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Pre-Cum and the Safety of Fellatio
Nov 26, 1996

I recently had an encounter I am concerned about. I performed oral sex on a man without swallowing his ejaculation. My question is how much HIV can there be in pre-cum and and has there ever been a case in which someone got AIDS without swallowing semen? I do not believe I had any sores in my mouth at the time. The man also told me he had not had any recent partners and is tested regularly when he gives blood. I also did the visual inspection you mentioned before hand and did not see any sores, discharge, or other suspicious signs. Also, has anyone ever gotten AIDS from performing oral sex on a woman? Either the receiver or the giver?

Response from Mr. Sowadsky

Hi. Thank you for your question.

If you get semen in your mouth, there is still a risk of infection (even if you don't swallow it) since the virus can get into your bloodstream directly from your mouth, if there are any types of cuts, open sores, abrasions, or gum disease. So you don't have to swallow the semen to become infected. Once the semen gets into the stomach, the acids in the stomach can kill the virus. But if there are any openings anywhere before the stomach (including the mouth), there is a risk of infection.

Looking at the risks of oral sex in more detail........

If you are RECEIVING oral sex from someone else, you are only being exposed to saliva. The concentrations of the virus in saliva are so low, that nobody has ever been infected from saliva. Keep in mind however that you can get other sexually transmitted diseases (like herpes) by receiving oral sex. However, as far as HIV is concerned, receiving oral sex is extremely low risk.

If you are GIVING someone oral sex, there is a risk of infection since pre-cum, semen, vaginal secretions, and menstrual blood can get into your mouth. The more of these body fluids you are exposed to, the greater the risk of infection there would be. If you have any open sores, cuts, abrasions, or gum disease in the mouth, the virus can get into your bloodstream. The risk is less than vaginal or anal intercourse, but the risk is real, and transmission can occur. There have already been reported cases of HIV infection specifically through giving oral sex. In addition to HIV, while giving oral sex, you could also be at risk for other Sexually Transmitted Diseases (STD's) including herpes and gonorrhea.

Now, when we're talking about the levels of risk by giving a man oral sex, there is no one answer since several variables actually determine the true level of risk.

Both pre-cum and semen contain high concentrations of HIV. Semen is however a riskier body fluid because you are normally exposed to a greater quantity of semen as compared to pre-cum. Does that mean that pre-cum is totally safe? No! But we can say that the more infectious body fluid you are exposed to, the greater the liklihood of transmission. So, you can become infected by pre-cum alone, but you are much more likely to become infected if the guy cums in your mouth, since you're exposed to a much greater quantity of his body fluid.

Of course, the virus must also be able to get into the bloodstream through some type of open sore, abrasion, gum disease etc. The more openings that HIV has to get into your bloodstream, the greater your risk would be.

Without ejaculation, there still is some risk of getting infected through giving oral sex, but the risk would be much greater if the man ejaculated in the mouth. So rather than saying high risk vs. low risk, it's actually a spectrum of risk.

NO EXPOSURE TO PRE-CUM OR SEMEN: very low/no risk as far as HIV is concerned.

EXPOSURE TO PRE-CUM ONLY: low risk (but still possible). The more pre-cum you get exposed to, the greater the risk would be.

EXPOSURE TO BOTH PRE-CUM AND SEMEN: risky, especially if there are cuts/open sores in the mouth. The more semen you're exposed to, and the more cuts/abrasions/gum disease in the mouth, the greater the risk. But overall, although risky, it is still generally considered less of a risk than unprotected intercourse.

So again, we're talking about a spectrum of risk. This is why there will be no absolute answer of high vs. low risk of giving oral sex. But we can say that HIV has now been found to be transmitted by GIVING oral sex....especially if there is ejaculation (but not receiving oral sex).

And by the way.....A VERY IMPORTANT THING TO REMEMBER is that there doesn't necessarily have to be ejaculation to be infected with other Sexually Transmitted Diseases (STD's). For example, if you give a man oral sex, and that man has gonorrhea, you could get infected with gonorrhea in the throat, whether the man ejaculates or not. Gonorrhea can cause a discharge that can be very infectious if it gets into the throat (or penis/rectum/vagina) of another person. So things that may be lower risk for HIV (giving oral sex without ejaculation) may be high risk for other diseases, like gonorrhea. Also remember a person can have an STD, have no apparent symptoms, and still infect you. Gonorrhea is a good example of this. But if you do see symptoms (lesions, discharges, growths etc.), don't come in physical contact with them. But just because you don't see symptoms doesn't necessarily mean they don't have an STD.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Rick Sowadsky MSPH CDS



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