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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. Recent research has shown that people living with HIV who take HIV drugs and whose viral load is undetectable (too low to be found with standard tests) cannot pass the virus on to their sexual partners even during unprotected sex. That said, unprotected sex puts you at risk for other sexually transmitted infections.
Oral sex involves contact between the mouth and the genitals. It includes giving or receiving licking, sucking, or biting of the vulva (clitoris, and labia, or “lips”), vagina, penis, or anus ("butt"). Under most circumstances, oral sex poses little to no risk of transmitting HIV. Oral sex may not be risk-free, but it has been shown to be much less risky than anal or vaginal sex, or sharing needles.
There is HIV virus in female sexual fluid (vaginal secretions), male sexual fluids (semen or ejaculate, also called "cum" and "pre-cum"), and blood. HIV cannot be spread through saliva (spit). One of these other fluids must be present, and there must be a way for the fluid to enter the HIV-negative person's bloodstream (such as mouth sores or genital ulcers) for HIV transmission to be possible.
It is possible to get other sexually transmitted infections or diseases (STIs or STDs), such as syphilis, herpes, gonorrhea, and human papilloma virus (HPV), through unprotected oral sex. HIV treatment as prevention does not protect against STIs other than HIV.
Oral sex is a low-risk activity for HIV. The risk of HIV transmission through oral sex is greater if one of the partners has bleeding gums, mouth ulcers, gum disease, genital sores, and other sexually transmitted infections. Several reports suggest that in rare instances people have acquired HIV through oral sexual activity. A number of studies have tried to figure out the exact level of risk that oral sex poses, but it can be difficult to get accurate information. When HIV is transmitted, it is difficult to tell if oral sex or another, more risky, sexual activity was responsible.
The take-home message is that oral sex may, under certain circumstances, carry a small but real risk of HIV transmission.
Oral sex is riskier if you or your partner:
- has an untreated sexually transmitted infection
- has bleeding gums, mouth ulcers (open sores), or gum disease
- takes ejaculate (semen, or cum) in the mouth
- puts their 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 could 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 or polyisoprene 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 on 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, no research has shown that it prevents HIV transmission.
- Avoid oral sex on a woman's vagina when she 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 on the vibrator and put on a new condom if you share the vibrator)
- Avoid giving a man oral sex if his penis is bruising your throat or tonsils (sometimes caused by "deep-throating"), or if you get injuries around your mouth
While the risk of acquiring HIV 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, it is important that you decide what steps to take to make all types of sex safer (see our fact sheet 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 riskier. If you would like to discuss these issues, see a sex educator or health care provider at your local AIDS service organization (ASO) or treatment center. To find an ASO in your area, click here. For services worldwide, please use aidsmap's e-atlas.
Adapted from article written by LM Arnal