Kolahi et al. International Archives of Medicine 2010, 3:9 http://www.intarchmed.com/content/3/1/9 Open Access HYPOTHESIS © 2010 Kolahi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Hypothesis Chlorhexidine rinse for prevention of urethritis in men linked to oral sex Jafar Kolahi 1 , Mohamadreza Abrishami* 2 , Mohamad Fazilati 3 and Ahmad Soolari 4 Abstract Background: Oral sex among teenagers is on the rise. Similarity between the oral flora and organisms recovered from nongonococcal urethritis and prostatitis, points to retrograde entry of bacteria from oral cavity into the urethra following insertive oral intercourse. Presentation of the hypothesis: Chlorhexidine has a wide spectrum of anti-bactericidal activity encompassing gram positive and negative bacteria. It is also effective against HIV and HBV. It produced large and prolonged reductions in salivary bacterial counts within 7-h of its use. Hence, it would seem logic to postulate that rinsing with chlorhexidine before oral sex will be effective for prevention of retrograde entry of bacteria from oral cavity into the urethra. The recommendation for rinsing will be: 15 ml of a 0.12% or 10 ml of 0.2% chlorhexidine rinse for 30 seconds. Also other drug delivery systems such as chlorhexidine chewing gum or spray can be used. Testing the hypothesis: Men suffering from recurrent nongonococcal urethritis or prostatitis are good subjects for testing the hypothesis. They perform genital safe sex via consistent use of condom. Yet they generally received unprotected insertive oral intercourse. Chlorhexidine can be used for prevention of recurrences of the disease. Implications of the hypothesis: The chlorhexidine will be a new, easy, attractive and effective method for reduction of nongonococcal urethritis, prostatitis and epidydimitis following insertive oral intercourse. It is poorly absorbed from skin, mucosa and gastrointestinal tract indicating systemic safety of chlorhexidine. The agent does not cause any bacterial resistance and supra-infection. Background The first comprehensive study to examine the prevalence of the oral sex was published in the Time magazine [1]. The report by the National Center for Health Statistics was based on a computer-administered survey of over 12,000 Americans between the ages of 15 and 44, and stated that over half of the teenagers questioned have had oral sex. This report provided evidence that oral sex among teenagers is "on the rise". However, direct and indirect evidence from studies of patients with nongonococcal urethritis and prostatitis points to retrograde entry of bacteria from the oral cavity to the urethra following oral intercourse as primary mode of transmission for pathogenesis of infection [2-6]. Evi- dence is based upon similarity of organisms recovered from infection and normal oropharyngeal flora such as Streptococci, Haemophilus species, N. meningitides, Adenoviruses and HSV-1 [4]. Nevertheless, if sexually transmitted disease (STD) sta- tus is unknown for partners, condoms or dental dams is recommended when performing or receiving oral inter- course. The plastic wrap may also be used as a barrier during oral intercourse, but many find that the thickness of the plastic dulls sensation [7]. The aim of this hypothesis is to suggest a new, easy, attractive and effective method for prevention of non- gonococcal urethritis, prostatitis and epidydimitis follow- ing oral intercourse. Presentation of the hypothesis Chlorhexidine is a bisbiguanide antiseptic which has a wide spectrum of bactericidal activity encompassing gram positive and gram negative bacteria. It is also effec- tive against some fungi and yeast, including Candida, and some lipophilic viruses including HIV and HBV [8]. * Correspondence: mr-abrishami@dent.sbmu.ac.ir 2 Department of Periodontology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Full list of author information is available at the end of the article