Oral sex is defined as the act of sexual intimacy from mouth to penis (fellatio), mouth to vagina (cunnilingus) or mouth to anus (anilingus). Or in slang terms: a blowjob, going down, giving head or rimming. Although you can't get pregnant from oral sex, you can get an sexually transmissible infection (STI) [3].
There is a commonly held belief among many people that oral sex carries little or no risk. In fact, some consider oral sex a safer sex alternative. But the truth is, like any other sexual activity, oral sex carries a risk of transmitting HIV and other sexually transmitted diseases. The risk is even greater in couples where one partner is HIV positive while the other is negative, people who are not monogamous, or in people who inject drugs and/or share needles and syringes [2]. Truth be told, abstaining from oral, anal, and vaginal sex all together is the only effective way to avoid most of the sexually transmitted diseases.
People who are considering having sex should get regular gynecological or male genital examinations. There are two reasons for this. First, these exams give doctors a chance to teach people about STDs and protecting themselves. And second, regular exams give doctors more opportunities to check for STDs while they're still in their earliest, most treatable stage [4].
What are the Risks of Oral Sex?
Risk is classified as either being documented (transmission that has actually occurred, been investigated, and documented in the scientific literature) or theoretical (passing an infection from one person to another is possible). While there is documented risk when having oral sex with an HIV infected partner the risk is much less than with anal or vaginal intercourse. This fact makes it very hard to calculate the actual risk with oral sex. Another factor that makes risk determination difficult is the fact that most people who engage in oral sex also engage in other types of sexual practices, namely vaginal and anal intercourse. Still, there have been document cases of HIV transmission strictly from oral sex [2].
Some of the things that increase a person's chances of getting an STD are [4]:
- Sexual activity at a young age. The younger a person starts having sex, the greater his or her chances of becoming infected with an STD.
- Lots of sex partners. People who have sexual contact — not just intercourse, but any form of intimate activity — with many different partners are more at risk than those who stay with the same partner.
- Unprotected sex. Latex condoms are the only form of birth control that reduce your risk of getting an STD, and must be used every time. Spermicides, diaphragms, and other birth control methods may help prevent pregnancy, but they don't protect a person against STDs.
Before you have oral sex, talk to your partner about sexual history, history of STIs and protection. Communication is essential.
Oral-Penile Contact (fellatio)
Theoretical Risk: With fellatio, there is a theoretical risk of transmission for the receptive partner because infected pre-ejaculate ("pre-cum") fluid or semen can get into the mouth. For the insertive partner there is a theoretical risk of infection because infected blood from a partner's bleeding gums or an open sore could come in contact with a scratch, cut, or sore on the penis.
Documented Risk: Although the risk is many times less than anal or vaginal sex, HIV has been transmitted to receptive partners through fellatio, even in cases when insertive partners didn't ejaculate.
Oral-Vaginal Contact (cunnilingus)
Theoretical Risk: Cunnilingus carries a theoretical risk of HIV transmission for the insertive partner (the person who is licking or sucking the vaginal area) because infected vaginal fluids and blood can get into the mouth. (This includes, but is not limited to, menstrual blood). Likewise, there is a theoretical risk of HIV transmission during cunnilingus for the receptive partner (the person who is having her vagina licked or sucked) if infected blood from oral sores or bleeding gums comes in contact with vulvar or vaginal cuts or sores.
Documented Risk: The risk of HIV transmission during cunnilingus is extremely low compared to vaginal and anal sex. However, there have been a few cases of HIV transmission most likely resulting from oral-vaginal sex.
Oral-Anal Contact (anilingus)
Theoretical Risk: Anilingus carries a theoretical risk of transmission for the person who is licking or sucking the anus if there is exposure to infected blood, either through bloody fecal matter (bodily waste) or cuts/sores in the anal area. Anilingus carries a theoretical risk to the receptive partner (the person who is being licked/sucked) if infected blood in saliva comes in contact with anal/rectal lining.
Documented Risk: There has been one published case of HIV transmission associated with oral-anal sexual contact.
Oral Sex and STDs
What infections can I catch through oral sex?
HIV
Although oral sex is a relatively low-risk activity, particularly when compared to vaginal or anal sex, it is possible to transmit HIV through oral sex. Using latex or polyurethane condoms, female condoms, or dental dams is an effective way to reduce your chances of contracting the virus when engaging in oral sex. If you don't choose to use protection for oral sex, you should know that the risk of HIV transmission increases if the person performing the act has cuts or sores in his/her mouth, if ejaculation takes place in the mouth, and if the individual receiving oral sex has any other sexually transmitted diseases. The risk is primarily for the person performing the oral sex. Unless a partner has significant amounts of blood in his/her mouth, such as from dental surgery, oral sex is unlikely to expose the receptive partner to HIV [1].
Same applies when kissing someone. However there is no risk from closed-mouth kissing, there are extremely rare cases of HIV being transmitted via deep “French” kissing but in each case, infected blood was exchanged due to bleeding gums or sores in the mouth. Because of this remote risk, it is recommended that individuals who are HIV-infected avoid deep, open-mouth “French” kissing with a non-infected partner, as there is a potential risk of transferring infected blood.
How is HIV passed from one person to another?
HIV can be detected in several fluids and tissue of a person living with HIV. It is important to understand however, that finding a small amount of HIV in a body fluid or tissue does not mean that HIV is transmitted by that body fluid or tissue. Only specific fluids (blood, semen, vaginal secretions, breast milk , and fluids surrounding the brain, the spinal cord and bone joints) from an HIV-infected person can transmit HIV. These specific fluids must come in contact with a mucous membrane (e.g. eyes or inside nose) or damaged tissue or be directly injected into the blood-stream (from a needle or syringe) for transmission to possibly occur. It is also possible to acquire HIV through transfusions of infected blood, blood products, or organ transplantation, though this risk is extremely remote due to rigorous testing of the U.S. blood supply and donated organs.
Genital Herpes
Although genital herpes and oral herpes are usually caused by different strains of the herpes virus, HSV-2 and HSV-1 respectively, it is possible for either virus to infect either site. Therefore, it is possible to transmit herpes during oral sex, and the virus can spread from either partner. Herpes is contagious even when symptoms are not present. Even though prophylactic medications, such as Zovirax (acyclovir), can reduce the likelihood of both outbreaks and transmitting the herpes virus to your partner, they can not eliminate the risk entirely. Although they should greatly reduce the risk of herpes transmission, condoms are also not completely effective in preventing transmission of herpes during oral sex, since the virus can spread from skin to skin [1].
HPV
It is possible to spread HPV through oral sex, and it is in fact thought that HPV acquired while performing oral sex is a major risk factor for throat cancer. HPV can also appear in the oral cavity through vertical transmission (transmission from mother to child during birth). As with herpes, it seems likely that the use of condoms or dental dams during oral sex should reduce the risk of infection, but they will not necessarily eliminate it entirely since HPV spreads via skin-to-skin contact [1].
Gonorrhea
In recent years, teenagers with throat infections caused by gonorrhea have often been in the news. Gonorrhea can be transmitted in both directions when oral sex is performed on a man, and throat infections with gonorrhea are notoriously difficult to treat. There is limited research to suggest that it may be possible for someone to acquire a gonorrheal throat infection while performing oral sex on a woman, but transmission in the other direction is relatively unlikely since the site of infection is the cervix -- a part of the female anatomy not reached during cunnilingus. Condoms and dental dams should be extremely effective in preventing transmission of gonorrhea during oral sex [1].
Chlamydia
It is possible to transmit chlamydia during fellatio, and both the recipient and the person performing the act are at risk. There has been little research on whether it is possible to transmit chlamydia during cunnilingus, but infection risk is probably similar to that for gonorrhea [1].
Syphilis
Syphilis is extremely easy to transmit via oral sex. In fact, in some areas of the United States, oral sex has been shown to be responsible for as many as 15% of syphilis cases. Although syphilis can only be transmitted in the presence of symptoms, during the primary and secondary stages of the disease, the painless sores it causes are easy to miss [1].
Hepatitis B
The research is inconclusive as to whether or not hepatitis B can be transmitted via oral sex. Oral-anal contact, however, is definitely a risk factor for hepatitis A infection, and it may also be a risk factor for hepatitis B. Fortunately both hepatitis A and B can be prevented by vaccines. If you practice rimming, you should talk with your doctor about getting vaccinated. Vaccination is a good idea in any case, and the hepatitis B vaccine is currently recommended for all children and many groups of adults [1].
The Bottom Line
In summary, unprotected oral sex puts you at risk for numerous sexually transmitted diseases. If you perform unprotected oral sex on your sexual partners, you should mention it to your physician. She may want to check your throat when she is screening you for other STDs [1].
How to prevent it
Abstinence
Abstinence or the voluntary choice to refrain from sexual activity is the only 100% effective means to prevent HIV and STD transmission. Non-coital (non-sexual) forms of sexual intimacy range from holding hands, hugging, kissing, and dancing to mutual masturbation, petting, and the use of stimulating devices such as vibrators. While abstinence is an effective means of safer sex, it may be difficult to maintain [2].
Dental Dams
Dental dams are rectangular squares of latex that are used during oral sex, both oral-vaginal and oral-anal. During sex, latex dams are stretched across your partner's genitals to prevent your tongue from touching your partner's bodily secretions. They are effective method of disease prevention, but can be difficult to hold in place. A dab of water soluble lubricant placed on the genital side of the dam can help hold it in place [2]. Remember that dental dams can only be used once, so after you are done, throw it away.
Plastic Wrap
A plastic wrap such as Saran or Cling Wrap is inexpensive and can easily be found in any grocery or drug store. Besides that, it covers larger area than a dental dam and can be used with oil- or water-based lubricants. On the other hand, it is usually a weaker barrier.
Female Condom
While data on the effectiveness of the female condom is limited it is a good alternative for a woman whose partner is reluctant to wear a condom or is unable due to a latex allergy. Female condoms allow a woman to assume control over safer sex. Slipping inside the vagina, the female condom provides a lubricated barrier that is stronger than latex. It can be inserted up to eight hours prior to intercourse, providing for the spontaneity that often is lost with latex condoms [2].
Condoms
Latex condoms provide the most effective means of preventing HIV and STD transmission during sexual encounters. But to be effective, condoms must be used correctly. An erect penis can leak seminal fluid prior to ejaculation. This fluid can contain infectious organisms that have the ability to cause infection in others. For this reason, condoms must be applied onto the penis prior to any oral, vaginal, or anal contact is made. In addition, condoms can break, allowing seminal fluids to leak.
References
[1] Boskey Elizabeth, Is Oral Sex Safe Sex?. About.com. July 06, 2009
[2] Cichocki, Mark. About.com Guide. January 10, 2010.
[3] http://www.pamf.org/teen/sex/std/oral/. Safer Oral Sex. Last reviewed February 2009
[4] Larissa Hirsch. About Sexually Transmitted Diseases (STDs). kidshealth.org. June 2010
[5] "Can I get HIV from oral sex? from the CDC. Accessed 2/15/07.
[6] Edwards S. and Carne C."Oral sex and the transmission of viral STIs" Sex. Transm. Inf. 1998;74;6-10.
[7] Edwards S. and Carne C."Oral sex and the transmission of non - viral STIs" Sex. Transm. Inf. 1998;74;95-100.
[8] Kent C.K. et al. "Prevalence of Rectal, Urethral, and Pharyngeal Chlamydia and Gonorrhea Detected in 2 Clinical Settings among Men Who Have Sex with Men: San Francisco, California, 2003" Clin. Infect. Dis. 2005; 41:67–74.
[9] Kreimer A.R. et al. "Oral Human Papillomavirus Infection in Adults Is Associated with Sexual Behavior and HIV Serostatus" J. Infect. Dis. 2004;189:686–98.
[10] Lafferty, W.E. et al. "Herpes Simplex Virus Type 1 as a Cause of Genital Herpes: Impact on Surveillance and Prevention" J. Infect. Dis. 2000; 181:1454–7
[11] Papp J.R. et al. "The use and performance of oral–throat rinses to detect pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections" Diag. Micro. Infect. Dis 2007; 59:259–264.
[12] Petermana T.A. and Furnessa, B.W. "The resurgence of syphilis among men who have sex with men" Curr Opin Infect Dis 20:54–59.
[13] "Transmission of Primary and Secondary Syphilis by Oral Sex --- Chicago, Illinois, 1998-2002" MMWR 53(41):966-968 Accessed 2/17/07.
