Are Yeast Infections, Thrush, and Oral Sex Connected?

Question: Is there a relationship between yeast infections, thrush, and oral sex?

I recently received a question from a woman who wanted to know why I hadn't written about the relationship between oral sex and yeast infections. My answer at the time was that it had never occurred to me to do so. It wasn't a concern I'd heard discussed. However, I offered to dig into the literature to see what I could find about sexual transmission of yeast infections. Specifically, I looked at whether it was possible to get oral thrush from oral sex. (Or, conversely, if it was possible to get a yeast infection from oral sex.) 

Answer: It's not entirely clear if you can transmit yeast infections through oral sex. 

Vaginal yeast infections can be caused by a number of fungal species. The most common cause is Candida albicans. That is the same organism that is responsible for most cases of oral thrush. Therefore, it is quite natural to wonder whether or not yeast can be transmitted from the mouth to the vagina, or vice versa, during oral sex.

The answer, however, is not at all clear. There have been numerous studies of sexual transmission of yeast infections. However, the results have been decidedly mixed. Some studies have found that both members of a couple are occasionally, but not reliably, infected with the same strain of yeast. However, other research suggests that those results may be misleading. When scientists look further, they often find that the similarities between the yeast are usually only superficial. In other words, both colonies of yeast may be from the same general species (i.e. Candida albicans). However, they could still be very different strains. Many times, the biological "fingerprints" of the yeast seen in sexual partners are different enough to suggest they originated from different sources.

There is somewhat more data on the transmission of vaginal yeast infections to infants during delivery. That route is not quite the same pathway as transmission through sex, but the research largely shows similar results. As one might expect if the yeast were directly transmitted from mother to infant, thrush infections are more common in infants born vaginally than in those delivered by c-section. However, the strains infecting the infants have rarely been found to be the same as the ones infecting the mother. That makes direct transmission less likely.

Taken as a whole, the bulk of the evidence seems to suggest that sexual transmission does not play a major role in vaginal or oral yeast infections. In other words, it's unlikely that you would get oral thrush from oral sex. That said, there is some evidence that suggests that caution may be in order. This is particularly relevant for women who have experienced recurrent vaginal yeast infections.

A small study found that clearing up reservoirs of yeast in a partner’s mouth, ejaculate, or rectum helped these women. When combined with restricting sexual activity until the yeast were eliminated, partner treatment was an effective way to get rid of recurrent yeast infections in women who had repeatedly failed to respond to direct treatment.

This research also suggests the possibility that one reason direct treatment may not work is that a woman is being re-infected by her partner. 

Most women probably do not need to be particularly concerned about sexual transmission of yeast infections. However, women who suffer from recurrent vaginal yeast infections may want to discuss the benefits of partner testing with their doctors. In addition, regularly practicing safer sex for vaginal and oral sex may help as well. Doing so may reduce the likelihood of coming into contact with yeast in your partner's secretions.

As for avoiding yeast infections generally, there are other changes you can make. Yeast infections have been linked to several systemic health conditions such as HIV and diabetes. People on steroids are also at greater risk for yeast infections. So are those who have recently been on antibiotics.

That last factor may seem counter-intuitive. However, yeast are almost always present in our systems. They only become a problem (i.e. a yeast infection) when they overgrow the rest of the normal flora. This generally happens after some sort of physical imbalance. Such imbalances can be caused by antibiotics. When these medications knock out healthy bacteria, yeast populations can expand to fill the empty space. Bacterial imbalances are also what anti-candida diets and other lifestyle interventions try to counteract. In addition, anti-candida diets may try to eliminate the sugars that yeast use as food, in order to make the mouth and vagina less favorable places for them to grow.

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