Oral Sex and HIV

posted: 10/09/2010

The gay men’s sex survey sometimes tells us surprising things, but the news that almost all gay and bisexual men have oral sex - 99% - was no surprise at all. With HIV, what do men need to know?
 

What about HIV?
How risky is oral sex for men with HIV? How risky is it for positive men’s partners?

There’s a lot of confusion about this – at all our newly diagnosed courses this causes big discussions and lots of questions.
 

Doctors and researchers aren't sure exactly how many people get HIV from oral sex. Some think hardly anybody ever gets HIV from oral sex, but others think 3 out of every 100 HIV+ people got HIV through oral sex. A review of all the oral sex studies in late 2008 worked out that the risk of getting from oral sex was very low, but the risk isn't zero.

Whatever the oral sex risk, it is always much safer than anal or vaginal sex without a condom.
 

How risky is oral sex?
The likelihood that HIV is passed on from an HIV-positive person to an HIV-negative person during oral sex depends on

• whether a man with HIV sucks, or gets sucked
• the viral load of the man with HIV 
• the dental health of the man sucking
• if the man sucking has a sore mouth, or throat, oral cuts, sores or abrasions 
• if either man has a Sexually Transmitted Infection (STI).

Having a high viral load in the blood usually means that the viral load is also high in the semen, and that makes HIV easier to pass on during sex. Although having an undetectable viral load in the blood usually means there is an undetectable viral load in the semen, this isn't always true. And untreated sexually transmitted infections (including infections without symptoms), cause viral load in semen to increase.

But all in all, if you have an undetectable viral load, the chances of passing on HIV are very low in oral sex.
 

Oral sex is never risk free. It’s also easy to pass on and get some other sexually transmitted infections, such as syphilis, herpes and gonorrhoea.

Oral studies
A number of studies looked at the risks of HIV transmission from oral sex.

• One American study reported that of 122 gay men with HIV, 8% reported oral sex as their only risk activity. But this study is not really trusted. It is based on very few men and some of the men who first of all said oral sex was the only risk they took later on admitted they had anal sex without condoms.
• Another study of over 100 couples didn’t find any cases of oral transmission of HIV over a ten year period, where one partner was HIV-positive and the other HIV-negative.
• Another study from the USA found the risk to be effectively zero, but didn't exclude the possibility of there being a risk.
• Other researchers in 2008 pooled the results from all the oral studies and found that the risk was very low, but not zero.
   

We are unlikely to ever have an exact answer: the best we can say is low risk, but not no risk.
 

When is oral sex more risky?
It is important to put oral sex HIV transmission risks in perspective.

If you and your partners are having anal sex without condoms, first do something about reducing your anal sex risks, because the risks of HIV transmission during anal sex are so very much higher than in oral sex. Using condoms during anal sex will make far more difference in reducing the risk of passing on HIV, than trying to reduce the already small risk from oral sex.
 

Think of oral sex like being a safe car driver – an accident is always possible, but unlikely.

Think of anal sex like speeding and drink driving – an accident is quite likely. To reduce the chance of passing on (or getting HIV), using condoms makes sense, like it makes sense to stop drink driving and speeding. Using condoms reliably during anal sex is what we should really try to do better.
 

How can you reduce oral risks?
If you do want to cut the HIV risks during oral sex, there are several ways. Some of these are more acceptable than others, so make your own risk decisions. Many of these steps will also cut the risk of other sexually transmitted infections:

• You may decide the risks with oral sex are low enough to carry on as before
• You may prefer not to have oral sex because you do not want to take even a tiny risk
• You may decide to have oral sex with fewer men at a time, and in total
• You may decide to have oral sex using a condom
• Men with HIV may decide only to suck, as this is far less likely to pass on HIV than sucking
• Men who don't have HIV may decide only to be sucked, as being sucked by a positive man is far less likely to pass on HIV 
• Men with HIV may decide not to cum in a partner’s mouth. There is a theoretical risk of getting another HIV strain, or drug resistant HIV, if you let another man with HIV come in your mouth. 
• You may decide to have less vigorous oral sex, and not to deep throat
• HIV negative men should look after their teeth and mouths. The risk of HIV transmission increases if a HIV negative man sucking has bleeding gums, ulcers, cuts or sores in his mouth. He should not brush his teeth or floss before sucking, because that makes the gums more open to HIV
• Get regular sexual health checks. Sexually transmitted infections raise the risk of passing on HIV to a negative partner. For HIV negative men, sexually transmitted infections raise the risk of getting HIV.

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