Oral Chlamydia: Can Chlamydia infect your mouth?
Can I get Chlamydia from oral sex?
The short answer is, “Yes.”
The act of oral sex can and is responsible for the transmission and spread of many types of STD’s. The three most common STD’s that are transmitted by oral sex are Chlamydia, Syphilis, and Gonorrhea. In 2016, according to the CDC chlamydia was the most prevalent and reported STD in the United States since 1994.1
While vaginal or anal sex are the primary ways to contract chlamydia, the transmission of chlamydia via oral sex is widespread and is of particular interest to Americans because oral sex is widely, yet mistakenly, considered to be more “safe” than sexual acts that involve genital-to-genital contact While vaginal or anal sex are the primary ways to contract chlamydia, the transmission of chlamydia via oral sex is widespread and is of particular interest to Americans because oral sex is widely, yet mistakenly, considered to be more “safe” than sexual acts that involve genital-to-genital contact. The misperception that oral sex is safer than genital sex is especially common in individuals between the age of 15 and 24 who are more worried about pregnancy and perhaps have less maturity and education where consideration of STD’s is concerned. Click here to learn more about oral sex trends among teens.
Alarmingly, of the 90 million global cases reported each year, over half of the infected men and the majority of women reported not having any symptoms. Which lead to a delay in identification and treatment as well as ongoing infection to additional sexual partners,2 making it increasingly important to be tested for STD’s anytime you have a new sexual partner.
It is important to know that the main STD risks that come with oral sex are not limited to Chlamydia, Gonnorhea, and Syphilis but also includes HPV (Human Papillomavirus), which can lead to throat cancer, Herpes, Trichomoniasis, as well as HIV, the virus that causes the deadly autoimmune disease AIDS.
Oral sex performed on the anus can lead to other infections such as Hepatitis A, Shigella, and intestinal parasites.
How Chlamydia is Transmitted
Chlamydia is transmitted, like any other STD, through the exchange of bodily fluids, and skin-to-skin contact with a mucous membrane. While it usually attacks the cervix, urethra, urinary tract and/or rectum, it is not uncommon for it to affect that mouth, throat, and eyes.
Below are the ways in which Chlamydia is most commonly contracted/transmitted:
- Unprotected intercourse (vaginal or anal) with an infected partner
- Unprotected oral sex
- Sharing of sex toys
- Transference from fingers to the genitals or other parts of the body such as the eyes
- Anytime infected bodily secretion are transferred to another susceptible part of the body such as might occur when a woman wipes their vagina and secretion is transferred to the rectum
- Mother to the newborn during vaginal childbirth through the infected birth channel
The transmission of chlamydia, specifically as pertains to oral sex, occurs when oral contact is made with infected genitalia. Or, in cases where an individual’s mouth or throat is infected from prior contact with an infected partner, the mouth/throat then becomes the mode of transmission. In either instance, symptoms may or may not be present.
What is Oral Sex?
Oral sex is the act of one person placing their mouth and/or tongue on the genitals or anus of another. It is extremely popular in America, especially among individuals under the age of 45.
The main types of oral sex are:
- Cunnilingus – stimulation of the vagina with the lips and tongue
- Fellatio – stimulation of the penis with the lips and tongue and a sucking action with the mouth. Most commonly referred to as a “blow job,” the term “blow” is a misnomer as it is actually very dangerous to blow into the penis or the vagina.
- Nippling – licking, sucking or light biting of the nipples (there is nearly zero STD risk except in rare occasion the transmission of syphilis)
- Oro-anal sex – stimulation of the anus with the lips and tongue (often referred to as “rimming”)
Oral sex does carry a high degree of risk because even the smallest microscopic cut, abrasion, or open wound on a genital area can present an increased opportunity for bacteria to be transmitted. It is very likely that one will contract new diseases and infections in the genitals and anus if oral sex is received from an individual who is infected.
How Common is Oral Sex?
The short answer is, “It is very common.”
Historically, oral sex was thought to be reserved for heterosexual couples and was considered not only more intimate than intercourse but also to be reserved for those who were married. In the late 1970’s the societal attitudes in America began to change, and oral sex has become more prevalent in any type of relationship.
According to a joint study issued by the National Institute of Health and the Centers for Disease Control, over eighty percent of adults ages 15-44 have engaged in oral sex at least once in their lifetimes. Another sixty-five percent admit to having numerous oral sex partners over the course of their lifetimes. The same survey found that forty-five percent of teenagers ages 15-19 have engaged in oral sex with at least one partner.
In a controlled study by the National Center for Biotechnology Information (NCBI) to explore oral sex behavior based on gender, age and ethnicity it was found that the majority of men (85.4%) and women (83.2%) had performed oral sex. Men were more likely than women to have more than five oral sex partners (32.4% men vs. 17.6% women).
Results for oral sex engagement by age showed that individuals between the ages of 45-69 were less likely to have ever performed oral sex, whereas over 90% adults between the age of 30-44 and over 82% of adults between the ages of 20-29 reported having performed oral sex.
Study results for oral sex behaviors by race showed that white men and women had the highest number of lifetime oral sex partners compared to all other racial/ethnic groups. By contrast, black men had the highest number of lifetime sexual partners for any sexual act, but white men were significantly more likely than black men to have more than five oral sex partners in their lifetime (38.8% white males vs. 20.7% black males). A lower proportion was observed amongst Mexican-American and other races to have reported having more than five oral sex partners over their lifetime.
Is Oral Sex Safer Than Vaginal or Anal Sex?
It is difficult to evaluate the risk of oral sex alone because most survey studies show that individuals who participate in oral sex also engage in other sexual acts. What we do know is that many STD’s and STI’s ARE communicable through oral sex.
Risk of transmission is variable on the type of STD/STI. Any STD that causes an open sore or blister such as herpes or syphilis will be very easily transmitted by oral sex. Chlamydia is also transmitted through oral sex but carries a slightly reduced risk as compared to vaginal or anal sex. And while HIV may be less commonly transmitted through oral sex, it is still prevalent enough to be a concern. Additionally, individuals who have an oral chlamydia or oral gonorrhea infection may be at a slightly reduced health risk than if they have the infection in the genitals, however having the infection orally could put them at a higher risk of contracting HIV. Oral gonorrhea can spread to the rest of the body and become a more substantial and harder to treat concern, especially if additional infectious variables are introduced.
How Common is Chlamydia?
In the year 2000, all 50 states and Washington D.C. began reporting of Chlamydia testing and diagnosis. Reports revealed that Chlamydia is currently the most common STD in America, particularly among young women. Statistics are based on the rate of diagnosis and reporting to the CDC.
According to the CDC, in 2016 1,598,354 cases of chlamydia infection were reported. Regionally, it was found that the highest rates of infection by population occurred in the South, followed by the Midwest and West. The American States with the highest rates of infection by population were New Hampshire and Alaska.
The rate of infection by race and ethnicity is highest among African American, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander women. The overall rate of infection is 5.6 times higher among African American than in Caucasian populations.
Chlamydia infections are most prevalent in females under the age of 25. However, this may be due to the fact that male infections are often asymptomatic and may go undiagnosed or reported for a more extended time. The possibility of a male, unknowingly, having and transmitting chlamydia makes regular testing all the more critical for both men and women.
Is Chlamydia a Bacterial or Viral Infection?
Chlamydia trachomatis is a bacterium that acts like a virus. While most bacteria will self-replicate when in a suitable environment, chlamydia lacks the biosynthetic and metabolic ability to propagate without a host, such as the throat, vagina, rectum, and in rare cases, the eyes.
The lifecycle of a chlamydia bacterium is unique in the medical world. Chlamydia exists in two forms. The infectious form called the elementary body and the replicating form called the reticulate body. The elementary body is what travels between cells and people and then becomes the reticulate body which invades and feeds on a host cell until that cell no longer has the capacity to contain it, at which point it bursts and releases new elementary bodies.
While the human body will produce antibodies to fight against a chlamydia infection, it will not prevent re-infection. This fact highlights the criticality of ensuring the infection is adequately treated and that the infection is thoroughly eradicated in both partners before re-engaging in sexual activity. In other words, successful treatment of a chlamydia infection does not make an individual immune to the disease.
The above is an image of a micrograph of an infected cell as the reticulate bodies replicate within the inclusion cell.
The time it takes for symptoms to begin after being exposed to chlamydia, or the incubation period, is 7-21 days.
Symptoms of Chlamydia
Because oral chlamydia does not occur without coming into contact with infected genitalia or secretions, it is important to be aware of both genital and oral symptoms in order to identify warning signs in a partner whom oral sex may have been or is considered being performed upon. That said: it is unfortunate and critical to know that Chlamydia is one of the “silent” infections; Meaning that it often comes without signs or symptoms. This fact is what makes chlamydia particularly prevalent in America today, as it is often passed from individual to individual without anyone knowing.
Oral Chlamydia infects the cellular lining of the throat and individuals who suffer from asymptomatic chlamydia oral infection often experience a sore throat and a feeling of being “hoarse.” These symptoms are often, but not always, coupled with pain or difficulty swallowing, a low-grade fever and swollen lymph nodes in the neck. The symptoms may come and go or be persistent. These symptoms can often be mistaken for strep throat and are also associated with a gonorrhea infection. Proper testing and diagnosis should be sought before treatment.
Chlamydia infection of the genitalia differs in symptoms in men and women. The following symptoms most commonly characterize a chlamydia infection in women:
- Abnormal vaginal discharge (with or without an odor)
- Painful, difficult or frequent urination
- Painful intercourse
- Pain or bleeding after sex
- Abnormal bleeding between menstrual periods
- Lower abdominal pain
- Swollen skin around the vagina and or anus
- Any of the above coupled with a low-grade fever and/or nausea
In severe cases and if left untreated, the infection can spread the infection to the urinary tract, cervix, uterus, and the fallopian tubes causing a condition called Pelvic Inflammatory Disease (PID), which can scar or block the fallopian tubes and increases the risk of ectopic pregnancy and long-term pelvic pain.
Below is a list of the primary symptoms of a chlamydia infection in men:
- Pain, difficulty, or burning during urination
- Penile or rectal discharge, or bleeding
- Swelling of the testicular or anal region
Untreated infections in men can lead to complications such as inflammation of the vas deferens and urethra. Although rare, inflammation of the vas deferens and urethra can lead to infertility and damage to the kidneys.
In both genders, prolonged lack of treatment can cause the immune system to become less efficient and “leaves the door open” for other STD’s, STI’s and an increased risk of contracting HIV. Another rare but notable consequence of an untreated infection is what is called reactive arthritis, which manifests as pain in the joints or eyes that can be debilitating. These symptoms are also associated with gonorrhea, making proper diagnosis critical for treatment.
Though less frequent, a chlamydia infection in the eyes is most often associated with:
- Burning and irritations of the eyes and eyelids
- In advanced cases, blurred vision and clouding of the cornea
Ocular chlamydia is most often associated with mother to child transmission when the baby is born by passing through an infected birth canal. As mentioned previously, symptoms may come and go during an active infection, and it is important to be tested even if symptoms seem to have disappeared.
Pregnancy and Chlamydia
Chlamydia is the most common STD found in pregnant women. Testing for Chlamydia and other STD’s, including HIV, is, generally, routinely performed or suggested during the first trimester during prenatal care. A pregnant patient can decline this screening during prenatal consulting based on previous negative test results or screenings, but most doctors will heavily suggest or enforce screening, especially in areas or demographics of high prevalence in certain STD rates. For women over the age of 25 with new or multiple sexual partners, or sexual partners who have a history of chlamydia, should be tested during the first trimester. And women who at high risk of a chlamydia infection, are under the age of 25 should be retested during the third trimester, or anytime there is a change in sexual partner(s).
Chlamydia infection during pregnancy has been linked to infections of the amniotic fluid, preterm birth, preterm premature rupture of the membranes (PPRM), which is when the water breaks early, or the cervix opens without contractions,, and miscarriage. Untreated infections also increase the risk of postnatal uterine infection. Treatment for cases of prenatal chlamydia is about 90% effective, making a standard “test-to-cure” test necessary 3-4 weeks after treatment is completed along with a follow test 3 months after initial testing to prevent postnatal complications. Any sexual partner(s) should also be tested and treated to ensure that reinfection does not occur.
In any case, it is crucial to the woman and baby’s health for pregnant women. Approximately 50% of babies delivered vaginally from an infected mother will contract chlamydia in their eyes or respiratory tract (presented as pneumonia) or both and can also attack the infant’s urogenital tract and rectum and persist for 2-3 years even with treatment. This is particularly alarming in the instance(s) that a chlamydia infection contributes to premature labor and the infant is born with an already compromised immune system.
Infants who are appropriately identified as having chlamydia infections shortly after birth are easily treated and have a high rate of recovery. In most American hospitals, when an infant is born vaginally, it is standard to apply ointment on the baby’s eyes to treat and prevent both gonorrhea and chlamydia.
Chlamydia in Adolescents and Children
Anytime a child under the age of 13 has a Chlamydia or other STD/STI infection the possibility of sexual abuse should be considered and reported. This requires the close cooperation and management of clinicians, laboratories, and child protective services. Official investigations should be initiated immediately when suspected, especially in cases of young children infected with gonorrhea, syphilis, and chlamydia.
Outside of that, young adults and adolescents in America have the highest rate of chlamydia infections with the majority of infections being reported in adolescent girls and women between the ages of 15 and 24.
The younger a person is when they first begin sexual activity the higher their risk for STD’s in general. The main factors for this statement being that, in general, adolescents and young adults often have multiple or consecutive sexual partners in a short period of time along with a naïve or uneducated perspective on safe sex practices and the prevalence and risk of STD’s.
A contributing factor to these high rates in adolescents is the failure of many family physicians to inquire about an adolescent’s sexual activities and a failure for the adolescent to openly disclose their behaviors or concerns because of fear or embarrassment.
Routine screening should be performed or requested for all sexually active adolescents and adults. The following are screening recommendations presented by the CDC from a compilation of federal and medical clinical guidelines for sexually active adolescents:
- Routine Screening for Chlamydia Trachomatis on an annual basis
- Routine Screenings for N. Gonorrhea on an annual basis for females under the age of 25 and YMSM or other at risk groups depending on geographic location
- HIV testing should be discussed and offered to all sexually active adolescents and suggested for at risk individuals
- A Routine Screening for HPV/Cervical Cancer on an annual basis for all sexually active females
- An HPV vaccination is available and should be administered to both males and females age 11 & 12. There are other considerations for this vaccine that a medical professional should be consulted for. Individuals with HIV should receive the vaccination through the age of 26. This vaccine has not been shown to change the perception of the amount of risk in sexual activity
- Other screenings for asymptomatic STD’s are not typically suggested but should be offered based on the level of risk for the individual. However, YMSM and pregnant adolescents should be screened for syphilis
- HBV vaccines are recommended for all adolescents who have not previously been vaccinated for hepatitis B
- HAV vaccinations are recommended for all adolescents who have not yet receive the HAV vaccine
Adolescents or young adults worried about getting an STD test without their parent’s consent should be aware that, in the United States, minors have access to health services and STD screening, tests, and treatment without parental consent. While no state requires that parents be notified that a minor has received testing or care for an STD, with a few exceptions such as rape, some states do allow providers to inform the parents of services provided to minors. This is part of a larger insurance provider issue that has to do with billing and how services are presented on an invoice that the parent of the treated minor might receive.
STDAware takes confidentiality very seriously and was built with these concerns in mind and operates outside of insurance or any other billing, or medical practice. This means that no one, including insurance, medical doctors, parents or guardians, will see testing or treatment results or be aware that testing has been performed at all.
Risk Factors and Prevention
There are specific factors that can increase an individual’s risk of contracting chlamydia and/or other STD’s/STI’s during any sexual act. A few of the risk factors and prevention by category are listed below.
Oral Sex Risk Factors
- Poor oral hygiene
- Open sores in the mouth or on the genitals being contacted by the mouth
- Exposure to any bodily fluid
Oral Sex Prevention Options
- Use of a condom
- Use of a dental dam or a cut open condom to make a square barrier device
- Abstinence (not having oral sex)
- Limiting the number of lifetime oral sexual partners
- Having a monogamous sexual partner who has been properly tested or treated for any existing or pre-existing infections
Vaginal/Anal Sex Risk Factors
- Sexual activity before the age of 25
- Multiple or consecutive sex partners
- Not using a condom correctly or consistently
- History of prior STD’s or STI’s
Vaginal/Anal Sex Prevention Options
- Abstinence (not having vaginal or anal sex)
- Correct and consistent use of a condom
- Having a monogamous sexual partner who has been properly tested or treated for any existing or pre-existing infections
- Limit the number of lifetime sexual partners
- Regular screenings and well visits with a primary care physician along with open dialogue about sexual behaviors/activities, changes and concerns
- Avoid douching (for women) as this may increase the risk for infection
Catching STD’s and STI’s early, treating them properly and not continuing the cycle of transmission is a priority for sexual health The main factors, for any sexually active individual, in STD/STI risk reduction and prevention, is to be tested regularly for STD’s and HIV, open and honest discussion with primary care physician’s and any sexual partner (especially when there is a change in partners).
Proper and consistent use of male condoms dramatically reduces the risk of transmission of STD’s, STI’s and HIV. Unfortunately, the use of condoms does not guarantee 100% effectiveness in prevention, and therefore the only fail-proof method of avoiding infection is abstinence or maintaining a mutually monogamous relationship with an uninfected individual.
Statistics on the efficacy of condom use and prevention is based on laboratory and epidemiological studies along with empirical data and STD rate studies over the years.
Laboratory studies have demonstrated that the use of latex condoms is effective against most strains and molecular structures of STD’s.
Epidemiologic studies that compared the rate of HIV and STD infections in condom users versus non-condom users who have sex with an HIV or STD -infected partners show that consistent condom use produced a significantly lower rate of transmission. There are unknown variables in these studies due to private behaviors that were not measured or observable, but the outcomes are significant enough to make broad generalizations about the effectiveness of condom use.
Empirical data showed that while condoms will provide a reasonable level of protection for many STDs, there are still risks due to the fact that condoms may not cover all of the areas that are or could become infected. Condoms provide the most significant protection against STD’s that transmitted through the contact of genital fluids. The risk associated with Skin to skin transmission of STD’s is reduced but not eliminated. Some of STD’s of this nature are genital herpes, human papillomavirus [HPV] infection, syphilis, and chancroid). To see more information about the STD’s mentioned above, click here for the fact sheet provided by CDC.
The Three C’s of safe sex are:
- Condom Use
Consistent, Correct, Condom use involves following the standards listed below:
- Use a new condom for every sexual interaction
- If the condom does not have a reservoir tip, pinch the tip enough to leave a half-inch space to create a reservoir. Hold on to the tip as you unroll the condom. This prevents semen from overflowing.
- To remove the condom, grip the rim of the condom and carefully withdraw from your partner. Gently pull the condom off, making sure not to spill
- Wrap used condoms in tissue before discarding in the trash
- If the condom breaks at any point during sexual activity, stop immediately, withdraw, remove the broken condom, and put on a new condom
- If using lubricant, be sure to choose one that is water based as oil-based lubricants can weaken the latex of the condom and lead to breakage
The CDC provides an in-depth condom fact sheet.
Testing and Treatment of Chlamydia
Routine Chlamydia and STD screening is advised for any sexually active individual who is not in a long-term, mutually monogamous relationship where both partners have been tested and do not have an STD. Any change in sexual partner(s) is a reason to request both parties are screened before sexual contact is started.
If an existing partner is diagnosed with an STD, it is imperative that the other partner is notified and tested. Honest communication is another major factor in sexual health. For tips on talking to partners about sex and STD testing, click here a free resource and support. Infected partners should be treated, and both partners should abstain from sex until the infection is completely resolved. This prevents re-infection and passing the infection back and forth. Continual and ongoing infection and re-infection can lead to more serious complications.
Routine Screening is especially important when it comes to chlamydia because it does not always present symptoms. Catching chlamydia symptoms early drastically reduces the risks for further health complications to the reproductive system.
Diagnostic tests for Chlamydia are simple and easily gathered, either by urine sample or vaginal swab. Testing is for chlamydia, and other STD’s is very common in laboratories, today, and test results can be turned around fairly quickly.
Treatment of chlamydia has a high rate of success when correctly taken as prescribed. An antibiotic is prescribed in either a single or 7-day regimen, depending on patient history and health factors. To avoid reinfection, sexual activity should be avoided for a full seven days after the completion of treatment to ensure the infection has been completely eradicated from the system.
If symptoms persist seven days after treatment has been completed, the patient should seek medical follow up immediately as other factors could be present. Proper medication will cure most cases of chlamydia, but if any other damage has occurred due to a prolonged infection, additional medical advice or treatment will be required.
Anyone treated for chlamydia should be retested within three months of initial treatment regardless if they believe that their partners were successfully treated.
Chlamydia infections are very common, widespread, and easily transmitted through the act of oral sex as well as vaginal and anal sex. While oral sex carries a slightly reduced risk of transmission compared to vaginal or oral sex, the prevalence of oral infection is high and having an oral infection of chlamydia, and some other STDs can place one at higher risk of contracting HIV.
While chlamydia is an easily treatable disease it often goes undetected because it does not always present symptoms. Routine screening is advised in any sexually active individual in order to identify and treat and reduce the spread of chlamydia.
The best way to avoid a chlamydia infection or other STD is to abstain from any kind of sex. Where abstinence is not an option, one should try to reduce the number of lifetime sexual partners or maintain a mutually monogamous relationship. Following the “Three C’s” of safe sex: Consistent, Correct Condom Use will significantly reduce the risk of infection and transmission.
Anytime there is a change in sexual partner(s) it is important to be screened for chlamydia and other STD’s before sexual contact is made to identify and address any potential sexual health risks. Open and honest communication with a primary care physician as well as sexual partners is vital to sexual health and wellbeing.
Minors can retrieve screening and treatment for STDs without parental consent but depending on the State laws, parents or guardians may or may not be notified or made aware of treatment either by the treating facility of the insurance billing. Children under the age of 14 with a Chlamydia or other STD infection should be considered at risk of sexual abuse and proper reporting and follow up should be conducted.
Pregnant women should be tested for chlamydia and can be treated during pregnancy along with their sexual partner(s).
While treatment of chlamydia infection has a high rate of success, it will not resolve any additional issues that may have resulted from a prolonged infection. Treatment is typically given in a single or 7-day dose regime of antibiotics, which will be prescribed based on individual health and history. Individuals being treated for chlamydia should abstain from all sexual activity for seven days after the completion of treatment and retest for infection should be conducted within three months of initial treatment.