterial STDs syphilis, gonorrhea and chlamydia.

When it comes to HIV transmission, receptive anal sex carries the highest risk, followed by receptive vaginal sex, according to ACOG. However, there have been cases of HIV linked to oral sex.

“Noncoital sexual activity is not necessarily ‘safe sex’,” Guido and his colleagues write in the report.

They advise “correct and consistent” condom use for all types of sexual activity, but especially vaginal and anal sex. Staying in a mutually monogamous relationship, and getting tested for STDs before starting a new relationship, are among the other ways to curb STD transmission. Another precaution, the committee notes, is to clean sex toys between uses.

It’s recommended that all sexually active women age 25 or younger be screened for chlamydia once a year, while all sexually active teenagers should be screened for gonorrhea. Other screening tests are done based on individuals’ STD risk factors or any symptoms they may have.

The ACOG committee points out that lesbian women should be screened on the same basis as heterosexual women.

“Most lesbians have been sexually active with men at some point,” Guido said. “Even without this sexual history, there are some STDs that can be transmitted between two women during sexual activity.”

SOURCE: Obstetrics & Gynecology, September 2008.

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