Oral Sex: What?s the Real Risk?
by LiseMay Arnal, August 2005

In the heat of passion, lovers sometimes engage in sexual behaviors that, afterward, seem risky or, at worse, suicidal. For many years, people have debated whether or not oral sex is one such risky behavior.

Studies on the Risks of Oral Sex

The likelihood of HIV being transmitted from an HIV+ person to an HIV- person depends on the type of contact. HIV is most easily transmitted through unprotected (no condoms) anal sex, unprotected vaginal sex, and sharing injection drug equipment.

Oral sex has been shown to be less risky than these activities, but it is not risk free. It is also possible to get other sexually-transmitted diseases (such as syphilis, herpes, and gonorrhea) through oral sex.

Even though oral sex is a lower-risk activity, there have been reports of people being infected with HIV in this way. A number of studies have tried to determine the exact level of risk of oral sex, but it can be difficult to get accurate information from study participants. Since most people don't just have oral sex, it is also difficult to single out oral sex as the definite way HIV was transmitted. Because of these issues, different studies have reported different levels of risk ranging from less than 1 percent to about 8 percent.

The Options Project in San Francisco conducted one recent study. They found that about 8 percent of recently-infected men who have sex with men were probably infected through oral sex. Most of these men believed that the risk was very low or non-existent.

At least half of the men in the study who were likely infected through oral sex had gum disease or an oral ulcer. In addition, most of the men engaged in oral sex that included ejaculation (receiving cum in the mouth).

According to the results of a survey of newly-diagnosed patients in England, Wales, and Northern Ireland, oral sex probably accounts for about 3 percent of HIV infections in men who have sex with men.

The take home message of these studies is that oral sex carries a small but real risk, especially if you have bad oral hygiene (bleeding gums, ulcers, gum disease) and take ejaculate in your mouth.

Tips for safer oral sex
There are things you can do to reduce the risk of oral sex:

• Don't have oral sex if you or your partner has mouth sores (such as oral herpes lesions).
• Discreetly inspect your partner's genitals for lesions.
    If you find something, don't believe your partner if he or she tells you it was
    caused by "the heat," or "the weather," or "the clothes." You should avoid any
    contact with the area until a doctor has examined it.
• Don't floss, brush your teeth, or engage in any behavior that would create abrasions or cuts in your mouth prior to performing oral sex. Use mouthwash or a breath mint instead.
• Avoid swallowing pre-cum, semen, or vaginal fluids.
• Use latex condoms for oral sex on a man (try the unlubricated, flavored ones).
    If you perform oral sex without a condom, finish up with the hand, or spit semen
    out and rinse with a mouthwash rather than swallowing.
• Use a dental dam for oral sex on a woman or for rimming (licking the anus).
    Dental dams are large squares made from latex. Plastic food wrap (not
    microwave-style plastic wrap) is just as effective. Put some water-based lube on one
    side of the dam or plastic wrap. Then stretch the dam over the vagina or anus
    with the lubed side facing down. This gives you a thin barrier between
    your mouth and the vagina or anus.
• Avoid vaginal oral sex during menstruation to prevent contact with blood.
• Look after your mouth. The likelihood of oral HIV transmission increases if you have bleeding gums, ulcers, cuts, sores or infections in the mouth.
• Find alternatives
    Massage your partner, use caresses, or mutual masturbation.
    Use a vibrator (use a condom when sharing).
• Avoid vigorous, prolonged oral sex ("deep-throating").
• Avoid mouth or throat trauma caused by a large number of partners in a short period of time.

Taking Care of Yourself

Any type of sexual activity with an infected person carries a risk of HIV transmission. While the risk of becoming infected through unprotected oral sex is lower than that of unprotected anal or vaginal sex, bad oral hygiene and taking cum in your mouth makes oral sex more risky.

As in any other sexual behavior these days, oral sex reminds us that the choice of a safe partner is extremely important. Before engaging in sex with anyone, it is wise to ask about his or her drug and alcohol history, count of partners, whether he or she engages in sex for money, or has been in prison (where at times inmates engage in risky behaviors). The best way to know if your partner is infected is to get tested together.

If you or your partner is HIV+, you should decide what steps to take to make all types of sex as safe as possible. If you would like to discuss these issues, ask to see a sex educator or health professional at your local AIDS service organization or treatment center.

1. Baron, S. (2001). Oral transmission of HIV, a rarity: emerging hypotheses. J Dent Res,80(7). 1602-4.
2. Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention. (2003). Facts Sheet: Primary HIV infection associated with oral transmission. Retrieved March 2005 from http://www.cdc.gov/hiv/pubs/facts/oralsexqa.htm.
3. Gadd, C. (2004). Oral sex between men a ?small but real risk? for HIV transmission, survey shows. aidsmap news: Retrieved March 2005 from http://www.aidsmap.com/en/news/8C50587D-7487-4440-BCFD-3AF7C9EE92C3.asp
4. Younai, F.S. (2001). Oral HIV transmission. J Calif Dent Assoc 29(2). 142-8.

Information provided on this website is for educational purposes only. It is designed to support, not replace, personal medical care and should never be used as a substitute for personal medical attention, diagnosis, or hands-on treatment. We recommend all medical decisions be made in consultation with your personal health care provider.