How can the dental team prevent the spread of STIs?

Gemma Forsythe speaks to Haley O'Neill about the problems in dental nursing

This month, Gemma Forsythe discusses the STIs you can spot during a check-up, their symptoms and how to approach the topic with patients.

Share love, not infections.

Something that is important to be aware of, but won’t be discussed much due to the stigma surrounding the subject, is sexually transmitted infections (STIs) in relation to oral health.

So, what does the dental team have to do with dealing with STIs? And what should happen if evidence of an oral manifestation of a sexually transmitted disease or infection is picked up by the dental team?

The more well-known and more discussed STIs – such as hepatitis B and chlamydia – will have little relevance to the dental team. However, gonorrhoea, syphilis and oral herpes are those that may be picked up during a dental examination and will need to be conveyed to the patient.

STIs have a direct impact on sexual and reproductive health through stigmatisation, infertility, cancers, pregnancy complications and can increase the risk of HIV.

What STIs can you identify during a dental examination?

Gonorrhoea will usually present itself in the form of a sore throat and swollen lymph nodes. However, there are times when the patient will not experience any symptoms. This means a lot of the time people will not know that they have gonorrhoea unless they have STI testing done.

Syphilis symptoms will appear the same way whether they affect their genitals or their mouth. If it is caught via oral sex it will appear as chancres – small sores which will appear three weeks to months after infection. There may be occasions that the sores go unnoticed by the patient or they are mistaken for something else such as a common mouth ulcer. Even when the sores disappear, you are still infected and can pass the infection on.

Herpes can be passed on via oral sex if a sexual partner is suffering from genital herpes. This will present itself as sores around your mouth, but following the initial outbreak these sores can disappear. This does not mean it is cured as there can be outbreaks in the future.

STIs are on the increase

It is important to remember that with these STIs and any others, there can be no symptoms whatsoever. Therefore, it is advisable to do STI testing between sexual partners in order to keep yourself healthy and safe.

It has never been more important to recognise these conditions. Data from the Office for Health Improvement and Disparities – responsible for public health improvement across England – shows that 97% of councils have seen increases in cases of gonorrhoea, with 10 councils seeing numbers triple. There has been an increase of 76% in rates of syphilis and a 36% rise in cases of chlamydia.

As dental professionals, we are in a unique position in that we can notice these things, even if a patient has not noticed themselves. There are occasions in which noticing symptoms such as above an turn into a safeguarding issue, eg if a patient has experienced sexual assault.

We should be able to make our surgeries feel like as a safe space where patients can confide in us.

How should the dental team approach STIs?

So, if the dental team has noticed something in a patient’s mouth that could be an STI, how do we approach it?

Explain to the patient gently, without judgement, that you have noticed something that may be an oral manifestation of an STI. Patients may get embarrassed or feel judged, but it is important to make them aware that their care and health comes first and it is your priority to help them
Know where to refer. Be aware of where your local sexual health testing clinic is and how to refer a patient you are concerned about to them. A patient can also self refer, of course, but sometimes an accompanying letter from a dentist can help detail specific concerns
Be aware that you do not need to ask personal questions such as sexual partners, sexual orientation etc. This is the job of the sexual health clinic and you do not need this information for a referral. Believing that needing to ask these questions may put dentists off discussing this with patients, but this is definitely not the case.

STI signs and symptoms

I first became aware of the relation between STIs and oral health when a very inspirational friend of mine, Preetee Hylton, was doing a lecture on this topic at the London Dentistry Show in 2023. Here is what Preetee had to say on the topic:

‘Dental professionals should prioritise reminding individuals about the importance of practicing safer sex by highlighting the need to be vigilant about oral manifestations of STIs acquired through unprotected oral sex, including cunnilingus (oral sex performed on the vulva/vagina), fellatio (oral sex performed on the penis), and anilingus (oral stimulation of the anus).

‘Common signs and symptoms in the mouth vary depending on the STI present, such as blisters, ulcers, rashes, itching, tingling, burning sensations, unusual discharge, bleeding, discomfort or pain during urination, and the presence of skin growths or warts. While certain STIs, like chlamydia, pubic lice, trichomoniasis, hepatitis (A, B, C), and scabies may not exhibit oral manifestations, there remains a risk of oral transmission for others like herpes, human papillomavirus (HPV), gonorrhoea and syphilis.

‘Measures to prevent the spread of STIs include:

Consistent condom use during vaginal and anal sex, using a latex (or non-latex, if you are allergic) plastic square (similar to a dental dam, which dental professionals are familiar with) to cover the female genitalia using protection for oral sex
Avoiding sharing sex toys and washing them thoroughly after every single use
Refraining from sexual activity while aware of an STD or STI
Informing sexual partners of one’s STI status
Undergoing regular STI testing
Ensuring new sexual partners get testing before engaging in sexual activity.’

STI testing is readily available through NHS sexual health clinics. You can find out more here.

Follow Preetee on Instagram @thelondondentalnurse.

Contact [email protected] for references

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