Oral Sex: What's the Real Risk?

The chances of HIV being transmitted from an HIV+ person to an HIV-negative 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 (STDs), such as syphilis, herpes, and gonorrhea through oral sex.

Even though oral sex is a lower-risk activity, people have reportedly become 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 oral sex is not the only sexual activity for most people, 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% to about 8%.

The take home message of these studies is that oral sex carries a small but real risk.

Oral sex is more risky if you or your partner have an untreated STD, bad oral hygiene (bleeding gums, ulcers, gum disease), or take ejaculate (cum) in the mouth. There are things you can do to reduce the risk associated with oral sex:

• Don’t have oral sex if you or your partner have mouth sores (such as oral herpes lesions).
• Look at your partner’s genitals for lesions (cuts or scrapes).
  • If you find something, don’t believe your partner if he or she tells you it was caused by the heat, the weather, or clothes. You should avoid any contact with the area until a health care worker has examined it.
• Don’t floss, brush your teeth, or do anything that would create abrasions or cuts in your mouth before 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 your hand, or spit semen out and rinse with a mouthwash rather than swallowing.
• Use a dental dam or cut-open condom for oral sex on a woman or for rimming (licking the anus).
  • Dental dams are squares made from latex. Put some water-based lube on one side of the dental dam or a condom that has been cut open. Then stretch the dam or condom 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. (Some people use plastic food wrap as a barrier. While plastic wrap has been shown to prevent the transmission of herpes infections, there is no proof that it will prevent the transmission of HIV.)
• Avoid vaginal oral sex during menstruation to prevent contact with blood.
• Take care of your mouth. The likelihood of oral HIV transmission increases if you have bleeding gums, ulcers, cuts, sores, or infections in the mouth.
• Find alternatives
  • Try massage 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.

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.

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, see a sex educator or health care provider at your local AIDS service organization or treatment center.