STD Sore Throat: Transmission, Symptoms, Treatment, and More

STDs that cause sore throat

Chlamydia

According to recent statistics, chlamydia is the most commonly reported bacterial sexually transmitted infection in the United States, with over 1.6 million cases reported each year, and that number is growing every year. There are three types of chlamydia bacteria. The one that causes an STD is called Chlamydia Trachomatis. [1, 2] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm
Sexually Transmitted Disease Surveillance 2021. Centers for Disease Control and Prevention (CDC).
https://www.cdc.gov/std/statistics/2021/default.htm#:~:text=The%20report%20indicates%20that%20in,return%20to%20pre%2Dpandemic%20levels.

Getting infected with oral chlamydia

According to the CDC, someone may get throat chlamydia when, during sex, oral mucosa comes into contact with: [1] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm

Chance of contracting chlamydia orally

The exact likelihood of contracting oral chlamydia is unknown (though it is estimated to be low). However, oral chlamydia is much less common than genital and anal infections because the bacteria that causes the infection "prefers" the genital and anal areas. Additionally, oral chlamydia testing is not common; the disease is usually asymptomatic (in over 95% of cases) and goes away on its own within six weeks of infection. Thus, cases of oral chlamydia are underreported, making it challenging to study and estimate transmission rates. [3] Routine universal testing versus selective or incidental testing for oropharyngeal Chlamydia trachomatis in women in the Netherlands: a retrospective cohort study. The Lancet Infextious Diseases https://www.sciencedirect.com/science/article/abs/pii/S1473309921004655

Certain factors may increase the risk of getting oral chlamydia. Those are: [1, 4] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm
Pharyngeal Chlamydia trachomatis in Men Who Have Sex With Men (MSM) in The Netherlands: A Large Retrospective Cohort Study. PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9049257/

Frequency of oral chlamydia for different genders and sexual orientations

According to available data, the prevalence of oral chlamydia for different groups of people is as follows: [5] Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. PubMed Central https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913006/

A study conducted in Sweden showed that among patients with genital chlamydia, throat chlamydia was diagnosed in 2.7% and 7% of men and women, respectively. [6] Pharyngeal Chlamydia trachomatis is not uncommon anymore. Scandinavian Journal of Infectious Diseases https://sci-hub.se/https://doi.org/10.3109/00365548.2011.553243

It is also worth noting that around 32% of women with throat chlamydia do not have concurrent anal or genital chlamydia. This fact highlights the importance of testing for oral STDs, even if the tests for anogenital STDs are negative. [3] Routine universal testing versus selective or incidental testing for oropharyngeal Chlamydia trachomatis in women in the Netherlands: a retrospective cohort study. The Lancet Infextious Diseases https://www.sciencedirect.com/science/article/abs/pii/S1473309921004655

Incubation period

For symptomatic people, it usually takes around 1-3 weeks for symptoms of oral chlamydia to develop.

Symptoms

In the majority of cases, people with oral chlamydia have no symptoms. Research shows that only 2-5% of oral chlamydia cases cause symptoms of pharyngitis or lymphadenitis. These symptoms may include: [3, 6] Routine universal testing versus selective or incidental testing for oropharyngeal Chlamydia trachomatis in women in the Netherlands: a retrospective cohort study. The Lancet Infextious Diseases
https://www.sciencedirect.com/science/article/abs/pii/S1473309921004655
Pharyngeal Chlamydia trachomatis is not uncommon anymore. Scandinavian Journal of Infectious Diseases
https://sci-hub.se/https://doi.org/10.3109/00365548.2011.553243

Complications

In about 36–57% of cases, infected people get rid of oral chlamydia without any treatment within 9–10 days (most cases resolve within six weeks of exposure). However, in some cases, this condition can cause complications such as gingivitis (gum infection) and periodontal disease (chronic inflammation of gums and other structures around the teeth), resulting in secondary mouth infections and tooth loss. [4] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm

Oral Chlamydia pictures

1. Chlamydia sore throat

Gonorrhea

Gonorrhea is an STI caused by the bacteria Neisseria gonorrhoeae that affects genital, oral, and anal regions. Annually, around 710,000 gonorrhea cases are reported in the US, making it the second most common bacterial STD after chlamydia. [5] Sexually Transmitted Disease Surveillance 2021. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/std/statistics/2021/default.htm#:~:text=The%20report%20indicates%20that%20in,return%20to%20pre%2Dpandemic%20levels.

Getting infected with oral gonorrhea

A person can contract oral gonorrhea when the oral mucosa comes into contact with gonorrhea-infected areas: [1] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm

Chance of contracting gonorrhea orally

It is difficult to determine the exact chance of contracting throat gonorrhea from a single oral intercourse since oral gonorrhea testing is not routinely performed, and the infection often goes undetected. However, it is estimated that the overall chance of getting oral gonorrhea can be relatively high, especially among the MSM population. [7] Factors associated with pharyngeal gonorrhea in young people: Implications for prevention. PubMed Central https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086760/

Additional factors that can significantly increase the risk of gonorrhea contraction are: [7] Factors associated with pharyngeal gonorrhea in young people: Implications for prevention. PubMed Central https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086760/

Frequency of oral gonorrhea for different genders and sexual orientations

The overall prevalence of oral gonorrhea among different population groups is as follows: [5] Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. PubMed Central https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913006/

Importantly, around 10- 20% of women diagnosed with cervical gonorrhea also suffer from gonorrhea of the throat. Therefore, women who test positive for genital gonorrhea and who also engage in oral sex should get tested for oral gonorrhea. [5] Diagnosis and Management of Gonococcal Infections. American Academy of Family Physicians https://www.aafp.org/pubs/afp/issues/2012/1115/p931.html

Incubation period

The incubation period for oral gonorrhea is around seven days.

Symptoms

Up to 90% of men and women with throat gonorrhea are asymptomatic. [5] Diagnosis and Management of Gonococcal Infections. American Academy of Family Physicians https://www.aafp.org/pubs/afp/issues/2012/1115/p931.html

In symptomatic patients, throat gonorrhea symptoms are nonspecific and include:

Complications

If left untreated, oral gonorrhea may persist for as long as 16 weeks, which may result in its further transmission to sexual partners as well as spread through the bloodstream, causing severe complications such as: [1, 9] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm
The Duration of Pharyngeal Gonorrhea: A Natural History Study. PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366826/

Oral Gonorrhea pictures

1. Gonorrhea sore throat

Syphilis

Syphilis is a common STD caused by the bacteria called Treponema pallidum. In 2021, 176,700 syphilis cases have been reported in the US. The disease develops in stages: primary, secondary, latent, and tertiary, each with a different manifestation. [2] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm

Getting infected with syphilis orally

Around 14% of syphilis cases are caused by oral sex. Oral transmission of syphilis occurs when, during oral sex, the syphilitic lesion (chancre) comes into direct contact with intact skin or mucous membrane. [10] Transmission of Primary and Secondary Syphilis by Oral Sex --- Chicago, Illinois, 1998—2002. CDC https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a2.htm

There is also evidence that in very rare cases, syphilis can be transmitted through kissing if the infected person has a chance on the lips, throat, or mouth. [11] Oral manifestations of syphilis. Elsevier https://www.elsevier.es/en-revista-clinics-22-articulo-oral-manifestations-of-syphilis-S1807593222029878#:~:text=Oral%20lesions%20arise%20in%20at,nodular%20lesions%20may%20rarely%20arise

The incidence of oral syphilis has been increasing in recent years, and it has been established that oral infection most often affects the tongue (37.5% of cases), lips (29.5% of cases), palate (19.3% of cases), and the buccal mucosa (6.8% of cases). [12] Oral Manifestations of Early Syphilis in Adults: A Systematic Review of Case Reports and Series. PubMed Central https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594522/

Chance of contracting syphilis orally

The per-intercourse probability of transmission of oral syphilis during penile-oral sex in the primary and secondary stages is around 1%. [13] Resurgence of Syphilis in the United States: An Assessment of Contributing Factors. Sage Journals. https://journals.sagepub.com/doi/10.1177/1178633719883282#:~:text=Sexual%20networks,-The%20ability%20of&text=In%20a%20study%20by%20Gray,per%20penile%2Doral%20sexual%20act

The likelihood of transmission of oral syphilis through oral-vaginal or oral-anal intercourses has not yet been established.

However, the risk of contracting oral syphilis may be increased in case of:

Incubation period

The incubation period of syphilis (the period between exposure and the development of syphilitic chancre) is about 1–3 weeks. [11] Oral manifestations of syphilis. Elsevier https://www.elsevier.es/en-revista-clinics-22-articulo-oral-manifestations-of-syphilis-S1807593222029878#:~:text=Oral%20lesions%20arise%20in%20at,nodular%20lesions%20may%20rarely%20arise

Symptoms

There are 4 stages of syphilis, which have different signs and symptoms. The initial stage of the disease is called primary syphilis, which is characterized by the appearance of a single (in most cases) painless ulcer (chancre) on the site of exposure. In the case of oral syphilis, this syphilitic chancre typically appears on the lip, rarely on the tongue or throat. The chancre is round and deep with irregularly raised borders and a red or purple base. In men, it is most commonly located on the upper lip, and in women, it is on the lower lip. This fact can be explained by the different techniques of performing fellatio and cunnilingus. [11] Oral manifestations of syphilis. Elsevier https://www.elsevier.es/en-revista-clinics-22-articulo-oral-manifestations-of-syphilis-S1807593222029878#:~:text=Oral%20lesions%20arise%20in%20at,nodular%20lesions%20may%20rarely%20arise

The chancre will go away with or without treatment within 3-6 weeks. [14] Syphilis – CDC Basic Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm However, if left untreated within 8 weeks of primary syphilis, the infection will enter the bloodstream and develop into a systematic infection with generalized symptoms. These symptoms include:

As with the primary stage, these symptoms will also resolve on their own but will eventually develop into further stages, causing life-threatening complications. [14] Syphilis – CDC Basic Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

Complications

Syphilis is a serious infection. If left untreated, it can lead to death or fatal complications such as: [1] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm

Oral Syphilis pictures

1. Primary syphilis lesion

2. Secondary syphilis mucosal patches

Herpes

Herpes is a highly contagious viral infection that causes cold sores (fever blisters). Herpes is caused by two types of herpes simplex virus (HSV) infection, namely HSV-1 and HSV-2. Both types can affect both oral and genital regions. However, HSV-1 most often affects the oral region, while HSV-2 affects the genitals. Herpes is incurable; once infected, it will remain in the body for the rest of your life. [15] Herpes Simplex Virus. WHO https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

Getting infected with oral herpes

Oral herpes is spread through skin-to-skin contact.

More specifically, the infection can be transmitted via: [16, 17] Oral Herpes. Johns Hopkins Medicine
https://www.hopkinsmedicine.org/health/conditions-and-diseases/herpes-hsv1-and-hsv2/oral-herpes
Herpes Simplex Virus (HSV) Mouth Infection. University of Rochester Medical Center
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00888

Chance of contracting herpes orally

Data on the per-exposure likelihood of herpes transmission through oral sex is not well defined since it is difficult to determine how exactly someone got the infection (herpes infection is widespread and can be transmitted even through non-sexual contact (e.g., kissing, sharing a lip balm or utensils)). Either way, the likelihood of contracting herpes through oral intercourse is likely high, as the infection is highly contagious. [18] Cold sore. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/cold-sore/symptoms-causes/syc-20371017

Different factors can increase the chance of herpes transmission. For example:

Frequency of oral herpes

Oral herpes is known to be highly contagious, with the HSV-1 virus alone affecting more than 67% of the world's population aged 50 years or younger. [15] Herpes Simplex Virus. WHO https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus In the US, the estimated percentage of the population with oral herpes ranges from 50-80%.

Incubation period

The incubation period (the period between exposure and the appearance of cold sores) of oral herpes ranges from 2 to 12 days (4 days on average).

Symptoms

Most herpes-positive people are unaware of their infection, as about 90% of all herpes cases do not cause noticeable symptoms. [19] Herpes: The Blistering Facts. University of Utah ttps://healthcare.utah.edu/healthfeed/2015/11/herpes-blistering-facts

For the rest, symptoms of the initial infection (first outbreak) include: [16] Oral Herpes. Johns Hopkins Medicine https://www.hopkinsmedicine.org/health/conditions-and-diseases/herpes-hsv1-and-hsv2/oral-herpes

Complications

In rare occasions, the herpes virus affects the eyes of the infected person, leading to eye infection, which may result in scaring of the surface of the eye, vision problems, and blindness. [1] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm

Oral herpes pictures

1. Herpes blister (cold sore)

2. Herpetic pharyngitis (sore throat)

HPV

HPV (Human Papillomavirus) is the most commonly occurring STI globally. Around 90% of males and 80% of females acquire this infection at least once. 20 Of the 200 known types of HPV, four affect the mucous membranes of the mouth and genitals, nine of which can cause cancer. [21] Oropharyngeal Human Papillomavirus (HPV) Infection. Cleveland Clinic https://my.clevelandclinic.org/health/diseases/15010-oropharyngeal-human-papilloma-virus-hpv-infection#:~:text=What%27s%20the%20oral%20HPV%20incubation,t%20develop%20symptoms%20at%20all

Getting infected with oral HPV

Oral HPV is transmitted via skin-to-skin (mucosa-to-mucosa) contact. Therefore, someone may contract the oral infection through: [22] Oral Human Papillomavirus Infection University of California San Francisco https://www.ucsfhealth.org/medical-tests/oral-human-papillomavirus-infection

Certain factors increase the risk of getting oral HPV. Those are: [22] Oral Human Papillomavirus Infection University of California San Francisco https://www.ucsfhealth.org/medical-tests/oral-human-papillomavirus-infection

In addition, males are more susceptible to oral HPV infection than females.

Chance of contracting HPV orally

The exact likelihood of HPV transmission through oral sexual intercourse has not yet been established. The thing is that oral HPV testing is not part of routine STD screening. Also, in 90% of cases (9 out of 10), HPV resolves on its own without causing any symptoms or complications and therefore goes unnoticed. [23] Genital HPV Infection – Basic Fact Sheet.Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/std/hpv/stdfact-hpv.htm

Anyways, the transmission rate is estimated to be high since the infection is highly contagious, and almost every sexually active person contracts the disease at least once in a lifetime.

Frequency of oral HPV for different genders

The prevalence of oral HPV is 11.5% and 3.2 % among men and women, respectively. [24] Prevalence of Oral HPV Infection in Men & Women. MDedge. https://www.mdedge.com/internalmedicine/clinical-edge/summary/infectious-diseases/prevalence-oral-hpv-infection-men-women

Research shows that about 19.3% of men and 5.1% of women with genital HPV have oral HPV. [25] Transmission and clearance of human papillomavirus infection in the oral cavity and its role in oropharyngeal carcinoma – A review. PubMed Central https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10078185/ At the same time, the prevalence of oral HPV without concurrent genital infection was only 4.4% and 2.1% among men and women, respectively. [26] Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection, NHANES 2011 to 2014. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203692/

Incubation period

Symptomatic patients typically develop oral HPV symptoms within 3 to 6 months of infection. [21] Oropharyngeal Human Papillomavirus (HPV) Infection. Cleveland Clinic https://my.clevelandclinic.org/health/diseases/15010-oropharyngeal-human-papilloma-virus-hpv-infection#:~:text=What%27s%20the%20oral%20HPV%20incubation,t%20develop%20symptoms%20at%20all

Please note that most of the oral HPV cases are asymptomatic, and the virus can remain in the tissues of the oral cavity without causing any noticeable signs or symptoms.

Symptoms

In most cases, the immunity fights HPV infection before the virus causes signs or symptoms. However, some people develop oral warts caused by the virus, which are characterized as tiny, flesh-colored bumps appearing anywhere in the oral cavity. [21] Oropharyngeal Human Papillomavirus (HPV) Infection. Cleveland Clinic https://my.clevelandclinic.org/health/diseases/15010-oropharyngeal-human-papilloma-virus-hpv-infection#:~:text=What%27s%20the%20oral%20HPV%20incubation,t%20develop%20symptoms%20at%20all

Complications

Rarely (in about 1% of cases) oral HPV infection can lead to oropharyngeal cancer, the symptoms of which include: [21] Oropharyngeal Human Papillomavirus (HPV) Infection. Cleveland Clinic https://my.clevelandclinic.org/health/diseases/15010-oropharyngeal-human-papilloma-virus-hpv-infection#:~:text=What%27s%20the%20oral%20HPV%20incubation,t%20develop%20symptoms%20at%20all

The majority of oropharyngeal cancers are caused by HPV-16 infection.

Oral HPV pictures

1. HPV oral warts

2. HPV oral cancer

HIV

HIV (human immunodeficiency virus) is a potentially deadly infection that affects more than 39 million people worldwide. This infection attacks white blood cells responsible for regulating immune responses, weakening the immune system and making a person more susceptible to various infectious (viruses, fungi, and bacteria) and non-infectious (for example, cancer) diseases. [27] HIV and AIDS. WHO. https://www.who.int/news-room/fact-sheets/detail/hiv-aids

HIV can be transmitted through body fluids such as blood, semen, vaginal secretions, and breast milk, as well as through mother-to-child transmission.

Oral Transmission of HIV

Theoretically, oral transmission of HIV is possible through: [1] STD Risk and Oral Sex – CDC Fact Sheet. Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm

Certain factors increase the risk of oral transmission of HIV, such as:

Chance of contracting HIV orally

The risk of acquiring HIV through oral intercourse is considered very low and virtually impossible if the infected partner's viral load is so low that it is undetectable. Oral intercourse carries a much lower risk of transmitting HIV than anal or vaginal intercourse. According to the literature, the estimated probability of contracting HIV per unprotected oral sex is 0.04%. [28] Oral sex and the risk of HIV transmission. Aidsmap. https://www.aidsmap.com/about-hiv/oral-sex-and-risk-hiv-transmission

Incubation period

The incubation period of HIV ranges between 1-6 weeks. However, having detectable antibodies in the blood will take 1-3 months. [29] HIV/AIDS. National Centre for Infectious Diseases https://www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/HIV-AIDS.aspx#:~:text=Incubation%20Period&text=Between%201%20and%206%20weeks,within%2010%20years%20after%20infection

Symptoms

HIV symptoms vary from person to person and from stage to stage. Symptoms of HIV affecting the oral cavity appear early in the infection, also known as acute HIV infection (within four weeks of infection).

Acute HIV

Up to 90% of people with acute HIV infection develop flu-like symptoms. These symptoms last for a few days (sometimes for a few months) and include: [30] Symptoms of HIV. HIV.gov https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv

Complications

The most common complications of AIDS are opportunistic infections (infections that typically do not cause disease in healthy people but may result in severe complications in people with weakened immunity). People with AIDS may also develop various types of cancer. [27, 30] HIV and AIDS. WHO.
https://www.who.int/news-room/fact-sheets/detail/hiv-aids
Symptoms of HIV. HIV.gov
https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv

Oral HIV pictures

1. HIV oral thrush