Nov 6, 2001
I've heard of various reports that receptive oral sex without a condom and without ejaculation carries risk of infection or only has theoretical risk of infection, and I'm confused.
I had a brief sexual encounter a few months ago that involved anal sex (receptive) with a condom and oral sex (receptive) without a condom as well as insertive oral sex without a condom but also without ejaculation. In terms of odds of infection, how does this single encounter rate?
Response from Mr. Kull
Receptive oral sex (in this case, having someone put their penis in your mouth) does carry a risk for infection, but the actual odds for infection seem small. The risk for infection through receptive oral sex with a man is not only theoretical. There is evidence that people have been infected through performing oral sex on a man.
The possibility of transmission makes sense if you think about the model for transmission: HIV infected fluids coming into contact with mucous membranes. The amount of fluid you get into your mouth, as well as the concentration of virus in that fluid, will have some influence on the risk of transmission.
There is a relative difference in risk when comparing unprotected anal sex to unprotected oral sex. The risk for HIV transmission during unprotected anal sex is much higher than the risk of transmission during unprotected oral sex. This is based on the observed patterns of transmission among men who have sex with men.
There are two recent studies that speak to the risks of performing oral sex on a man. In the most recent study, which was conducted over two years, researchers attempted to identify the likelihood of HIV transmission by interviewing men who engaged in receptive oral sex with men. Participants were recruited in testing clinics in the San Francisco area. Out of 194 men who have sex with men who reported having no anal or vaginal sex in the prior six months and engaging in multiple oral sex encounters, only one was HIV infected (which could be attributed to transmission through anal sex prior to the six month window). 89% did not use a condom for oral sex and 40% swallowed ejaculate (cum, semen). 20% knew that they had contact with an HIV infected man. The study's conclusion is that the risk for infection through receptive oral sex with men is practically zero. Another study examined the risks of infection through oral sex in a different way. Researchers asked about the sexual behavior of gay men who recently became infected with HIV. It was estimated that approximately 7-8% of the men were probably infected through performing oral sex on other men. All of them had contact with ejaculate or pre-ejaculate.
If you choose to engage in receptive oral sex with a man without a condom, do your best to get as little fluid as possible in your mouth (ie, avoid ejaculation in the mouth). It is also better to avoid receptive oral sex when there are problems with your oral health, such as bleeding gums, canker sores, STD-related infections, and sore throat.
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