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非直接性行为并不像想象中安全  

2008-10-11 14:58:56|  分类: 之初本善 |  标签: |举报 |字号 订阅

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September 4, 2008 — The American College of Obstetricians and Gynecologists has issued a committee opinion about the health risks associated with noncoital sexual activity and has published it in the September issue of Obstetrics & Gynecology.

"Noncoital sexual behaviors, which include mutual masturbation, oral sex, and anal sex, are common expressions of human sexuality," the ACOG [American College of Obstetricians and Gynecologists] Committee on Adolescent Health Care and Committee on Gynecologic Practice write. "Couples may engage in noncoital sexual activity instead of penile-vagina intercourse hoping to reduce the risk of sexually transmitted diseases and unintended pregnancy. Although these behaviors carry little or no risk of pregnancy, women engaging in noncoital behaviors may be at risk of acquiring sexually transmitted diseases."

Most individuals engaging in oral sex are unlikely to use barrier protection. However, sexually transmitted diseases (STDs) may be spread through saliva, blood, vaginal secretions, semen, and fecal matter, especially in the presence of preexisting infections, open sores, or other lesions.

HIV transmission correlates highly with HIV viral load of the infected partner, is most likely with receptive rather than insertive activities, and is 5-fold greater with receptive anal sex vs receptive vaginal sex.

Herpes simplex virus (HSV-1) is usually associated with oral lesions and HSV-2 with genital lesions. However, both types can infect oral, anal, and genital sites. Human papillomavirus (HPV) is a highly prevalent, sexually transmitted virus that can cause anogenital and oral cancers as well as benign genital warts. Transmission is less efficient to the mouth vs the genitals.

Hepatitis B virus is commonly spread through noncoital sexual activities, as it is found in semen, saliva, and feces. Hepatitis A is transmitted via fecal contamination of the oral cavity and is more common in men practicing oral-anal contact. Although sexual transmission of hepatitis C virus is uncommon, it may occur with preexisting hepatitis B virus and HIV infection and with oral-genital contact.

Nonviral STDs associated with noncoital sexual activities include syphilis, gonorrhea, and chlamydia, and there have been a few case reports of chancroid, shigellosis, and salmonellosis.

To counsel patients effectively, clinicians should inquire about specific noncoital sexual activities as well as about intercourse and about the gender of the partner or partners. Consistent and correct condom use should be encouraged. Reducing STD risk factors such as multiple partners may be more effective than discouraging oral or anal sex.

Other risk reduction strategies may include abstinence, mutual monogamy, engaging in relatively safer behaviors, and STD testing before initiating sexual activity with a new partner. All sexually active women 25 years or younger should be screened annually for chlamydia, and all sexually active adolescents should be screened for gonorrhea. Lesbians and bisexual women should be screened for STDs according to the same risk factors as other women.

"Great efforts are needed to educate health care practitioners and the public regarding the potential health risks of noncoital sexual activities and the importance of risk reduction and barrier methods of protection," the study authors conclude. "Practitioners can assist by assessing patient risk and providing risk reduction counseling for those participating in noncoital sexual activities. Ultimately, additional research is needed to determine the full impact of noncoital sexual activity on the health of patients."

Obstet Gynecol. 2008;112:735-738.



丁香园:
编译:

2008年9月4日 美国妇产科医学院在9月份的妇产科学杂志上公布了一项专家意见,这项意见指出了非直接性行为的健康风险。

ACOG(美国妇产科医学院)的成人健康保护委员会和妇产科委员会在报告中写道,非性交性行为,包括手淫,口交,肛交都是人类性方面的表现。伴侣可能会弄一些非性交的性行为来取代性交,以希望降低感染性传播疾病和怀孕的风险。尽管这些行为导致怀孕的机率很小或者几乎没有,但是女性在这种非性交性行为中仍有可能被感染性病的风险。

大部分个人在口交时是不太愿意用到防护措施。但是,性病可能会通过唾液,血液,阴道分泌物,精液和粪便传播,在已经有感染史,疱疹伤口,和其他身体破损的时候几率就更大。

HIV的传染与被感染者HIV病毒含量高度相关,最有可能是被动接受感染而不一定要通过直接性交,大概前者的几率是后者的5倍。

1型单纯疱疹病毒通常与口腔病变相关,2型单纯疱疹病毒往往与生殖器病变相关。但是,两种病毒都能通过口腔,肛门和生殖器传播。人乳头状瘤病毒极其普遍,这种性传播病毒会导致生殖器或口腔癌症和生殖器疣。通过口腔的性病传播比起生殖器而言风险要小得多。

乙肝一般是通过非性交性行为来传播,经发现也有经过精液,唾液和粪便途径。甲肝一般是通过粪口途径的污染进行传播,在人类的粪口途径中这个病毒也更为常见。尽管丙肝通过性传播并不常见,但是还是有可能通过粪口途径发生在曾得过乙肝和艾滋的患者身上。

与非性行为有关的非病毒性传播疾病包括梅毒,淋病和衣原体感染,还有些许报道如软下疳,志贺氏菌病和沙门氏菌病。

为了更有效的忠告患者,临床医生应该询问具体的非直接性行为,性交的详情和性伴侣以及性别。坚持和正确使用避孕套应该得到鼓励支持。减少性病感染的风险因素如滥交或者比口交和肛交更有效。

其他可以减低感染风向的办法可能有禁欲,一夫一妻制,采取相对安全的性行为,并在新婚夫妇有性行为前进行性病检查。所有处于性行为活动期的25岁甚至更为年轻的女性
每年都应该接受衣原体的检查,所有性行为活动期的成年人都应该接受淋病的检查。和其他女性面临一样的风险因素,所以同性恋和双性恋的女性也应该接受全面的性病检查。

报告的作者总结道,在教导健康保健从业者和提高公众意识方面还需要付出更大的努力,让他们考虑到非直接的性行为所带来的潜在风险,适当的性保护措施可以减少感染几率的重要性。保健从业者可以帮助评估病人所冒的风险,并为那些有非直接性活动的人群提供降低感染风险的咨询服务。最后,非直接性行为对患者的健康有哪些影响因素还需要进一步的研究。



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