The sexually transmitted diseases affect a significant group of our population. Diseases such as syphilis, gonorrhea, chlamydia are commonly contracted through sexual activities. Transmission of different virus such as HPV, HIV, Epstein Barr virus, Herpes simplex virus, cytomegalovirus can occur through oral sex. Let us see the oral manifestations of these diseases and how they can be avoided.

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Let us see what is STD in the mouth, its symptoms, prevention, cure, etc.

Common STD in mouth symptoms

Syphilis

Syphilis is a bacterial infection caused by Treponema pallidum bacterium. It occurs after coming into sexual contact with someone who has open syphilitic lesions which are also called chancres. When transferred to the mouth on contact with the genitals, the symptoms can appear after 3-6 weeks (1).

Oral manifestations of syphilis can be seen on the lips, tongue, and inside of the mouth. They can appear as

  • Indurate ulceration of the tongue dorsum
  • Hyperplastic foliate papillae
  • Erythema and edema of soft tissue
  • Petechial hemorrhage
  • A red rash and or raised bump on the mucosa
  • Open lesions
  • Chancre sores

Gonorrhea

Gonorrhea is transmitted when a person comes in contact with the bodily fluids of an infected person. It affects the tissue of the mouth and throat (2).

Oral manifestations of gonorrhea include,

  • Burning sensation and pain
  • Swollen glands
  • White spots on the tissue

Chlamydia

Chlamydia is one of the most common STD in the mouth and is caused by Chlamydia trachomatis (3). The transmission occurs during sexual contact with the genitals, anus or mouth of an infected person. Oral chlamydia infections often do not cause symptoms, and if they do occur are typically mild. The most common symptoms are –

  • A sore throat
  • Difficulty in swallowing
  • Pharyngitis
  • Swollen lymph nodes

Herpes Simplex Virus

Cold sores or fever blisters which form on the lips and inside of the mouth are caused due to herpes simplex virus infection. Herpes labialis or oral herpes are mostly caused by the herpes simplex virus type 1 (HSV-1).

For most people, this virus remains dormant in the facial nerve ganglion (4). During times of stress, compromised immunity, and hormonal changes, this virus becomes active and creates blisters and sores.

HSV-1 can be transmitted by personal contact, touching open sores or being in contact with shared items like towels and dishes. The herpes virus type 2 (HSV-2) mostly causes genital herpes.

Sometimes HSV-2 spreads to the mouth on contact with infected partners genitals, causing oral herpes (5). About 22% of sexually active people have genital herpes from HSV-2, and most will show no symptoms and are unaware they have it. Symptoms of cold sores are,

  • Burning or itching sensation
  • Soreness in the area of blister formation
  • Scab formation
  • Bleeding from the crust

Human papillomavirus

Human papillomavirus (HPV) can be transmitted to the mouth and throat through oral sex and affects the oropharynx area involving the mouth, tongue, throat, and tonsils. HPV is the leading cause of various oropharyngeal cancer (6).

Some low-risk strains of HPV cause raised bumps which look like warts in your mouth or throat.  These lesions may not present any outward symptoms making it difficult to detect.

Aside from their appearance, they often are non-symptomatic, are painless and non-cancerous. HPV can affect the throat and cause laryngeal or respiratory papillomatosis.

The symptoms can include,

  • Vocal changes
  • Shortness of breath
  • Difficulty speaking
  • Warts inside the throat

Human immunodeficiency virus

AIDS caused by human immunodeficiency virus (HIV) makes a person immunodeficient. Opportunistic bacteria and fungus can then create infections due to the immune system of the body.

Oral thrush, also called candidiasis is the most common condition associated with HIV infection (7). It occurs due to overgrowth of yeast in the body.

Symptoms of thrush seen on the tongue, inside the mouth and gums include,

  • White lesions or raised lesions with
  • Cottage cheese-like appearance
  • Redness and bleeding gums
  • Cracking at the corners of the mouth

Other than candidiasis, the different manifestations of HIV infection are,

  • Xerostomia,
  • Oral hairy leukoplakia,
  • Periodontal diseases
  • Linear gingival erythema
  • Necrotizing ulcerative periodontitis
  • Kaposi’s sarcoma (8)

Epstein Barr Virus

Epstein Barr Virus (EBV) is transmitted through contact with bodily fluids from an infected person. Contagion through saliva is the most common route for the spread of the infection (9).

EBV is the leading cause of mononucleosis also known as kissing disease or glandular fever. It is also associated with various types of lymphoid and epithelial malignancies.

Oral manifestations of EBV infection are,

  • Oral aphthous ulcers
  • Aggressive periodontitis lesions
  • Swollen lymph nodes
  • Oral hairy leukoplakia

Cytomegalovirus

Cytomegalovirus (CMV) is another disease infecting half of the adults older than 40. While sexual transmission is possible, CMV is also contracted through contact with bodily fluids including saliva, tears and breast milk (10).

It can also be transmitted from affected babies to adult caregivers. Healthcare professionals recommend regular hand washing, especially after changing children’s diapers, to decrease exposure to CMV. Immunocompromised individuals are at highest risk for CMV.

The Oral manifestations of CMV infection are,

  • Gingival overgrowth
  • Hyperplastic gingiva
  • Localized ulcerated areas.

Hepatitis

The most common hepatitis virus expressing in the human body and causing a diseased state are -hepatitis A, B, and C. Hepatitis A and C can be transmitted through oral sex, although risk factors are low. Adults with hepatitis fall under the risk group for oral cancer. Oral manifestations of hepatitis infection are,

  • Painless sores and lesions in the mouth
  • Red, swollen and painful throat
  • Difficulty swallowing.

Hepatitis C infection can sometimes also cause,

  • Sjogren’s Syndrome
  • Oral Lichen Planus
  • Xerostomia
  • Sialadenitis

Diagnosis

Sexually active men and women should regularly get tested for sexually transmitted infections. People with multiple partners or new partners, pregnant women should have an annual STD screening.

Also be regular with your dentist. The dental health care professional can help identify any underlying pathology associated with the oropharyngeal region.

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A throat swab can help in the diagnosis of various infections. People who are immunocompromised should have a regular blood test.

Treatment

The line of treatment will depend on the type of STD and its severity. Mild oral herpes, for example, can be treated through the prescription of a topical anesthetic to reduce the pain from oral blisters and lesions while the immune system works to restore your oral health. Antiviral medications can help to speed up the process.

Oral gonorrhea is usually treated with antibiotics called cephalosporins. Syphilis is treated with penicillin. Antibiotics such as doxycycline or azithromycin can also treat chlamydia.

Our immune system resolves the mild variants of any infection.

Prevention

  • Most sexually transmitted diseases spread when a person comes in contact with bodily fluids of an infected person.
  • To avoid the oral communication of infection, always use protection before engaging in any sexual activity.
  • Kissing or coming in contact with the saliva of an infected person can also cause transmission and spread of infection.
  • Do not share your utensils or cups with other individuals.
  • Toothbrushes should not be shared and changed regularly.
  • Maintain adequate oral hygiene to reduce the risk of any oral infection or sores.

Over to you on STD in mouth

Some strains of HPV can cause oral cancers. STDs can have various levels of oral manifestations ranging from fever blisters to necrotizing periodontitis. One should always be careful and avoid sharing items of personal hygiene with anyone. Always use protection even while engaging in oral sex. Be regular for STI screening.

STD in mouth affects a significant group of our population. Diseases such as syphilis, gonorrhea, chlamydia are commonly contracted through sexual activities. Transmission of different virus such as HPV, HIV, Epstein Barr virus, Herpes simplex virus, cytomegalovirus can occur through oral sex.
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