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Information

Oral Sex and HIV Risk

May 21, 2014

Fast Facts
  • The risk of HIV transmission through oral sex is much less than that from anal or vaginal sex -- but it is not zero.
  • Performing oral sex on an HIV-infected man, with ejaculation in the mouth, is the riskiest oral sex activity.
  • Factors that may increase the risk of HIV transmission through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted diseases.


Oral sex involves giving or receiving oral stimulation (i.e., sucking or licking) to the penis (fellatio), the vagina (cunnilingus), or the anus (anilingus). HIV can be transmitted during any of these activities, but the risk is much less than that from anal or vaginal sex. Receiving  fellatio, giving or receiving cunnilingus, and giving or receiving anilingus carry little to no risk. The highest oral sex risk is to individuals performing fellatio on an HIV-infected man, with ejaculation in the mouth.1,2


Risk of HIV

Even though oral sex carries a lower risk of HIV transmission than other sexual activities, the risk is not zero. It is difficult to measure the exact risk because people who practice oral sex may also practice other forms of sex during the same encounter. When transmission occurs, it may be the result of oral sex or other, riskier sexual activities, such as anal or vaginal sex.

If the person receiving oral sex has HIV, their blood, semen, pre-seminal fluid, or vaginal fluid may contain the virus. If the person performing oral sex has HIV, blood from their mouth may enter the body of the person receiving oral sex through the lining of the urethra (the opening at the tip of the penis), vagina, cervix, or anus, or through cuts and sores.

Several factors may increase the risk of HIV transmission through oral sex, including oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted diseases (STDs).


Risk of Other Infections

In addition to HIV, other organisms can be transmitted through oral sex with an infected partner, leading to herpes, syphilis, gonorrhea, genital warts (human papillomavirus, or HPV), intestinal parasites (amebiasis), or hepatitis A or B infection.


Reducing the Risk

The following things can reduce the risk of getting HIV through oral sex:

  • If giving oral sex, avoid having your partner ejaculate in your mouth.
  • Use barriers, such as condoms, natural rubber latex sheets, dental dams, or cut-open nonlubricated condoms between your mouth and your partner's genitals or rectum.

The risk of getting HIV from oral sex is lower if you are already taking pre-exposure prophylaxis (PrEP) consistently and correctly or if your partner is living with HIV and is taking antiretroviral therapy (ART) consistently and correctly. PrEP is a drug (Truvada) that can be prescribed to people at substantial risk of HIV to prevent infection. ART is a combination of drugs to treat HIV in people who already have HIV.

Keep in mind that barrier methods are the only way to protect against some STDs, including gonorrhea of the throat. Although the chance of getting or transmitting HIV from rimming (mouth to rectum) is small, there is a greater chance of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming. There are effective vaccines that protect against hepatitis A and B and the human papillomavirus infections (HPV).

For information on reducing the risk of HIV infection from anal or vaginal sex or for information on PrEP, please visit the HIV Basics section.


References

  1. Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR 2005;54(RR-2):7.
  2. AIDS.gov. Reducing your sexual risk. Accessed May 24, 2012.


Additional Resources

CDC-INFO 1-800-CDC-INFO (232-4636)
CDC HIV Website
CDC Act Against AIDS Campaign



  
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This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.
 
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Reader Comments:

Comment by: Rusty Brennan (Reading PA) Fri., Feb. 28, 2014 at 10:38 am EST
I am an HIV counselor and yesterday a young msm told me he heard form a doctor that oral sex is the riskiest form of transmission for HIV. I did inform him that anal is in fact the top but he was very worried because oral is his most usual form of contact. Is there any truth to his statement? I am aware that other std's are easy to transmit orally but I always heard the if there are not sores or open portals the the risk of HIV transmission was pretty low.
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Comment by: Jessica Sanchez (Albany New York ) Wed., Aug. 14, 2013 at 1:54 am EDT
Wow
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Comment by: Ross (Mysore) Thu., Aug. 1, 2013 at 11:32 am EDT
Good title
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Comment by: nicto (cambodra) Tue., Jun. 25, 2013 at 7:34 pm EDT
i still not sure about having anal sex, infact, if one of the partner drining or swallowing the semen can couse the hiv? Or did the hiv live in the semen ? Testing the semen through the panic could risk to get hiv? I am still wonder about this. And i hope s.o will reply me! :)
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Comment by: xiao yinhao (China) Tue., Feb. 7, 2012 at 2:34 am EST
I totally disagree with what was said in the passage. Fellatio has never been proved as a way of transmitting HIV(with some theoritical risk and zero risk for practical purposes). Saliva carries no hiv virus, ironically, inhibitates them. In China, I saw lots of people who only received oral sex from CSW got a negative result finally 3 months after that exposure. If oral sex is really a significantly risky behavior, I dont believe that there are still so many CSWs would do that anymore. Moreover, could u give out the evidence that someone got infected through oral sex? Lacking of the credible evidence, I am not convinced.

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Comment by: Sylvia (Enugu state-Nigeria) Sat., May. 14, 2011 at 5:37 am EDT
For the singles:Plz my fellow people abstain from sex in order to stay out from being infected with deadly disease. For the married: be faithful to ur partner
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Comment by: Dave (NJ) Wed., Nov. 17, 2010 at 2:54 pm EST
This is a vague and poorly written article. Distinctions needed are the relative probability of acuring/ tranmitting HIV when one is the recipient or the performer of the sex act and the presence of HIV in each of the possible scenario's.
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Comment by: Jim M. (Canton, Ohio) Tue., Nov. 16, 2010 at 1:02 am EST
I'm sorry, but I'm STILL not buying this. The main reason we don't really know for sure (as far as I'm concerned)about oral sex and HIV transmission is because lots of men LIE, to themselves as well as everyone else. Many men who have sex with men do not consider themselves gay as long as they don't engage in unprotected receptive anal sex. However, lots of these same men HAVE had unprotected anal sex with other men but will never admit this to themselves, let alone to anyone else, mostly due to their internalized homophobia. As a result, many are simply NOT TRUTHFUL when questioned about their sexual practices, usually insisting that all they did was engage in oral sex. I have personally witnessed this many times since this insidious epidemic began back in the early 1980's. Also, when I perform oral sex, I want to taste skin, NOT latex or vinyl; whenever a guy puts a condom on first before oral sex, that ruins it for me and I walk away. I know thousands of guys who DO strictly have oral sex only because they do not like anal sex, and I have yet to see one of them, including myself, contract HIV via the oral-genital route. The CDC still insists upon spreading this oral sex LIE because they're simply afraid of some liar contracting HIV through unprotected anal or vaginal intercourse, and then claiming that they never engaged in anything except oral sex and then trying to sue them for having said that oral sex was safe, when in fact they actually contracted it via anal or vaginal sex and NOT oral sex. As long as the conditions in the oral mucosa are intact and healthy and not bleeding, I just do not believe that HIV is transmitted in this way, and I have spoken to many professional people in the medical community who concur with this sentiment.
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Comment by: dheeraj dev (india) Mon., Mar. 8, 2010 at 10:05 am EST
thanks for giving such a usefull information
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Comment by: Mzwandile (South Africa, University of KZN ) Sat., Feb. 6, 2010 at 6:30 am EST
this site has elped me in terms of awarenes of oral. this is because presviously i did noy know know that oral sex has risks of infection. i thoght that it is safe as kissing is. and i also learned safers ways of engaging in oral sex. thatk you.
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Comment by: Danny (DC) Wed., Sep. 2, 2009 at 2:45 pm EDT
I agree with everyone. The article is very general. It also doesn't address the risk for the guy who is receiving oral sex. I don't suck but boy do I love being sucked. So what's the risk for me? I am Latino and uncut. Does being uncut puts me at risk? Let's look at the issue from both end, the giver and the receiver. Us guys who enjoy being sucked also worry about it.
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Comment by: Jalil Fahad (new york usa) Tue., Jul. 28, 2009 at 12:17 am EDT
That is why I watch porn and masturbate..

No worries....guys use some imagination...
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Comment by: Kitty (Tokyo) Tue., Jul. 14, 2009 at 11:17 am EDT
I read this, because tomorrow I will recieve my HIV test results. Very nervous. I performed oral sex on a boy whom I found out to be bi-sexual. Although Im not sure the level of HIV infections in Tokyo amongst which group or whatever. The point is previously I had been tested because I though I had gotten it from a past boyfriend and I had do the same and performed oral sex. The health consultant I called about chances told me you cant get HIV through oral sex. So I felt safe to and gave the boy I met in a club oral sex. Now it says on the internet that its possible to get it that way. I never noticed any pre-cum on him. He also didnt ejaculate. Well everyone is right to say this page wasnt helpful, it just made me worry more actually. Wish we had some real statistics if you know what I mean, seems like surely by now 2009 they would have done some research that had some answers.
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Comment by: picaro (spain) Sat., Jul. 11, 2009 at 3:05 am EDT
I agree with most others here, this article says nothing of use. In my case, the question is if, as a positive individual I can easily transmit HIV to my negative partner by performing oral sex on him. Such information is not offered in this article and actually reads like a general-information piece for the national media. Especially disturbing is the assertion: "Abstaining from oral, anal, and vaginal sex altogether or having sex only with a mutually monogamous, uninfected partner are the only ways that individuals can be completely protected from the sexual transmission of HIV." in the first paragraph. Makes me want to not read any more at The Body. Bad work here, guys and gals. Give us useful stuff not more of the same old "go hide in a closet and weep" dung that we've been getting for decades.
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Comment by: Matt (Texas) Fri., Jul. 10, 2009 at 9:52 pm EDT
This leaves so much out such as the reliability of the reporting parties, whether or not ejaculation occurs, the action of saliva as found in other research, the studies that show people on HAART therapy non detectable/ low viral load's % and that im pact alone VS someone who was recently diagnosed that would of had a higher VL, presence of other VD. By not addressing ejaculation / non ejaculation the whole study is meaningless in it's findings unless we are going back to the days when saliva and tears were believed to cause aids. This wasn't much more helpful than the advice I got from a friend in the mid 80's who said I couldn't get " IT " If I didn't sit on some the leather seat of a biker dud's motorcycle and so long as I avoided having sex with men with moustaches.. Please a little more research would help addressing men performing oral sex on each other without sores, or open cuts, and with the probability of pre-seminal fluid but no ejaculation. A little less of open sored mouthed individuals going down on someone while they hemorrhage into their partners big open gash in the throat.
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Comment by: Mark (NYC) Fri., Jul. 10, 2009 at 3:15 pm EDT
Of course, the CDC can't tell the whole story, and The Body should add more to this minimal fact sheet. Yes, we can't quantify the risk, so how do you make a decision? You look at the info we have, look at the studies that are out there, and decide what level of risk you're comfortable with.

I'm positive, and my boyfriend has given me head for 7 years, He remains negative, even though my viral load has been as high as 750,000. I made sure he read the studies before he made the decision that was right for him - I didn't push him at all. It was his choice.
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Comment by: JIM (Mexico City, Mexico) Thu., Jul. 9, 2009 at 7:17 pm EDT
The plastic food wrap is a cheap, easy to find and to use barrier when performing oral sex. If there are no studies regarding the efectiveness of the food plastic wrap, well, we should also remark the lack of studies regarding the efectiveness of latex dental dams for the same purpose, or for the use of cut-opened condoms, whatsoever. Latex dental dams are so extremely expensive, specially when compared with food plastic wrap. I`m surprised for these support to the no-proved-efectiveness latex dental dams...
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Comment by: Chris (Los Angeles) Thu., Jul. 9, 2009 at 1:49 pm EDT
This article is worthless because it provides absolutely no data whatsoever. As Frank asked, there are too many variable to draw any conclusions here. In addition to Frank's question, what about the probability if someone is undetectable. Cut or uncut. Yes, it is possible, but that may be .0000001. Its also possible to get struck by lightning. Until the scientific community gets off their *#@ and actually provides meaningful data, I don't know what purpose this article serves other then to create fear. Being positive, my last 3 boyfriends all performed oral sex on me and none of them are positive today. Yes, I guess if I was bleeding from a wound pouring into their throat, the probability probably changes. How often does that happen? Stop creating fear until you have some meaningful data to back it up.
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Comment by: Frank (Copenhagen, Denmark) Thu., Jul. 9, 2009 at 6:09 am EDT
Hello there, thank you for this very nice fact sheet on Oral Sex!
I'm surprised though, that it doesn't mention anything specific about ejaculation/semen. I mean: does it make any difference whether or not the guy ejaculates in your mouth or not. When we talk about HIV Risk, does it make sense to distinguish oral sex with ejaculation from oral sex without? Or is the risk just about the same in any case?

Looking forward to your comments :-)

/Frank
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