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      Heterosexual Anal and Oral Sex in Adolescents and Adults in the United States, 2011–2015

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      Author(s): , MPH, , PhD, , PhD, , PhD, , PhD
      Publication date PMC-release:
      Journal: Sexually transmitted diseases

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          Abstract

          Background:

          Heterosexual anal and oral sex are related to the acquisition and transmission of sexually transmitted diseases (STDs). As common reportable STDs (chlamydia, gonorrhea, and syphilis) in the United States are increasing, it is important to understand recent oral and anal sexual behaviors.

          Methods:

          We examined the prevalence and correlates of heterosexual anal and oral sex, associated condom use, and having multiple partners among men and women aged 15 to 44 years.

          Results:

          Approximately one third of women and men had ever engaged in anal sex, including 11% of adolescents (15–19 years). Most women and men had ever received or given oral sex (at >75%). Six percent and 7% of women and men, respectively, used a condom at last oral sex compared with 20% and 30% who used a condom at last anal sex. Having multiple sex partners in the past year was most common among adolescents, never or formerly married persons, and those who had a nonmonogamous partner. Less than 10% reported multiple anal sex partners in the past year. A substantial minority had multiple oral or anal sex partners; black women and men had the highest reports of oral sex partners by race/ethnicity.

          Conclusions:

          Anal and oral sex are common sexual practices. Given the low rates of condom use during these behaviors, it is important that recommendations for sexual risk assessments are followed. Tailored messaging regarding risk for STD and human immunodeficiency virus acquisition during oral and anal sex may benefit adolescents, singles, and divorced individuals. Future discussions regarding the benefits of extragenital STD testing for heterosexuals may be useful.

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          Sexually transmitted infection as a cause of anal cancer.

          M Frisch, B Glimelius, A J van den Brule … (1997)
          The incidence of anal cancer has increased in recent decades, particularly among women. To identify underlying risk factors, we conducted a population-based case-control study in Denmark and Sweden. We conducted telephone interviews with 324 women and 93 men in whom invasive or in situ anal cancer was diagnosed between 1991 and 1994, 534 controls with adenocarcinoma of the rectum, and 554 population controls. The interviews covered a wide spectrum of possible risk factors for anal cancer. Odds ratios were calculated by logistic regression. Specimens of anal-cancer tissue and samples of rectal adenocarcinomas were tested for human papillomavirus (HPV) DNA with the polymerase chain reaction. Multivariate analysis revealed consistent and statistically significant associations between measures of sexual promiscuity and the risk of anal cancer in both men and women. There was a significant trend toward an association between higher numbers of partners of the opposite sex in women (P<0.001) and men (P<0.05) and strong associations with a variety of venereal diseases. In women, receptive anal intercourse, particularly before the age of 30 years, and venereal infections in the partner were also associated with an increased risk (odds ratios, 3.4 and 2.4, respectively). Fifteen percent of the men with anal cancer reported having had homosexual contact, as compared with none of the controls (P<0.001). High-risk types of HPV, notably HPV-16, were detected in 84 percent of the anal-cancer specimens examined, whereas all rectal-adenocarcinoma specimens tested were negative for HPV. Our study provides strong evidence that a sexually transmitted infection causes anal cancer. The presence of high-risk types of HPV, notably HPV-16 (which is known to cause cancer of the cervix), in the majority of anal-cancer tissue specimens suggests that most anal cancers are potentially preventable.
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            Differences in Oral Sexual Behaviors by Gender, Age, and Race Explain Observed Differences in Prevalence of Oral Human Papillomavirus Infection

            Gypsyamber D’Souza, Kevin Cullen, Janice Bowie … (2014)
            Purpose This study explores whether gender, age and race differences in oral sexual behavior account for the demographic distribution of oral human papillomavirus infection (HPV) and HPV-positive oropharyngeal cancer (HPV-OSCC) Methods This analysis included 2,116 men and 2,140 women from NHANES (2009–10) who answered a behavioral questionnaire and provided an oral-rinse sample for HPV detection. Weighted prevalence estimates and prevalence ratios (PR) were calculated for sexual behaviors and oral HPV infection by gender, age-cohort (20–29, 30–44, 45–59, 60–69), and race, and contrasted with incidence rate ratios (IRR) of OSCC from SEER 2009. Multivariate logistic regression was used to evaluate predictors of oral sexual behavior and oral HPV16 infection. Results Differences in oral sexual behavior were observed by gender, age-cohort and race. Most men (85.4%) and women (83.2%) had ever performed oral sex, but men had more lifetime oral and vaginal sexual partners and higher oral HPV16 prevalence than women (each p<0.001). 60–69 year olds (yo) were less likely than 45–59 or 30–44 (yo) to have performed oral sex (72.7%, 84.8%, and 90.3%, p<0.001), although oral HPV16 prevalence was similar. Prevalence ratios (PR) of ever oral sex in men vs. women (PR = 1.03), and 45–59 vs. 30–44 year-old men (PR = 0.96) were modest relative to ratios for oral HPV16 infection (PRs = 1.3–6.8) and OSCC (IRR = 4.7–8.1). In multivariate analysis, gender, age-cohort, and race were significant predictors of oral sexual behavior. Oral sexual behavior was the primary predictor of oral HPV16 infection; once this behavior was adjusted for, age-cohort and race were no longer associated with oral HPV16. Conclusion There are differences in oral sexual behaviors when considering gender, age-cohort and race which explain observed epidemiologic differences in oral HPV16 infection across these groups.
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              Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States.

              V Schick, S. Sanders, Michael Reece … (2010)
              Given the efficacy of latex condoms for preventing pregnancy, HIV, and most STI, their promotion remains central to global sexual health efforts. To inform the development of accurate and appropriately-targeted interventions, there is a need for contemporary condom use rates among specific populations. The purpose of this study was to establish rates of condom use among sexually active individuals in the U.S. population. Data were collected via a national probability sample of 5,865 U.S. adolescents and adults aged 14 to 94 years. Condom use was assessed during the most recent partnered vaginal or anal sexual event and over the past 10 vaginal and anal intercourse events. Condom use by men during past 10 vaginal intercourse events was slightly higher (21.5%) than that reported by women (18.4%), and consistent with rates of condom use reported during most recent vaginal intercourse by men (24.7%) and women (21.8%). Adolescent men reported condom use during 79.1% of the past 10 vaginal intercourse events, adolescent women reported use during 58.1% of the same. Condom use during past 10 anal intercourse events was higher among men (25.8%) than women (13.2%); the same was observed for most recent anal intercourse event (26.5% for insertive men, 44.1% for receptive men, and 10.8% for receptive women). Generally, condom use was highest among unmarried adults, higher among adolescents than adults, and higher among black and Hispanic individuals when compared with other racial groups. These data indicate clear trends in condom use across age, gender, relationship status, and race/ethnicity. These contemporary rates of condom use will be helpful to those who lead efforts to increase condom use among individuals who may be at risk for sexually transmitted infections or who desire to prevent pregnancy. © 2010 International Society for Sexual Medicine.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 7705941
                Journal ID (pubmed-jr-id): 7382
                Journal ID (nlm-ta): Sex Transm Dis
                Journal ID (iso-abbrev): Sex Transm Dis
                Title: Sexually transmitted diseases
                ISSN (Print): 0148-5717
                ISSN (Electronic): 1537-4521
                Publication date Nihms-submitted: 11 September 2019
                Publication date (Print): December 2018
                Publication date PMC-release: 01 December 2019
                Volume: 45
                Issue: 12
                Pages: 775-782
                Affiliations
                Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
                Author notes
                Correspondence: Melissa A. Habel, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-04, Atlanta, GA 30329. mhabel@ 123456cdc.gov .
                Article
                Accession ID: PMC6753934 Pmcid ID: PMC6753934 Pmc-uid ID: 6753934 Manuscript ID: hhspa1049929
                DOI: 10.1097/OLQ.0000000000000889
                PMC ID: 6753934
                PubMed ID: 29965947
                SO-VID: e6f38c97-f8f2-4a2a-9da9-29f61b63c626
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