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Noncoital Sexual Activity May Not Be "Safe" Sex

September 4, 2008 — The American College of Obstetricians and Gynecologists has issued a committee opinion about the health risks associated with noncoital sexual activity and has published it in the September issue of Obstetrics & Gynecology.
"Noncoital sexual behaviors, which include mutual masturbation, oral sex, and anal sex, are common expressions of human sexuality," the ACOG Committee on Adolescent Health Care and Committee on Gynecologic Practice write. "Couples may engage in noncoital sexual activity instead of penile-vagina intercourse hoping to reduce the risk of sexually transmitted diseases and unintended pregnancy. Although these behaviors carry little or no risk of pregnancy, women engaging in noncoital behaviors may be at risk of acquiring sexually transmitted diseases."
Most individuals engaging in oral sex are unlikely to use barrier protection. However, sexually transmitted diseases (STDs) may be spread through saliva, blood, vaginal secretions, semen, and fecal matter, especially in the presence of preexisting infections, open sores, or other lesions.
HIV transmission correlates highly with HIV viral load of the infected partner, is most likely with receptive rather than insertive activities, and is 5-fold greater with receptive anal sex vs receptive vaginal sex.
Herpes simplex virus (HSV-1) is usually associated with oral lesions and HSV-2 with genital lesions. However, both types can infect oral, anal, and genital sites. Human papillomavirus (HPV) is a highly prevalent, sexually transmitted virus that can cause anogenital and oral cancers as well as benign genital warts. Transmission is less efficient to the mouth vs the genitals.
Hepatitis B virus is commonly spread through noncoital sexual activities, as it is found in semen, saliva, and feces. Hepatitis A is transmitted via fecal contamination of the oral cavity and is more common in men practicing oral-anal contact. Although sexual transmission of hepatitis C virus is uncommon, it may occur with preexisting hepatitis B virus and HIV infection and with oral-genital contact.
Nonviral STDs associated with noncoital sexual activities include syphilis, gonorrhea, and chlamydia, and there have been a few case reports of chancroid, shigellosis, and salmonellosis.
To counsel patients effectively, clinicians should inquire about specific noncoital sexual activities as well as about intercourse and about the gender of the partner or partners. Consistent and correct condom use should be encouraged. Reducing STD risk factors such as multiple partners may be more effective than discouraging oral or anal sex.
Other risk reduction strategies may include abstinence, mutual monogamy, engaging in relatively safer behaviors, and STD testing before initiating sexual activity with a new partner. All sexually active women 25 years or younger should be screened annually for chlamydia, and all sexually active adolescents should be screened for gonorrhea. Lesbians and bisexual women should be screened for STDs according to the same risk factors as other women.
"Great efforts are needed to educate health care practitioners and the public regarding the potential health risks of noncoital sexual activities and the importance of risk reduction and barrier methods of protection," the study authors conclude. "Practitioners can assist by assessing patient risk and providing risk reduction counseling for those participating in noncoital sexual activities. Ultimately, additional research is needed to determine the full impact of noncoital sexual activity on the health of patients."

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