Is Oral Sex Really Safe Sex?

Oral Sex and STDs

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(c) 2014 Elizabeth R. Boskey licensed to About.com, Inc.

Many people question whether oral sex is really sex. That depends on how you define sex, but one thing is clear. Oral sex isn't inherently safe sex. Oral sex STDs are definitely a risk, at least if you don't take proper precautions. Below, you can find overview of some common oral sex STDs and the risk of STD transmission during oral sex.

HIV

Oral sex is a relatively low-risk activity for HIV transmission, particularly when compared to vaginal or anal sex.

However, although such transmission is rare, it is possible to transmit HIV through oral sex. Using latex or polyurethane condoms, female condoms, or dental dams is an effective way to reduce your chances of contracting the virus when engaging in oral sex. If you don't choose to use protection for oral sex, you should know that the risk of HIV transmission increases:

  • if the person performing the act has cuts or sores in his/her mouth,
  • if ejaculation takes place in the mouth
  • if the individual receiving oral sex has any other sexually transmitted diseases.

The risk of oral HIV transmission is primarily for the person performing the oral sex. Unless a partner has significant amounts of blood in his/her mouth, such as from dental surgery, oral sex is unlikely to expose the receptive partner to HIV.

Herpes

Although genital herpes and oral herpes are usually caused by different strains of the herpes virus, HSV-2 and HSV-1 respectively, it is possible for either virus to infect either site.

Therefore, it is possible to transmit herpes during oral sex. Furthermore, unlike with HIV, the herpes virus can spread from either partner during oral sex.

Herpes transmission during oral sex is a significant risk. Herpes is contagious even when symptoms are not present. Prophylactic medications, such as Zovirax (acyclovir), can reduce the likelihood of both outbreaks and transmitting the herpes virus to your partner, but they can not eliminate the risk entirely.

Condoms and other barriers should be able to greatly reduce the risk of giving a partner herpes during oral sex. However,  condoms are not completely effective, since the virus can spread from skin to skin.

HPV

It is possible to spread HPV through oral sex. In fact, it is believed that HPV acquired while performing oral sex is a major risk factor for oral and throat cancers. HPV can also appear in the oral cavity through vertical transmission (transmission from mother to child during birth). As with herpes, it seems likely that the use of condoms or dental dams during oral sex should reduce the risk of infection, but they will not necessarily eliminate it entirely. This is because, as with herpes, HPV spreads via skin-to-skin contact, not through bodily fluids.

Gonorrhea

In recent years, teenagers with throat infections caused by gonorrhea have often been in the news. Gonorrhea can be transmitted in both directions when oral sex is performed on a man, and throat infections with gonorrhea are notoriously difficult to treat. There is limited research to suggest that it may be possible for someone to acquire a gonorrhea throat infection while performing oral sex on a woman. However, transmission in the other direction is relatively unlikely since the site of infection is the cervix.

That's a part of the female anatomy not usually reached during cunnilingus. Condoms and dental dams should be extremely effective in preventing transmission of gonorrhea during oral sex.

Chlamydia

It is possible to transmit chlamydia during fellatio. With this STD and oral sex, both the recipient and the person performing the act are at risk. There has been little research on whether it is possible to transmit chlamydia during cunnilingus. However, due to the similarity of the diseases, the infection risk is probably similar to that for gonorrhea.

Syphilis

Syphilis is extremely easy to transmit via oral sex.

In fact, in some areas of the United States, oral sex has been shown to be responsible for as many as 15% of syphilis cases. Although syphilis can only be transmitted in the presence of symptoms, during the primary and secondary stages of the disease, the painless sores it causes are easy to miss. Therefore, many people don't know they have syphilis symptoms when they transmit syphilis to their partner. 

Hepatitis B

The research is inconclusive as to whether or not hepatitis B can be transmitted via oral sex. Oral-anal contact, however, is definitely a risk factor for hepatitis A infection. It may also be a risk factor for hepatitis B. Fortunately both hepatitis A and B can be prevented by vaccines. If you practice rimming, you should talk with your doctor about getting vaccinated. Vaccination is a good idea in any case, and the hepatitis B vaccine is currently recommended for all children and many groups of adults.

Making Oral Sex Less Risky

It is possible to reduce the risk of getting an oral sex STD by using barriers during oral sex. That means using dental dams (either purchased or made from condoms or gloves) during cunnilingus and rimming and condoms during fellatio. Doing so won't eliminate the risk of diseases such as syphilis and herpes, which are spread skin-to-skin. However, practicing safer sex will greatly reduce the risk of oral sex STDs. 

The Bottom Line

In summary, unprotected oral sex puts you at risk for numerous sexually transmitted diseases. If you perform unprotected oral sex on your sexual partners, you should mention it to your physician. She may want to check your throat when she is screening you for other STDs.

Sources:

Fernández-López C, Morales-Angulo C. Otorhinolaryngology manifestations secondary to oral sex. Acta Otorrinolaringol Esp. 2017 May - Jun;68(3):169-180. doi: 10.1016/j.otorri.2016.04.003.

Glynn TR, Operario D, Montgomery M, Almonte A, Chan PA. The Duality of Oral Sex for Men Who Have Sex with Men: An Examination Into the Increase of Sexually Transmitted Infections Amid the Age of HIV Prevention. AIDS Patient Care STDS. 2017 Jun;31(6):261-267. doi: 10.1089/apc.2017.0027.

Sanders AE, Slade GD, Patton LL. National prevalence of oral HPV infection and related risk factors in the U.S. adult population. Oral Dis. 2012 Jul;18(5):430-41. doi: 10.1111/j.1601-0825.2011.01892.x.

Wong ML, Chan RK, Koh D. Promoting condoms for oral sex: impact on pharyngeal gonorrhea among female brothel-based sex workers. Sex Transm Dis. 2002 Jun;29(6):311-8.

Yang CJ, Chang SY, Wu BR, Yang SP, Liu WC, Wu PY, Zhang JY, Luo YZ, Hung CC, Chang SC. Unexpectedly high prevalence of Treponema pallidum infection in the oral cavity of human immunodeficiency virus-infected patients with early syphilis who had engaged in unprotected sex practices. Clin Microbiol Infect. 2015 Aug;21(8):787.e1-7. doi: 10.1016/j.cmi.2015.04.018.

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