Ironically, April is both Sexually Transmitted Disease (STD) Awareness month as well as Oral, Head and Neck Cancer Awareness month. Many people don't even realize how these two diseases are linked and how they both pose a serious health risk, especially for our adolescent boys.
As far as STDs, according to the United States Centers for Disease Control and Prevention (CDC), even though only a quarter of the sexually active population is made up of people age 15 to 24, this group comprises almost half of the newly diagnosed 19 million STD cases each year.
A recent study looked at sexual activity in the high school population. Published in the Archives of Pediatrics and Adolescent Medicine, this study found that for high school students, oral sex was most commonly their first sexual experience when they were beginning experimentation with sexual activity. It was twice as likely to precede vaginal intercourse than the other way around. Teens who engaged in oral sex by 9th grade were more likely to eventually have had vaginal intercourse by the end of 11th grade. In fact, often experimentation with oral sex led to riskier sexual activity within six months. The reverse was also found to be true: teens that delayed having oral sex were less likely to engage in vaginal intercourse during high school.
There was also this disturbing notion that many teens think of oral sex as a low-risk sexual activity. They look at it as a way to have sex without the risk of getting pregnant. However, more importantly, they have a misguided notion that it has less of a risk of contracting sexually transmitted diseases. However this is not true, almost all STDs can be contracted from oral sex too. And while contracting a bacterial STD such as gonorrhea from oral sex can have more immediate short-term effects and symptoms such as an inflamed throat infection called gonorrheal pharyngitis, a viral STD such as human papillomavirus (HPV) can have insidious, serious long-term health consequences later in life.
While many teens are aware of the dangers of STDs such as chlamydia and gonorrhea, HPV is another story. Some think it only concerns girls. More recently there has been a push to educate and vaccinate girls to prevent cervical cancer, but not much is being said about the potential problem it poses for adolescent boys.
HPV, according to the CDC, is a very common sexually transmitted disease infecting about 6 million people a year. It's estimated that 50 percent of sexually active men and women have been exposed at some point in their lives. In the majority of infections, our body's immune system takes care of it without any treatment. However, the same way certain strains of the virus get into cells of the cervix and change them into cancerous cells, it can also happen with the cells in the mouth and throat when exposed during oral sex.
Which brings us to the Oral, Head and Neck Cancer Awareness portion of April. According to the National Cancer Institute, around 65 percent of the cases of oropharynx cancer at the base of the tongue and tonsils are associated with HPV. Almost 80 percent of these cases occur in men. Recent research finds a rise in the incidence of head and neck cancers in this new demographic of younger men who never smoked or drank alcohol excessively. This younger demographic of patients were all found to be HPV-positive secondary to exposure during oral sex. This is corroborated by a CDC survey that found about 90 percent of males in general report having oral sex with partners of the opposite sex. Other studies have found that having six or more oral sex partners in a lifetime is associated with a three-times higher risk of HPV-induced oropharyngeal cancer.
A surgical colleague of mine agrees. He does research into the immuno-biology of head and neck cancers transformed by viruses such as HPV. Dr. Duane Sewell, M.D., associate professor of Otorhinolaryngology-Head and Neck Surgery at the University of Maryland School of Medicine, says "Despite the slight overall decrease we are seeing in the number of head and neck cancer patients associated with smoking and alcohol use, we are seeing a rise in a subset of younger men contracting these cancers and they are attributed to oral sex and HPV."
The good news is that these HPV-related head and neck cancers are somewhat easier to treat. Some studies have found better survival rates; almost 85 percent of nonsmokers with HPV tumors survive compared to only 45 to 50 percent of those people who are HPV-negative and smoke. And another bright spot is that while the new vaccines for HPV have been found to prevent only about 70 percent of cervical cancers in women, they are much more effective at preventing head and neck cancers. Dr. Sewell states, "About 95 percent of HPV tumors are attributed to strain 16 which can be prevented by both commercially available vaccines."
Right now, the CDC only recommends vaccinating adolescent girls -- they came in just short of a recommendation for boys, stating physicians and parents have the option to vaccinate their sons if they choose. The public health community does advocate the vaccination of boys as a form of "herd immunity." That means that if we vaccinate boys, we will see fewer men walking around with HPV and, correspondingly, fewer women, as well. But in light of the recent study I discussed above, which found oral sex is the gateway to sexual activity for teens, as both the mother of an adolescent boy and as a physician, I think people should seriously consider the vaccine for their sons.
Another important caveat to learn from all this is that we need to speak frankly and explicitly with our teens about sex. We cannot be squeamish and dance around the words, even if it means using slang terms and specifics to get the point across. As uncomfortable as your kids or you may feel, don't let it stand in the way of their health. It's not worth it. Unlike cancer, no one ever really died of embarrassment!
Follow Leigh Vinocur, M.D. on Twitter: www.twitter.com/doctor_leigh