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Oral sex and HIV

man with his arm around a naked man's body

Oral sex is when someone licks or sucks someone else’s genitals. It has a very low risk of HIV transmission. When the person with HIV has an undetectable viral load, there is no risk.

What is the risk?

Results from the PARTNER study show that if someone with HIV is taking HIV medication and has an undetectable viral load they cannot pass on HIV.

According to Public Health England, around 1-3% of sexual HIV transmissions in the UK are because of oral sex. Other studies found that the risk is very low but is not zero.

Unprotected anal and vaginal sex leads to far more HIV infections than oral sex.

The risks are higher if the person giving oral sex has:

  • cuts, sores or abrasions in their mouth or gums
  • a sore throat or infection in the mouth or throat.

Or if the person receiving oral sex is:

  • HIV positive
  • has a detectable viral load
  • has any cuts, sores or inflammation on the genital area.

If their viral load is undetectable there would be no risk.

Other sexually transmitted infections (STIs) such as gonorrhoea, herpes and syphilis can be passed on through oral sex.


Receiving oral sex from someone with HIV

Even if their viral load is detectable, this is considered to be an extremely low risk and infection would really only be possible if someone with HIV was giving someone oral sex when their mouth was bleeding.


Performing oral sex on a man with HIV

There’s a potential risk if an HIV negative person performs oral sex on a man with HIV with a detectable viral load.

This risk increases if his infected pre-cum or semen gets into the other person’s mouth.

Avoid getting semen in your mouth - all but one of the cases where someone has been infected with HIV through oral sex took place when the HIV positive person ejaculated into their mouth.


Performing oral sex on a woman with HIV

Even if her viral load is detectable, this carries a very small risk, which can be reduced by holding a latex barrier over her vagina.

Oral sex during her period carries a greater risk.


How is HIV passed on?

HIV can be passed on through sex when infected sexual fluids or blood enter the bloodstream of an HIV negative person.

This can happen if the person with HIV has a detectable viral load and no form of protection is being used.

During oral sex this could potentially happen if the mouth, gums and/or throat of the person giving oral sex has cuts and sores or is inflamed or infected.


What is protected sex?

Protected sex means using a male or female condom during sex if one of you has HIV and a detectable viral load. Some people choose to use condoms during oral sex - flavoured ones taste better.

HIV treatment is also a form of protection.

How HIV treatment stops HIV being passed on:

  1. A person with HIV who is taking treatment and has an undetectable viral load cannot pass on HIV.
  2. Pre-exposure prophylaxis (PrEP), when taken correctly, significantly reduces the chances of becoming HIV positive. PrEP is a course of HIV drugs taken by an HIV negative person to lower the chance of infection.

Oral sex advice for people who don’t have HIV

The risk from unprotected oral sex with someone with a detectable viral load increases if you have:

  • a throat infection (including an STI in the throat)
  • damage to the lining of the mouth or throat
  • had recent dental work or your gums bleed a lot.

Avoid performing oral sex without protection on someone with a detectable viral load while you have any of the above.

Don’t floss or brush teeth before oral sex (use gum or rub tooth paste on your teeth). Regular check-ups for STIs will pick up infections in your throat.

By cutting down on the number of oral sex partners, you make the very small HIV risk even lower.

Remember that other STIs can also be passed on through oral sex, including herpes, gonorrhoea, chlamydia and syphilis.


More information and support:


Unprotected sex and HIV ››

 

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The Information Standard: Certified member

This article was last reviewed on 6/6/2016 by Anna Peters

Date due for the next review: 6/6/2019

Content Author: R. Scholey

Current Owner: Kerri Virani

More information:

Transmission from mouth to genitals, NAM

Factors influencing risk, NAM

How could HIV infect the mouth and throat?, NAM

Oral sex, NAM

EAGA/BHIVA Extremely low risk with undetectable viral load 

Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy, Journal of the American Medical Association: Alison J. Rodger, MD; Valentina Cambiano, PhD; Tina Bruun, RN; Pietro Vernazza, MD; Simon Collins; Jan van Lunzen, PhD; Giulio Maria Corbelli; Vicente Estrada, MD; Anna Maria Geretti, MD; Apostolos Beloukas, PhD; David Asboe, FRCP; Pompeyo Viciana, MD1; Félix Gutiérrez, MD; Bonaventura Clotet, PhD; Christian Pradier, MD; Jan Gerstoft, MD; Rainer Weber, MD; Katarina Westling, MD; Gilles Wandeler, MD; Jan M. Prins, PhD; Armin Rieger, MD; Marcel Stoeckle, MD; Tim Kümmerle, PhD; Teresa Bini, MD; Adriana Ammassari, MD; Richard Gilson, MD; Ivanka Krznaric, PhD; Matti Ristola, PhD; Robert Zangerle, MD; Pia Handberg, RN; Antonio Antela, PhD; Sris Allan, FRCP; Andrew N. Phillips, PhD; Jens Lundgren, MD
JAMA. 2016;316(2):171-181. doi:10.1001/jama.2016.5148

Viral load, Michael Carter, Greta Hughson, NAM Aidsmap, March 2014

More confidence on zero risk: still no transmissions seen from people with an undetectable viral load in PARTNER study, Gus Cairns, NAM, Aidsmap, July 2016

Open your eyes to STIs, NHS Choices, Nov 2015

What infections can I catch through oral sex?, NHS Choices, May 2015

Risks from oral sex with undetectable viral load?, iBase, July 2016

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