They can't point to clear statistics, but local health officials say they are seeing a growing number of oral sexually transmitted diseases among teens.
"Oral sex is taking the place of intercourse. They think it's safer - they can't get pregnant, can't get an STD," said Mary Stacy, an adolescent health and youth development coordinator for the Richmond County Health Department.
Much of it, health officials say, has to do with the belief that oral sex is not sex.
"They don't look at it as sex and feel they are still virgins," said registered nurse Denise Scott, of the Richmond County Health Department's sexually transmitted disease clinic.
Gynecologist Dr. Yevgeny Kilman, an assistant professor with the Medical College of Georgia, agreed.
"They think if you can't get pregnant from it, then it's actually not considered sex," he said.
There has been an intense effort in past years to reduce teen pregnancy, a campaign that might have ignored related health concerns.
There is also a lack of education, officials say.
Parents either don't know all the facts or aren't talking to their children about it, and the sex education curriculum in schools emphasizes abstinence and does not address the needs of those who are active.
Mrs. Scott said she sees an average of 275 clients a month - 75 percent of them teens.
"They are quite surprised to find that anything you can get genitally, you can get orally. I don't think they realize that," Mrs. Scott said. "You need to practice safe sex either orally or genitally - condoms need to be used - if you are going to have sex at all."
Though several teen magazines and other media outlets have reported that teen oral sex is a new trend, experts say it is difficult to substantiate because of the difficulty in getting parents to allow their children to be surveyed about their sexual behavior and the government's reluctance to fund such controversial research.
"Our anecdotal evidence shows that kids think (oral sex) is considerably safer behavior than vaginal sex," Cory Richards stated in a report from the Alan Guttmacher Institute published in the journal Family Planning Perspectives.
According to the Urban Institute's 1995 National Survey of Adolescent Males, nearly half of all males ages 15-19 reported having oral sex, up from 44 percent in a 1988 survey.
In a recent report by The Kaiser Family Foundation, 26 percent of sexually active 15- to 17-year-olds surveyed said that one "cannot become infected with HIV by having unprotected oral sex."
By the time Mrs. Scott sees those who come to her clinic, it's likely too late. They are already sexually active and most have already contracted an STD.
"You have to take them where they are - Sexually Transmitted Diseases 101 - and walk them through it," Mrs. Scott said.
Though all STDs must be reported to the state, the numbers don't differentiate between oral and genital cases.
"Syphilis and gonorrhea are the most common things we find in the throat," Mrs. Scott said.
While most can be knocked out with antibiotics, viral infections such as herpes and warts can be treated but not cured.
One problem in diagnosing, treating and counseling teens with oral STDs is that they are often not forthcoming about their sexual experiences.
"You cannot examine kids without the consent of the parents," he said. "You can check them if they say they are having sex, but you cannot check them if they say they aren't."
Mrs. Scott said there is also the perception that sexually transmitted diseases are somehow wrongly linked to personal hygiene or personality - that a person who is dirty or mean is more likely to have a STD than one who is well-groomed or nice.
"We've noticed a definite increase in the number of cases of oral STDs due to teens having oral sex. All we can do is educate, educate, educate," Mrs. Scott said.
Dr. Kilman said it's time for sex education to move beyond the birds and the bees. Abstinence-based sex education, he said, is "not a reality."
"First we didn't talk about it at all, then we talked about sex. Now we should talk about more than vaginal intercourse," Dr. Kilman said. "Whoever sees teenagers and is talking to them about safe sex should also make them aware of this. Some will do it no matter what you tell them. It's good to arm them with the knowledge that it's not really safe."
Reach Melissa Hall at 868-1222, ext. 113, or firstname.lastname@example.org.
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