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The chances of HIV being passed from one person to another depend on the type of contact. HIV is most easily spread, or transmitted, through unprotected anal sex, unprotected vaginal sex, and sharing injection drug equipment. Unprotected sex means sex in which no condoms or other barriers are used.
Oral sex has been shown to be less risky than these activities, but it is not risk-free. Oral sex involves contact between the mouth and the genitals. It includes giving or receiving licking, sucking, or biting of the vulva (vagina, clitoris, and labia, or “lips”), penis, or anus.
HIV is present in female sexual fluid (vaginal secretions), male sexual fluids (“cum” and “pre-cum”), and blood. HIV cannot be spread through saliva (spit). It is also possible to get other sexually transmitted diseases (STDs), such as syphilis, herpes, gonorrhea, and human papilloma virus (HPV) through oral sex.
Studies on the Risks of Oral Sex
Even though oral sex is a lower-risk activity for HIV, several reports show that people have become infected with HIV through oral sexual activity. A number of studies have tried to figure out the exact level of risk of oral sex, but it can be difficult to get accurate information. When HIV is spread, it is difficult to tell if it was the oral sex or another, more risky sexual activity that was responsible for spreading HIV. Other factors also increase the risk of oral sex, including having bleeding gums, mouth ulcers, gum disease, genital sores, and other STDs.
The take home message is that oral sex carries a small but real risk.
Tips for Safer Oral Sex
Oral sex is more risky if you or your partner:
- has an untreated sexually transmitted infection
- has bleeding gums, mouth ulcers, or gum disease
- takes ejaculate (semen, or cum) in the mouth
- puts your mouth on the genitals of a woman who is menstruating (bleeding)
- has genital sores
There are things you can do to lower the risk associated with oral sex:
- Do not have oral sex if you or your partner has mouth sores (such as oral herpes lesions)
- Look at your partner’s genitals for lesions (cuts, scrapes, or sores)
- If you find something, avoid contact with the area until a health care provider examines it. Very rarely are genital lesions the result of the heat, the weather, or someone’s clothes.
- Do not floss, brush your teeth, or do anything that would create cuts or cause bleeding in your mouth before performing oral sex. Use a breath mint instead.
- Avoid swallowing pre-cum, semen, vaginal fluids, or menstrual blood
- Use latex condoms for oral sex on a man (fellatio)
- Try the flavored ones that come without lube on them
- If you perform oral sex without a condom, finish up with your hand, or spit semen out rather than swallowing it
- Use a dental dam or cut-open condom for oral sex on a woman (cunnilingus) 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 vulva 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 has been no research on its effectiveness in preventing HIV transmission.)
- Avoid vaginal oral sex when a woman is menstruating (having her period or cycle) to prevent contact with blood
- Take care of your mouth. The chances of getting HIV from oral sex increase if you have bleeding gums, ulcers, cuts, sores, or infections in the mouth.
- Use alternatives
- Try massage or mutual masturbation
- Try a vibrator (use a condom and put on a new condom when sharing)
- Avoid giving a man oral sex if his penis is bruising your throat or tonsils (sometimes caused by "deep-throating"), or if you experience injuries around your mouth
Taking Care of Yourself
While the risk of becoming infected through unprotected oral sex is lower than that of unprotected anal or vaginal sex, it is not risk-free. If you or your partner is living with HIV (HIV+), it is important that you decide what steps to take to make all types of sex safer (see The Well Project's article on safer sex). It is also important to remember that having bleeding gums, mouth ulcers, or gum disease and taking cum or menstrual blood in your mouth can make oral sex more risky. 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.
Adapted from article written by LM Arnal