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.

The likelihood 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 (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 Options Project in San Francisco conducted one study that found that about 8% of recently-infected men who have sex with men were probably infected through oral sex. Most of these men believed that the risk of getting HIV through oral sex 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% 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.

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).
• 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 has been shown to prevent the transmission of herpes infections, but there is no proof that this type of food wrap will prevent the transmission of HIV.) 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.
• 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
• • 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.

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-positive, 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.