Travis Sky Ingersoll, PH.D., MSW, M.ED. - Social Work & Sexual Health Education/Consulting/Research
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Q: What symptoms of sexually transmitted infections can appear around people’s mouths?

It is important to know that in most cases, STIs (sexually transmitted infections) do not cause any outwardly noticeable symptoms.  It is common for a STI to go unnoticed for years before exhibiting any noticeable symptoms; whereas internally, it may be wreaking havoc on one’s reproductive system and/or other organs.  Infections are only called diseases when they cause symptoms.  This is why STDs are also referred to as “sexually transmitted infections.”  

Nearly half of all sexually active people will be infected with some kind of STI during their lifetime.  The good news is that we can all protect ourselves, and our intimate partners, from STIs by practicing safer sex.  No form of sexual activity is completely safe, however, practicing safer sex allows you to reduce your risk of contracting a sexually transmitted disease.  The most common and easiest way to practice safer sex is by using condoms every time we engage in sexual activity (i.e., penis-vagina, penis-anus, penis-mouth, vulva-mouth).  In reality the best way to protect oneself from STIs is through abstinence.  

Herpes
Although there are a few STIs that can produce symptoms in and around the mouth, the most common STI that can cause such symptoms is Herpes.  There are two forms of Herpes, HSV-1 and HSV-2.  HSV-1 can cause genital herpes, but it is more commonly associated with infections of the mouth and lips (also called cold-sores or fever blisters).  It is also important to understand that HSV-1 is not typically caused by sexual activity.  However, a person with HSV-1 that engages in oral sex with a partner can transmit herpes to their partner’s genitals, especially if herpes blisters are present.  

Genital herpes is primarily caused by infection of the HSV-2 virus.  It is common for people who have HSV-2 to have no, or only minimal signs or symptoms of infection.  When symptoms do occur, they typically appear as one or more tiny blisters on or around the genitals or anus.  Females are more susceptible to HSV-2 transmission through sexual contact with males, than are males through sexual contact with females.  In other words, males can transmit herpes more easily to females than females can to males.  

Although most people infected with HSV-2 are not aware of their infection, if symptoms do occur, it usually takes place within two weeks of becoming infected.  Small painful blisters may appear on or around the genitals, anus or mouth, and typically take about two to four weeks to heal.  The first outbreak of herpes may also be accompanied by a fever or flu-like symptoms.  After the initial outbreak, those infected with HSV-2 can expect to experience recurrent breakouts four or five times a year.  

Treatment for Herpes
Herpes can be diagnosed through a visual inspection by a health care provider.  The health care provider may also take a sample from the herpes sores to be tested in a laboratory.  Once diagnosed with herpes there are antiviral medications that can shorten and/or prevent outbreaks while a person is taking such medication.  However, herpes has no cure, and although symptoms may disappear, it is always possible to spread herpes to others.  Even using a condom during sexual activity is not 100% effective, since herpes can be transmitted through the skin around the genitals, anus, and mouth.   


Human Papillomavirus (HPV) - Genital Warts 
Genital warts are growths on the skin of the genital area and around the anus, that are caused by certain types of the human papilloma virus (HPV).  There are more than 100 types of HPV.  Some can lead to certain cancers (ex., cervical cancer, cancer of the penis), and some produce genital warts.  

Genital wart symptoms are typically flesh-colored, soft bumps on the skin that resemble the surface of a cauliflower. They often grow in more than one place and may cluster in large masses.  Often genital warts are painless, but they may itch.  Although it is not common, genital warts can appear in the mouth, on the lips, tongue, palate, or in the throat.  The most common areas infected by genital warts are the vagina, vulva, cervix, penis, anus or urethra.  

Treatment for Genital Warts
Often, a person’s body is able to fight off the virus over time.  If such is the case, the warts will go away with no treatment.  But if one wishes to have them removed, there are a number of genital wart treatments to choose from.  A medical health provider will be able to review the available options.             


Syphilis           
Syphilis is a sexually transmitted disease caused by bacteria.  It can infect the vagina, anus, urethra, penis, as well as the mouth and lips.  Syphilis can become a serious health risk if not treated quickly.             

Syphilis is particularly dangerous since it often produces no symptoms, or such mild symptoms that the infected person doesn’t notice.  The most commonly noticeable symptom is a painless sore or open wet ulcer, called a chancre.  Chancres typically appear around three weeks after infection, but they may take up to 90 days to appear. Without proper treatment, chancres may last 3-6 weeks and can appear on the genitals, in the vagina, on the cervix, lips, mouth, breasts or anus.             

As Syphilis progresses it may cause body rashes, often on the palms of the hands and the soles of the feet that can last up to 6 weeks.  Other symptoms include mild fever, fatigue, hair loss, weight loss, swollen glands, headache, and muscle pains.  If left completely untreated, syphilis may lead to serious damage to the nervous system, heart, brain and other organs, and may eventually lead to death.             

Treatment for Syphilis           
A health care provider can do tests to determine if a person has syphilis, whether or not symptoms like chancres are present.  If chancres or a rash on one’s palms or soles of their feet are present, a medical provider will test any fluid coming from the sores.  Otherwise, a simple blood test is used for diagnosis.   In the early stages of infection, syphilis is easy to treat.  All one has to do is take an antibiotic.  Of course, it is also advisable for the infected person’s sexual partner(s) to also be treated at the same time regardless of whether they have symptoms.  However, it is important to understand that the damage caused in the later stages of infection cannot be undone.  

Final Note
Regardless of whether a person is exhibiting any kind of symptom around their mouth, it is imperative to understand that most STIs do not produce symptoms anywhere on the body.  The most effective way to protect oneself from getting a STI is through abstinence.  If one chooses to be sexually active, the use of condoms during every sexual encounter is imperative in order to practice the safest sex possible.  But remember, no sexual activity can be 100% safe, no matter what precautions one takes, so regular testing for STIs is wise.   
Referenced Resources 

Nevid, J. S. (1998).  Choices: Sex in the age of STDs.  Boston: Allyn and Bacon.  http://www.plannedparenthood.org 

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