oral sex (cunnilingus)

Question

How many cases have there been of HIV being transmitted through a male performing oral sex on a female? After performing oral sex on a suspect female (sex worker), I have had problems with a sore throat and salty taste in mouth (sometimes burning senestation). Dr. said I did not have thrush, but tongue seems more coated than usual to me and it is painful, also have had a few canker sores in mouth since incident. Also, is it possible for a male to get a yeast infection through performing oral sex on a female that has a yeast infection -- that could be an alternative to HIV explanation for the mouth problems!!!

Answer

There are only a few cases documented by the CDC that demonstrate HIV transmission to a person performing oral sex on a woman. This is the best evidence that the risk of transmission through cunnilingus is very low.

First of all, the risk of HIV transmission through oral sex is low when compared to unprotected vaginal and anal sex. The reasons for this, in part, have to do with biological differences: simply put, HIV seems to have a more difficult time causing infection when introduced to the mucous membranes of the mouth (saliva may provide additional protection and the cells in the mouth may not be as prone to infection). Secondly, the concentrations of HIV in vaginal secretions seem much lower than the concentrations of HIV in cervical secretions and menstrual blood. When performing oral sex on a female, the mouth is more likely to come into contact with vaginal secretions. Some sources suggest that vaginal fluids dilute the more infectious fluid, decreasing the chances of transmission to someone's mouth.

It is important that you do not perform unprotected oral sex on a woman when she is menstruating (blood has a much higher concentration of HIV), and if you are experiencing any problems with your oral health (sores, abrasions, inflammation). If you would like to decrease the risk of transmission even further, you can use a latex barrier--like a dental dam or a condom cut into a square--between your partner's vagina and your mouth.

For more about transmission through oral sex, see the CDC's fact sheet on oral transmission (http://www.thebody.com/cdc/oralsex.html).

In terms of oral candidiasis (yeast infections in the mouth or "thrush"), someone who is not immune compromised is unlikely to have problems with this. Candida, the fungus that causes candidiasis, normally exists in a person's mouth but is kept under control by normal bacteria. Certain illnesses (esp. HIV disease), use of medications, and possibly stress, can lead to oral thrush. So, transmission of candida among HIV negative people is possible during cunnilingus, but unlikely and rare.

RMK