Risk vs. reality: questioning a sex educator on STDs

You could say that all the main STDs are transmittable through unprotected oral sex, including HIV. But in terms of your HIV risk, unprotected oral sex is the least likely cause, with unprotected anal sex being the most risky. But you can’t take risk out of the equations. The ones we would be mainly concerned with from unprotected oral sex would be diseases that are transmittable from skin-to-skin contact, like herpes and HPV. The spread of HPV through unprotected oral sex is directly linked to head, throat, and neck cancer. Then you have the STDs like chlamydia and gonorrhea that love to live in warm, wet places, including the mouth, the eyes, inside the penis, inside the vagina, and inside the anus.


If you can transmit these diseases through oral sex, then you can transmit them through kissing, right?


Technically speaking.


And oral herpes is just as transmittable through kissing right?


Yes.


So why do no health officials advise people to kiss through a dental dam?


Because the risk is low.


Why is the risk lower than unprotected oral sex?


Prolonged exposure. There is more rubbing, more friction, whereas kissing usually happens for a short time.


What about an extended make-out session?


Haha. The risk is always there, but with oral sex you have more fluids. You have pre-ejaculate, semen, and vaginal fluid, which carry more bacteria. I know you want a cut and dry answer, but STDs are not like that. There are always cases that break the standard model of transmission. It is a gray area.

I know I'm being paranoid, but it just seems like if you could get HIV through oral sex you could get it through kissing, provided both parties have cuts in their mouths.


Yes, but blood has to be exchanged as opposed to just saliva. Many people get confused on that point.


If you had chlamydia or gonorrhea in your throat, would you get the same symptoms as having it in your genitals?


The problem with those is that they are mainly asymptomatic. If you did have a symptom, it would be like a sore throat, with possibly some discharge. You might pass it off as something else until it didn’t go away.


Is there a real difference between oral and genital herpes?


It’s the place they live. Herpes has two simplexes. Simplex 1 is the type that lives on the mouth. Simplex 2 lives on the genitals. However, given the opportunity, they will switch places.


How effective are condoms against blocking skin-to-skin STDs like herpes and HPV?


Male condoms only cover the shaft of the penis. Often herpes covers the scrotum or the area around. You greatly reduce your chance of infection by using a condom or a dental dam, but you will still have the skin-to-skin contact.


Is Hepatitis an STD or not?


Yes and no. There is a vaccine for Hepatitis B that most people are vaccinated for before they enter public school. Hepatitis B is transmitted sexually, but also through other bodily fluids. In close quarters like a school, the transmission of Hep A is easy, like a cold or the flu. Both Hepatitis B and C attack the liver. Hepatitis C usually comes from unsafe sex, tattooing, or sharing needles. It is transmitted through blood as well as sexual fluids.


For GYT, Planned Parenthood is offering free testing for chlamydia, gonorrhea, and HIV. Most STD tests do not screen for Hepatitis C. Why?


The number of people who have C is much lower in comparison to chlamydia and gonorrhea. They target the ones that are the most common. If you are going to get tested, you have to be very specific about what you want done as they test for each disease in a different way.


Last year I wanted to get a full-panel STD test during a routine physical exam, but it was like pulling teeth just to get my doctor to give me an HIV test. Why does that happen?


I think many doctors try to follow a medical model and sometimes they don’t take into consideration what the patient wants. You tried to advocate for yourself and said, 'I want it. I don’t care if I feel at risk. I just want the peace of mind.' Sometimes they say, 'You know, you are really not at risk.' I understand that.


The antiretroviral gels researchers have been testing in Africa seem to be pretty effective at blocking the transmission of HIV, even when condoms are not used. Do you think we will ever see antiretroviral gel packaged together with condoms like spermicide, or infused into personal lubricants?


I don’t know, but I would like to see that. As with male birth control, the main problem is just getting enough science behind it before they can say, 'Hey, this really works.'


If you go to jail in Florida, is it true that they give you an STD test?


It depends on the state. Some test you coming in. Some test you leaving. Some test both. Some test neither. It just depends on the funding of the state and the politics. Many don’t test on the way out because they make the assumption that you probably do have something. Very high risk sex happens in prison. Some do test on the way out to protect the citizens on the outside.


Is it possible to have safe sex in a pool or the ocean?


It is not impossible, but there is an increased risk of the condom slipping off. Also, you can get a vaginal or anal infection from whatever is in the water. It is just a bad idea all around.


What are some of the more shocking questions you get from students?


For a sex educator, nothing is surprising anymore. But, I would say some of the myths kids believe about sex, like that drinking bleach will kill HIV. Some people might be surprised by how much sexual behavior is happening at such a young age.


Is it an issue getting younger boys to use condoms that fit?


There are slim fit condoms, but you have to get them online as drug stores tend not to stock them. Most students tend to gravitate toward the Magnums just because of the name... Some kids only try condoms once then swear them off. You have to try several until you find one that works for you.


The first time I used a condom it broke because I had carried it around in my wallet for over a year. Is that still a problem?


Students tend to know not to do that now. Younger kids don’t. I tell them it is okay to carry a condom in their pocket a day or two but not to carry it in their wallet a year waiting for the big day. They know that. What scares me more in Florida is heat exposure, that they will leave condoms in the glove compartment or purses left in their car. That scares me more than the wallet problem.


What are your biggest challenges as an educator?


The political climate. I’ve gone to places for years and all of a sudden I am uninvited because one parent had a problem with it or schools lose funding. Most of it is politically motivated, or a side effect of the economy. But, no matter where you go, there is always an ally. These allies tend to be incredibly passionate and they will do everything they can to get you in there. Chances are they have used us before for their own health services.


I've read that one sex ed strategy being used recently is to emphasize the financial burden of having a child. Is this effective?


We use a lesson called, 'Baby Bill of Sale." We talk about how much diapers cost, how much wipes cost, how much medical bills cost, how much a car seat is. At the end it is over $10K. But the problem is some of these kids are 15. They don’t even have $2 so any amount of money seems like a lot to them. Many think they’ll get support from their families or the government that won’t make the cost seem so impossible. We do talk about the cost, especially if they ask, but it is not a major deterrent. A lot of kids we educate are the most at risk. If I say that having a child as a teen may prevent you from going to college, they’ll say, 'I wasn’t planning on going to college anyhow.' So we’ve already created a disconnect. We have to meet them where they are and be realistic in how we present the information. We have to make it useful to them.


Tuesday, April 24, Planned Parenthood of Southwest and Central Florida will offer free HIV (Dept. of Health test) and chlamydia/gonorrhea testing, and reduced-rate rapid HIV tests ($20) at its Tampa Health Center (8068 N. 56th St., 813-980.3555) from 9:00am to 6:00pm and its St. Petersburg Health Center (8950 Dr. Martin Luther King Jr. St N, Suite 102, 727-898.8199) from 11:00am to 6:00pm. Call or go to MyPlannedParenthood.org to make an appointment. Walk-ins are also welcome.


Follow Alfie on Twitter or Facebook and email him if interested in writing about Sex & Love

I'm usually in a state of abject horror when I visit an STD clinic. No matter how safe I've been, there is always a chance an STD has weaseled its way into my sex life. However, today as I sit across from Tami Shadduck, the Education Manager for Planned Parenthood of Southwest and Central Florida, I am oddly excited. Under the guise of interviewing her about the Get Yourself Tested (GYT) campaign, I get to ask her all the questions I've compiled about STDs in the years I've written about Sex & Love.

(For more info on the free STD testing Planned Parenthood will offer on Tuesday, April 24, scroll to the end of the article).

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What are the actual risks of unprotected oral sex?

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