Oral sex and oral cancer: A virus link.

Sir,

Oral sex refers to sexual activities involving the stimulation of the genitalia by the use of the mouth, tongue, teeth, or throat. Oral sex is now very common in both heterosexual and homosexual couples. People may involve in oral sex as part of foreplay before sexual intercourse, or during or following intercourse. Oral sex may be practiced by people of all sexual orientations and the various types of oral sex performed are cunnilingus, fellatio, and analingus.[1] Human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) can be transmitted through oral sex with an infected partner. The diverse conduit in the oral cavity that provides as a gateway of exposure of infection from the oral cavity to blood stream include any open sores, cuts, abrasions, or bleeding gum disease such as gingivitis and periodontitis. Current research suggests that oral sex may transmit human papillomavirus (HPV), the virus implicated in the majority of cervical cancers. HPV is ubiquitous, with 120 strains isolated from human beings, about 40 of which are in the mouth and genital tracts. In addition to mounting epidemiologic evidence, extensive laboratory evidence supports the association between HPV and a subset of cancers of the oropharynx. HPV is consistently and more frequently detected in cancers of the oropharynx and tonsil than at other head and neck sites, and HPV-16 tends to be the predominant type detected.[2] Accumulating molecular and pathologic evidence has strengthened the hypothesis that HPV infection could play a role in the etiology of some oral squamous cell carcinomas and in contrast to cervical and other genital cancers, there are limited epidemiologic data addressing the relationship between HPV infection and the development of oral cancer.[3] The association was similarly increased among subjects with oral HPV-16 infection, regardless of their tobacco and alcohol use. By contrast, tobacco and alcohol use increased the association with oropharyngeal cancer primarily among subjects without exposure to HPV-16. Oral HPV infection is strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use.[4] There are several ways to reduce the risks of oral sex. Generally, the use of a physical barrier during oral sex can reduce the risk of transmission of HIV and other STDs. To reduce the risk of infection during unprotected oral sex, limit exposure to sexual fluids and ensure that no cuts or lesions are present in the mouth or on the genitals. A good oral health, free from bleeding gums, lip sores, cuts, broken skin, and oral epithelium, enormously reduces the chances of transmission of infection among the partners indulging in oral sex.[5]