Ask A Pro: Oral STIs and Throat Swab Protocol

by Sarah Patterson on August 30, 2012 · 13 comments

in Health, Tools of the Trade

Ask A Pro is a our new column focusing on work and health, intended to share straightforward information about what you can do to keep yourself as safe as possible while on the job. Questions will be answered by sexual health expert Sarah Patterson, M.Ed. (See full bio below.) Questions you’d like to have answered can be sent to sarah.elspeth.patterson (at) gmail (dot) com, or to our info (at) titsandsass address. Full anonymity is guaranteed. 

Dear Ask A Pro,

I’ve been escorting for about six months and I usually don’t require that my clients wear condoms during blowjobs. I’m not having symptoms of anything, but I asked my gynecologist if I could do a test for oral STIs to be safe and she said I didn’t need it. She knows I’ve had some unprotected oral sex, but she doesn’t know about my job. I think she was trying to save me money but should I go back and tell her it’s important to me to get it? How at risk am I from giving bareback blowjobs anyway? I’ve heard that spitting isn’t much safer than swallowing but does that make a difference?

Sincerely,

Swab Seeker

Dear Swab Seeker,

Firstly, kudos to you for asking about a throat swab. It’s really important to ask health care providers what’s possible in terms of STI testing, so you can assess for yourself what you consider important, based on your own experience. It also sounds like your gynecologist is just basing her response on what she does know about your sexual activity and may not have enough information to give you the best answer. Using throat swabs is also pretty rare outside of providers who see men who have sex with men, so it’s also possible her clinic doesn’t do this as a standard procedure.

So, you have a few options in terms of your disclosure. You could tell her what you do for a living, you could tell her you are sexually active with multiple people, or you could simply tell her you want the throat swab in order to be thorough with your testing procedure. Whatever you decide, make sure you feel ok with the tone and content of her response, before continuing to see her as your sexual health provider. If you don’t like what she says or how she says it, you’re less likely to come to visit her regularly and get the tests you need for your own health.

Depending on how many clients you are seeing, you may want to have a throat swab every three to six months. Every six months is a limit set for HIV because of how long it takes to show up in your system, but chlamydia and gonorrhea show up much more quickly. So if you’re seeing a couple of people a week, there’s no reason you can’t get tested every three months for good measure. If you’re using protection for vaginal or anal sex, you probably don’t need to get an anal swab, but that is an option as well. Both of these swabs are designed to test for chlamydia and gonorrhea (HIV inhabits the whole body, so the general HIV test is what you will need every 6 months). In terms of exposure, chlamydia and gonorrhea are the two that folks are most likely to contract orally and can be treated easily with antibiotics.

In terms of the heavier hitters like HIV, there have been a few documented cases of HIV having been transmitted to receptive partners through fellatio, even in cases when insertive partners didn’t ejaculate, but it’s very, very rare and the risk is still significantly less than with anal or vaginal sex. And when HIV is documented, it often involves the person having more than one type of sex—some combination of anal, vaginal and oral sex. The truth is that there is no 100% safe sex, no matter what, and this is a risk that we all take on when we have sex with anybody. That’s why it’s always more desirable to have clients you can have brief, straightforward conversations about safety with, so you’re both clear on the risks.

In terms of the spit/swallow debate, there’s no evidence that it makes much of a difference, so the jury remains out. Best to do what you will not feel anxious doing in the moment (and also, not fret about afterwards). If you’re not comfortable, your session will not be as good, because you won’t be as relaxed and able to get into your groove. And while we’re on the subject of things you do to get in your groove, do not brush your teeth or use dental floss right before a session. Both of these things irritate the gums and open very tiny legions that STIs can get into. For the same reason, mouthwash (particularly the bite-y, Listerine variety) is too abrasive right before a session. Stick to mints and gum to be safe while keeping things fresh.

Sarah Elspeth Patterson is a health educator and founding organizer of Persist Health Project, a community-based health care organization in New York City. As the first health care provider in New York City run by and for folks involved with and impacted by the sex trade, Persist offers comprehensive health services while providing trainings to other health care professionals who serve us.

{ 13 comments… read them below or add one }

BP August 30, 2012 at 6:36 pm

This was informative – I would like to know more about the HPV and Herpes risks from oral, both protected & unprotected.

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T August 30, 2012 at 7:10 pm

THANK YOU. I’m not an escort (just adventurous) and it’s ridiculously, incredibly hard to find this kind of information for anything other than vaginal sex.

(If you have time to write about how safe sex with other girls is and/or the best way to keep your sex toys safe that would be super awesome.)

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Kai August 30, 2012 at 9:32 pm

Someone needs to tell my health teachers that I just learned as much from this post as I did from five years of sex ed.

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Charlotte Shane Charlotte Shane August 31, 2012 at 1:41 am

I am so glad there’s a mention here that lots of offices are unfamiliar with throat swabs. I finally insisted on getting one from my gynecologist and after waiting a ridiculous two weeks for results, I was told that the lab they sent it to couldn’t do the test and I’d have to come back to have it redone and sent elsewhere or just get a refund for what I’d paid. Really frustrating.

I hope lots of folks read the mouthwash thing. So many hos I know go crazy on the Listerine before, after, and even during sessions.

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meg February 25, 2013 at 11:28 pm

Yeah — I had the same experience.

I think that free, city-specialty-std clinics, or health clinics focusing on GLBT populations, are the best way to go on this one.

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Alan Robinson August 31, 2012 at 6:38 pm

I’d like to add a little more relating to oral health and STI’s. and in particular the HPV virus that causes cervical and oral cancer. Oral HPV is currently most common among people in their 20’s and 60’s. (I know its weird.) HPV-linked oral cancer is most common among men and women from their late 30’s through their early 60’s and is now more common than cervical cancer in the United States.

Current research states that individuals with have had 6 or more sexual partners are 9 times more likely to get oral cancer than those that have not had sex at all. What is confusing is that most people that get HPV-linked oral cancer got the infection 10 to 30 years before they got the cancer. I should note that while most people think men get oral HPV from performing oral sex on women, there is no research clearly showing how the virus gets in the mouth (some suggest it could be spread via kissing even) or how effective barriers are in preventing the introduction of the HPV virus into the mouth

Even though the HPV virus is linked to oral cancer, do not get snookered into paying for a test for oral HPV. There is no treatment for oral HPV and unlike cervical cancer there is little a doctor can do to treat the virus or prevent a lesion from developing years down the road. So knowing that you have the virus in your mouth does little good.

What you want to do instead is have regular dental checkups and keep your mouth as healthy as possible. When you have your checkup also make sure that you have your dentist during a normal semi-annual exam do an oral cancer exam when he does his examination. It is a painless visual exam that will ensure an earlier diagnosis. It is most important for people from their mid 30’s onward and is important for smokers and non-smokers alike.

Here are some other thoughts on good oral health for sexually active adults
1) Mouthwashes – Alcohol based mouthwashes dry out the mouth and remove protections provided by normal saliva. There are lots of alternatives without alcohol and those with fluoride also help improve teeth strength but use the fluoride one’s no more than once a day to avoid tooth discoloration. An alternative to mouthwashes that is good for oral health and rather cheap is salt water. A saline solution is conducive to healing and can improve breath as well by flushing food an other particles where odoriferous bacteria might congregate

2) Electric toothbrushes – this may sound silly but electric toothbrushes like those made by Oral-B and Phillips improve gums and teeth because they result in longer brushing times while making the brushing less abrasive. I am a fan of the the Soniccare Essential Line.

3) Floss at the end of the day – while flossing before sex may not be a good idea. Not flossing at all is not good either. The goal is to have healthy gums which create a lower risk of infection and flossing makes a difference. Just do it when your mouth has time to recover. Also to the extent that flossing irritates your mouth, following flossing with a saline rinse will help promote healing.

4) Avoid smoking – Smoking is an oral irritant. So smoking makes it tougher to maintain good oral health. I know of no research linking smoking to STD’s but there is indication that smoking is linked to oral cancer including HPV-linked oral cancer. More importantly smokers with oral cancer usually get a tumor that is tougher to treat and has a lower survivor rate than HPV-linked cancer.

If anyone has any questions about HPV and oral cancer check out the Oral Cancer Foundation or Head and Neck Cancer Alliance websites.

I hope this helps add to the

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krissy summers September 1, 2012 at 9:16 am

In the sexual health clinic we run at Magenta (sex worker support service of Western Australia), our docs always do a routine oral swab for G and C. We also advise workers to use condoms when doing oral sex and dental dams for females.If the condom breaks during oral we suggest swallowing if it is deep throat as the stomach will kill any virus. Spitting is also recommended if possible, but no teeth brushing or flossing for at least an hour later in case of gum disease, it will only make contracted something more likely, we also say mouthwash is fine but depends which one, would be differnt in Oz no doubt. Finally we suggest changing condoms between oral and intercourse. If the worker does have an STI in the throat she can cross contaminate to the vagina…same principal from anal to vaginal intercourse. This is common practice to change condoms amongst sex workers in Australia and we have ways of doing this so the ‘service’ in not interrupted too much…

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Sarah Patterson Sarah Patterson September 2, 2012 at 3:28 pm

Thank you Alan and Krissy for your insights! There is so much to cover on this topic and I am glad folks have more to share.

Krissy, thank you in particular for sharing your knowledge from Magenta. My point of view on the practice of throat swabbing is very United States-centric, so I really appreciate you sharing best practices from Western Australia, known for its healthy sex trade and strong relationships between medical providers and sex workers.

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chelsea g. summers September 5, 2012 at 11:52 am

Kudos for this column. It’s fantastic on every front.

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Elle Elle September 6, 2012 at 3:38 am

Interesting! I hadn’t thought about brushing/flossing/mouthwashing as being an irritant. Thank you for this.

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Cyd Nova September 9, 2012 at 1:48 pm

What a great resource! I just want to reinforce that HIV transmission through oral sex is indeed EXTREMELY rare. Although it is always a good idea to reduce risk by not brushing or flossing or sucking dick with any recent dental surgery – the likelihood someone would acquire HIV through receptive or insertive oral sex is very very low. This year the CDC released a chart of estimated probability of acquiring HIV from an infected source per sex act that people might be interested in taking a look at:
http://www.cdc.gov/hiv/law/transmission.htm

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Charlotte Shane Charlotte Shane September 9, 2012 at 8:53 pm

I don’t want to speak for Sarah but I think her point was that brushing and flossing makes you more likely contract all STIs that might be passed orally, not necessarily HIV.

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Sarah Patterson Sarah Patterson September 18, 2012 at 5:43 pm

Cyd, thank you for sharing that!

That is a super useful tool to look at. It’s very true, it’s highly unlikely that you will contract HIV orally, but yes, I do want folks to consider the other STIs we are often less aware of/less focused on. But as Cyd is rightly pointing out, we should know our full risk so we can assess what risks we want (or don’t want) to take.

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