Throat Oral

Throat Oral
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Questions Sore throat from oral sex?
Last updated May 14, 2015 Originally published Jan 03, 2008
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Is it possible to get sick from oral sex, when your partner doesn't have any STD's? I've only ever had one partner, and recently I performed oral sex on him. Only ever since I have had a sore throat, and swollen glands. Is this related, or did I just pick up cold germs he was carrying?
Whether it is related or not, having a sore throat and swollen glands can be a real drag. The symptoms you describe could be a common cold or strep throat , but they could also be caused by an infection you may have received during oral sex. It's possible that your partner may have a sexually transmitted infection (STI) without knowing it, and passed it on to you through fluids exchanged during oral sex. Some STIs are passed more easily during oral sex including herpes and gonorrhea . Yeast infections can also be spread to partners during oral sex (See Do I have thrush? for more information). Oral STI symptoms may include:
There are ways to protect yourself and your partner from oral infections during sex including:
It's a good idea to see a health care professional anytime you suspect that you may have an infection, or when cold symptoms last for more than a few days as an untreated infection can become serious. If you do have an infection, your health care professional may take a throat culture to find its cause. If it turns out that you have an STI, be sure to talk to your partner so he can get treated as well, even if he has no noticeable symptoms. Without treatment, your partner could give you the infection again, even if you have been treated.
Seeking help and information when you are concerned about something is always a good idea. After all, it's your health and well-being.
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Introduction
Equipment
General inspection
Lips and gums
Tongue
Buccal mucosa, cavity floor and hard palate
Oropharynx
Palpation
Completion
Interactive markscheme

Patients with severe odynophagia (pain on swallowing) are more likely to suffer from trismus (reduced opening of the jaw, also known as “lockjaw”). This can greatly hinder your ability to examine and therefore it may be appropriate to offer analgesia and examine the patient after this has taken effect.

If there is any abnormal tongue movement, perform a cranial nerve examination.

Asking the patient to say “aaah” will cause them to naturally depress the base of the tongue and aid you in your examination.

Use your index or middle finger to palpate on the inside of the oral cavity, and your thumb or a finger of the opposing hand to palpate externally. You may choose to do this with one or two hands depending on their size.

When assessing each other, click on each list item as you go along. Doing so will turn the list item green. Make careful note of any steps missed at the end. We recommend completing any examination or procedure in under 10 minutes, but you can adjust the timer to suit your needs.

Introduce yourself, confirm the patient's name and date of birth, obtain consent and proceed to wash hands.
Ask the patient to remove any dentures and to sit on a chair and face you. Check if they are in any pain or discomfort and offer analgesia if necessary.
Start by facing the patient and observing for any obvious swelling around the cheek or mandible, which may be due to swollen parotid or submandibular glands.

In addition to multiple small salivary glands littered around the mucosa of the oral cavity there are three large salivary glands which open into it on each side:

General causes of salivary gland enlargement include:

Unique causes of parotid enlargement include:

Ask the patient to open their mouth and use your torch to inspect the patients lips for any colour changes , such as “ brown freckles ” found in Peutz-Jegher’s syndrome, or signs of inflammation (stomatitis/cheilitis). Look for any ulcers (sores) which may be sequelae of erythema multiforme or infections, such as syphilis or herpes simplex virus. Very rarely, a lip ulcer with a hard edge may be due to cancer.
Briefly observe for inflammatory dental disease in the gums (gingivitis) and teeth (periodontitis).

Hereditary intestinal polyposis syndrome, or “Peutz-Jegher's syndrome,” is an autosomal dominant disease characterised by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules (brown freckles) on the lips and oral mucosa.

Inflammation of the mouth and lips (stomatitis) or the lips only (cheilitis), is most commonly caused by irritation at the corners of the mouth (called angular cheilitis). This can be precipitated by vitamin (B2) and mineral (iron) deficiencies or candida infection.

Ask the patient to stick out their tongue and move it from side to side to observe for any obstruction, which may be due to swellings .

Glossitis refers of inflammation of the tongue. This can be infective or nutritional in origin. The tongue will be sore , the dorsal surface will usually be smooth and erythematous , and there will be absence of some of the lingual papillae. Two important types of glossitis are as follows:

Use your tongue depressors to manipulate the tongue and have a good look at the buccal mucosa. Ask the patient to lift their tongue to view the floor of the oral cavity and then to tilt their head back so you can observe the hard palate.
Ask the patient to centre their tongue. Using your tongue depressors, gently press the tongue so that you can get a good view of the oropharynx. Identify the soft palate and uvula. Mucosal changes described above may also be present here. Position your torch to get good views of the anterior palatoglossal and posterior palatopharyngeal arches. The pharyngeal tonsils will be sat in the tonsillar depressions in between the pharyngeal folds (pillars) which form the arches.
Identify the various structures in the oropharynx.
Inflammation of the pharyngeal folds and uvula will be present in pharyngitis. Pharyngitis may also present with uvular swelling . Other causes of swelling include injury (for example, during intubation) or acid reflux.
Identify the position of the uvula. Deviation with the absence of any other signs or symptoms may be normal, but otherwise may be due to a contralateral glossopharyngeal nerve lesion (the uvula is deviated “away” from the lesion). If there is nearby palatine swelling , such the presence of a peritonsillar abscess (quinsy), then this will push the uvula to the contralateral side.
In most healthy individuals, the tonsils can be difficult to identify. Chronic, bilaterally enlarged tonsils are usually benign. Causes of a unilateral tonsillar enlargement however include papilloma and carcinoma. Pharyngitis may spread to the tonsils causing tonsillar inflammation (tonsillitis). Swelling is often bilateral, usually with one tonsil swelling more than the other. White exudate may be present if the cause is bacterial in nature.
Tonsils will be absent in a tonsillectomy; white granulation tissue is often present in the weeks immediately following one.

Inflammation of the pharynx is known as pharyngitis. The patient will present with odynophagia and fever. This is typically caused by “common-cold” viruses such as adenovirus and are self-limiting. More aggressive viruses include Epstein-Barr virus and measles virus. Bacterial infections are much less common but are almost always due to Group A streptococcal species such as Streptococcus pyogenes .

Tonsillitis is a subtype of pharyngitis, and hence has the same aetiology and presentation. Both viral and bacterial tonsillitis can cause swelling, but only the latter presents with exudate. Numerous infections of tonsillitis requiring antibiotics (>7 in the span of a year) may warrant consideration of a tonsillectomy.

One of the complications of bacterial tonsillitis is infection spreading to the peritonsillar space forming a peritonsillar abscess, also known as a “quinsy.” An untreated peritonsillar abscess can lead to oropharyngeal obstruction and trismus (due to odynophagia ). The size of the tonsils has no bearing on the presence or absence of a peritonsillar abscess; often the complication occurs when the tonsils are barely enlarged.

Put on the non-sterile gloves. Ask the patient if they mind if you palpate around the oral cavity.
Bimanually palpate the floor of the oral cavity, identifying any sialoliths or swelling of the submandibular or sublingual glands. Next palpate the lateral wall for swelling of the parotid gland. Characterise any such swellings assessing for size, tenderness, texture and consistency .
Complete the examination by thanking the patient, disposing of equipment and washing your hands. If appropriate, offer to examine the ears, nose, neck and cranial nerves. Further investigations would warrant referral to any of the following teams, depending on the pathology identified:
Present and/or document your findings.
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