Let's face it: Sex education in America is flimsy at best, but with access to a whole world online at your fingertips, it's become increasingly easy to become more educated — that is, if you know what you're looking for.
Recently, TikTok user @junahealth released this sex ed TikTok, informing viewers that it's totally fine to rinse your mouth out after oral sex, but advising not to brush or floss at least two hours before or after oral. The video claims that brushing and flossing will create tiny cuts in your mouth, which will allow pathogens like HIV to enter into your bloodstream.
Naturally, people were shocked:
So, I decided to talk to not one, not two, but THREE experts on the validity of this claim. First, I spoke with Rosa Topp, MSN, RN, NPD-BC, and the Director of Medical Standards Implementation of PPFA (Planned Parenthood Federation of America). First things first, she said that it's important to understand how STIs are transmitted, and how best to protect yourself. Typically, STIs are infections that are transmitted through oral, vaginal, or anal sex. Topp said, "The best way to prevent transmission of STIs is to avoid skin-to-skin contact by using a barrier method like a condom, dental dam, or latex underwear."
Topp explained, "Bacteria and/or viruses can live in sexual fluid or on skin or mucosal surfaces, and may or may not cause symptoms in the infected person. During oral sex, if barrier methods like condoms or dental dams are not used, then that infected skin or sexual fluid can pass along the bacteria or virus to the mouth or throat of the sex partner, and an infection can grow there — which, again, may or may not cause symptoms." This means oral STD transmission is always a possibility if you're not using protection.
Topp said that it's true that certain factors may increase the risk of contracting an STI during oral sex, like poor oral health and bleeding in gums. But she clarified, "There are no scientific studies that show whether these factors increase the risk of getting STIs from oral sex."
Topp also explained that symptoms can vary depending on the STI, as well as how you were infected. She said, "Each STI and the symptoms that come with it are different. For example, gonorrhea, a common STI, is mainly spread through vaginal, anal, or oral sex. While oral gonorrhea is less common than genital gonorrhea, it does happen and may present with different symptoms from anal or vaginal gonorrhea." For example, symptoms of oral gonorrhea may not show up, but if they do, they might present in the form of an itchy throat.
For more information about HIV, I spoke with Dr. Stacey Rizza, Executive Medical Director for International Practice, Infectious Diseases, Mayo Clinic. She said, "We have a very clear understanding of how HIV is transmitted. And it's transmitted through sex, whether it's oral, vaginal, or anal, it's transmitted through other blood or body fluids." She also added, "Any time somebody has unprotected sex, whether it's oral, vaginal, anal, they are at risk of HIV infection if they don't know their partner's HIV status, no matter what they do."
I also spoke with Dr. Zainab Mackie, a general dentist practicing in Grosse Pointe, Michigan. Dr. Mackie said that while brushing and flossing could possibly cause microscopic cuts in the mouth, the best way to prevent this is to actually brush and floss regularly. She explained, "The healthier your gums are the more firm they are and less likely to bleed." Dr. Mackie also added that when doing so, make sure you're being gentle. She said, "Any vigorous flossing or brushing will create cuts."
Dr. Mackie also echoed the previous statements by Dr. Rizza and Dr. Topp. She said, "Risk factors are unknown and/or if there was no use of a physical barrier. For example, if you don’t know your partner's history and overall health status, then it’s best to take those extra precautions." Dr. Mackie also said that in order to protect yourself against oral STI's, you should visit your dentist for regular checkups and said, "It’s also important to visit your dentist to make sure there are no sores or wounds like from cheek biting present."
The CDC reported that more than 85% of sexually active adults aged 18-44 years reported having oral sex at least once with a partner of the opposite sex. However, the Journal of Adolescent Health reported that fewer than 10% of teens and young adults surveyed used protection during oral sex.
There's a common misconception that oral transmission of STIs are less common or less serious than those transmitted vaginally or anally. Dr. Topp said, "Because there is no risk of pregnancy, there are many people who skip safe sex practices like condoms during oral sex. When it comes to HIV in particular, oral sex is much safer than vaginal or anal sex, but other infections like gonorrhea, herpes, syphilis, HPV, chlamydia, and hepatitis B can still be spread during oral sex." So, even though you reduce your risk of HIV during oral sex, you're still exposing yourself to other infections.
Dr. Rizza concluded that one of the best ways to make sure that you're not risking yourself or your partner in the transmission of STIs or HIV is to regularly get tested. She said, "We recommend you both (yourself and your partner) go together to get tested for sexually transmitted infections, including HIV, and show each other the results." Dr. Rizza said that if you and your partner are in a monogamous relationship and see that the both of you are negative, it would then be reasonable to stop using condoms, if you choose.
Dr. Topp echoed this point, and said that getting tested is also key, as STI infections don't always manifest physically, so you might not know you even have one. She said, "Many people with STIs have no symptoms at all but can still spread infection to others. Knowing your status can keep you and your partner(s) safe."
Dr. Topp also added that open communication between you and your partner about your status is not only important for your sex life, but for your relationship as well. She said, "Knowing your STI status can help you and your partner(s) feel more relaxed, which can strengthen your relationship and enhance intimacy in your intimate and your sexual experiences."
Sex education is often considered to be a taboo, with many curriculums offering lacking information, to the detriment of those involved. Dr. Rizza said, "Particularly as an infectious disease doctor and an HIV provider, I strongly recommend safe sex conversations in education. I think it's what we need to do in order to prevent transmissions and eventually end the pandemic." Dr. Topp added that, especially when talking about STI transmission during sex, there can be an added embarrassment or shame, which can prevent people from becoming properly educated, and even getting tested.
The most recent CDC analysis reported that 1 in 5 people in the US has an STI. In spite of this, there is an unnecessary stigma attached to getting tested. Dr. Topp said, "The stigma surrounding STIs is harmful to everyone, whether or not you have an STI. Stigma doesn’t prevent STIs — in fact, it does the opposite. Stigma makes it harder to do the very things that we know can actually prevent STIs: get tested, use barrier methods during sex, and talk openly with partners about STI status and testing. Being more honest and less judgmental about STIs is one of the best ways we can help keep ourselves and the people we know healthy."
She also added that sex education is key, and said, "Sex education is incredibly important in fighting stigma around STIs. Sex education gives people age-appropriate, medically accurate information and answers to their questions about sex and relationships, without being shamed or judged. It has been proven to positively impact young people’s lives."
I spoke with Peter Arian, the head of Juna Health, a company that offers mail-in STD testing and that posted the TikTok video, who said that the inspiration for the company was to offer an opportunity to get tested. "I felt like being able to provide at-home testing was really kind of a step forward toward a demographic that really doesn't get tested proactively."
Peter also added that Juna was formed to provide accessible testing to those who might not have nearby access to it. He said, "I was surprised to see the number of people that have reached out to say, essentially, like me, we get people that live in, like, Fort Worth, Texas, and they're just not comfortable with going to a lab...There's that kind of accessibility barrier, where a lot of people just don't feel comfortable being seen going into a lab and getting tested, or there's not a lot (of access to testing), and they have one clinic in that area."
Ultimately, it's important to take precautionary measures against STDs during any sexual contact and to get tested whenever necessary. For more information on STDs, click here.