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Oral sex is not likely to transmit HIV under most circumstances. Many large studies have shown that a person living with HIV who takes HIV drugs and has an undetectable viral load (too little virus in the body for a test to measure) cannot transmit the virus to their sexual partners. This includes any kind of sex, including oral sex – and sex without using condoms or barriers. This reality is known in the HIV community as Undetectable Equals Untransmittable, or U=U.
When a person living with HIV is not on treatment, oral sex is still a low-risk activity for HIV. If a person is not taking HIV drugs and/or has a detectable viral load, that low chance of transmission is greater if one of the partners has bleeding gums, mouth ulcers, gum disease, genital sores, and other sexually transmitted infections or diseases (STIs or STDs).
A number of studies have tried to figure out the exact level of HIV transmission risk that oral sex poses, but this is not easy to do. When HIV is transmitted, it is difficult to tell if oral sex or another activity that poses more risk was responsible.
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 that has not been cleaned. Unprotected sex means sex in which no condoms, other barriers, or HIV treatment-as-prevention methods are used.
HIV treatment as prevention (TasP) includes having an undetectable viral load, as described above. PrEP, or pre-exposure prophylaxis, refers to drugs a person can be prescribed to stay HIV-negative if they are not living with HIV. Where there is a chance of HIV transmission, PrEP has been shown to lower that chance even further.
There is HIV in sexual fluid from the vagina (vaginal secretions), sexual fluid from the penis (semen or ejaculate, also called "cum" and "pre-cum"), and blood. HIV cannot ever be spread through saliva (spit).
For HIV transmission to be possible:
- one of these fluids other than saliva must be present
- there must be detectable HIV in that fluid (person is not taking HIV drugs and has a detectable viral load)
- there must be an opening for the fluid to enter the HIV-negative person's bloodstream (such as mouth sores or genital ulcers – just swallowing does not count)
Please see our fact sheet on HIV Transmission for much more information on this topic.
It is important to note that it is possible to get other STIs, such as syphilis, herpes, gonorrhea, and human papilloma virus (HPV), through oral sex without condoms or barriers. Having an undetectable viral load or taking PrEP does not protect against STIs other than HIV.
If a partner who is living with HIV has an undetectable viral load, their risk of transmitting HIV during oral sex is zero, whether they use the tips below or they do not.
If a partner living with HIV is not taking HIV drugs and/or has a detectable viral load, the chance of HIV transmission during oral sex is still low. The tips below can lower that chance even further. If you are not sure of your or your partner’s HIV status, and are not taking PrEP – or if the partner living with HIV is not on treatment or is known to have a detectable viral load – oral sex can be safer if you and/or your partner:
- get treatment for any other STIs you may have
- do not have gum disease
- wait to have oral sex until any mouth sores (such as oral herpes lesions) or genital cuts, scrapes, or sores have healed
- wait until after having oral sex to floss, brush your teeth, or do anything that could create cuts or cause bleeding in your mouth
- If you want to freshen up before oral sex, consider using a breath mint instead
- avoid swallowing pre-cum, semen, vaginal fluids, or menstrual blood
- use latex or polyisoprene condoms for oral sex on a penis (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 vagina (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.
- wait to put your mouth on a person's vagina until after they finish menstruating (having their period or cycle) to prevent contact with blood
- take care of your mouth
- try an activity other than oral sex if your partner’s penis is bruising your throat or tonsils (sometimes caused by "deep-throating"), or if you get injuries around your mouth
For more information about safer options for sexual pleasure, including oral sex, see our Safer Sex fact sheet.
Oral sex can be fun, pleasurable, and very safe. It is important that you decide for yourself – and talk with your partners if you have them – about what steps to take to make all types of sex safer. If the partner living with HIV is taking HIV drugs and has an undetectable viral load, it is not possible to transmit HIV through sex, including oral sex. It is possible to acquire – and prevent – other STIs during oral sex.
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.
Adapted from original article written by LM Arnal