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In Live Action’s Perth Amboy, New Jersey Planned Parenthood sting, nurse manager Amy Woodruff is asked by the “pimp” and his “bottom girl” how soon a fourteen year old girl can go back to work after an abortion. Two weeks for intercourse was the reply. But in response, in the words of the pimp:

“I mean they still gotta make money, you know?”

Woodruff’s heartless reply:

“Waist up.”

Meaning that they can still do oral sex while their frail bodies recover from gynecological surgery. This beast couldn’t even screw up a shred of humanity to say,

“Hey man, they aren’t machines. Give them a little rest.”

That now-infamous line, “Waist up,” screams for a little epidemiology, and pathophysiology. Let’s look at a sampler platter with only some of the STD’s transmitted via oral sex performed on the most STD-riddled members of society.

{I don’t show clinical photos of disease manifestations. I leave it to the reader to Google the images if they so desire}

Human Papillomavirus (HPV)

According to the Centers for Disease Control and Prevention:

It is estimated that more than 1,700 new cases of HPV-associated head and neck cancers are diagnosed in women and nearly 5,700 are diagnosed in men each year in the United States.*

*These numbers are based on a large study that covered 83% of the U.S. population during 1998–2003, and may under-represent the actual number of cancers diagnosed during this time period. Also, this study used cancer registry data to estimate the amount of potentially HPV-associated cancer in the United States by examining cancer in parts of the body and cancer cell types that are more likely to be caused by HPV. Cancer registries do not collect data on the presence or absence of HPV in cancer tissue at the time of diagnosis. Cancers of the head and neck are usually caused by tobacco and alcohol, but recent studies show that about 25% of mouth and 35% of throat cancers are caused by HPV.

The following graph from CDC shows the incidence rates of head and neck cancers from HPV:

Chlamydia

This is a bacterial infection that remains asymptomatic (silent) in over 50% of patients who have it. If it gets established in the mouth, nose, or pharynx, it leads to infections of the eye that are not always easily treated. Since it remains silent in so many, a person with oral chlamydia (or any pathogen for that matter) can get it on their hands by simply wiping their mouth, and then transmit it to their genitals by merely wiping after toileting. Once transmitted to the genitalia in girls, it can lead to Pelvic Inflammatory Disease and sterility.

Here are CDC’s rates of Chlamydia by age and sex in the U.S. in 2008:

Gonorrhea

It should be noted that Chlamydia, Gonorrhea, and Syphilis are often travel companions, and many clinicians will treat for all three if one is found.

Gonorrhea, also caused by a bacterium will often spontaneously resolve in cases of oral infection, but can be transmitted to objects placed in the mouth and throat, such as another penis. In rare cases of depressed immune function, oral gonorrhea can spread systemically (throughout the body). Cases of girls in sex-trafficking rings who are kept stressed, hooked on heroin and cocaine, and malnourished, are more likely to suffer from immunosuppression and become a candidate for oral, leading to systemic infection.

Here are CDC’s rates by age and sex for 2009

HIV

According to CDC, the oral mode of HIV transmission is lower than the vaginal and anal routes, but still a risk factor:

If the person receiving oral sex has HIV, their blood, semen (cum), pre-seminal fluid (pre-cum), or vaginal fluid may contain the virus. Cells lining the mouth of the person performing oral sex may allow HIV to enter their body.

The risk of HIV transmission increases

if the person performing oral sex has cuts or sores around or in their mouth or throat;
if the person receiving oral sex ejaculates in the mouth of the person performing oral sex; or
if the person receiving oral sex has another sexually transmitted disease (STD).

Syphilis

This disease is on the rise world-wide, especially in sex industry workers. It progresses through three distinct stages.

In the primary stage a painless sore, or chancre as it is called, develops on the genitalia or in the mouth and spontaneously resolves in a few weeks. Cases of oral chancres can often be misdiagnosed as some other oral pathology, and therefore go untreated. When this happens the disease progresses to its secondary stage where it becomes more diffuse throughout the body.

A number of different lesions appear in secondary stage disease, and about 25% of secondary stage lesions will recur, even after treatment. One of the manifestations is Ulceronodular Disease:

Ulceronodular disease is an explosive generalized form of secondary syphilis characterized by fever, headache, and myalgia, followed by a papulopustular eruption that rapidly transforms into necrotic, sharply demarcated ulcers with hemorrhagic brown crusts, organized in rupioid layers commonly on the face and scalp. The mucosa is involved in about one third of affected patients. Lues maligna gives rise to crateriform or shallow ulcers on the gingivae, palate or buccal mucosa, with multiple erosions on the hard and soft palates, tongue and lower lip.

From the same paper, the manifestations of tertiary stage disease include:

Syphilitic leukoplakia would appear to be a homogenous white patch affecting large areas of the dorsum of the tongue. There are few good descriptions of syphilitic leukoplakia, and it is unclear whether this lesion truly reflects syphilis, or more likely a tobacco smoking habit—indeed this was observed by Hutchinson in the 19th century.

An association between tertiary syphilis and oral squamous cell carcinoma—particularly of the tongue—has been suggested for many years. Both clinically- and serologically-based studies have suggested an increased prevalence of syphilis in patient groups with squamous cell carcinoma of the tongue (up to 60% in one study), the association being stronger in males than females. A relatively recent study of 16,420 people with syphilis resident in the US found a significantly raised frequency of cancer of the tongue (and Kaposi’s sarcoma) in males.

Herpes

Herpes Simplex Virus (both HSV-I and HSV-2) can infect the mouth, genitals, and anus, and are readily transmitted from one site to the other by oral sex. Worse, in some 2/3 of cases the patient can shed the virus without having any visible sores (subclinical shedding). Patients with herpes sores may also transmit HIV and other STD’s to the mouth of the prostitute, as these sores become portals of transmissibility for the other pathogens.

Hepatitis A, B, and C can all be transmitted via oral sex, and lead to liver disease and death.

This was just an STD sampler platter. Planned Parenthood holds itself out as the STD experts. They know the data on the spotty condom efficacy from CDC’s Fact Sheet on the Male Latex Condom, and know well that condoms don’t prevent STD transmission entirely.

Yet Planned Parenthood nurse Amy Woodruff, the office manager, was quick to recommend “Waist Up” for post-operative/post-abortive young girls servicing the most STD-prone members of society.

Remember, these are the “experts”.

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