HIV and oral sex

Is there a connection between HIV and oral sex? There is a commonly held belief among many lay people that oral sex carries little or no risk. In fact, some consider oral sex a safer sex alternative. But the truth is, like any other sexual activity, oral sex carries a risk of transmitting HIV and other sexually transmitted diseases. The risk is even greater in serodiscordant couples (one partner is HIV positive while the other is negative), people who are not monogamous, or in people who inject drugs and/or share needles and syringes. Truth be told, abstaining from oral, anal, and vaginal sex all together is the only way to completely avoidthe sexual transmission of HIV. But how realistic is that?

What are the Risks of Oral Sex?
Risk is classified as either being documented (transmission that has actually occurred, been investigated, and documented in the scientific literature) or theoretical (passing an infection from one person to another is possible). While there is documented risk when having oral sex with an HIV infected partner the risk is much less than with anal or vaginal intercourse. This fact makes it very hard to calculate the actual risk with oral sex. Another factor that makes risk determination difficult is the fact that most people who engage in oral sex also engage in other types of sexual practices, namely vaginal and anal intercourse. Still, there have been document cases of HIV transmission strictly from oral sex.

Which Behaviors are the Riskiest?

Oral-Penile Contact (fellatio)
Theoretical Risk:With fellatio, there is a theoretical risk of transmission for the receptive partner because infected pre-ejaculate ("pre-cum") fluid or semen can get into the mouth. For the insertive partner there is a theoretical risk of infection because infected blood from a partner's bleeding gums or an open sore could come in contact with a scratch, cut, or sore on the penis.

Documented Risk: Although the risk is many times less than anal or vaginal sex, HIV has been transmitted to receptive partners through fellatio, even in cases when insertive partners didn't ejaculate.

Oral-Vaginal Contact (cunnilingus)
Theoretical Risk:Cunnilingus carries a theoretical risk of HIV transmission for the insertive partner (the person who is licking or sucking the vaginal area) because infected vaginal fluids and blood can get into the mouth. (This includes, but is not limited to, menstrual blood). Likewise, there is a theoretical risk of HIV transmission during cunnilingus for the receptive partner (the person who is having her vagina licked or sucked) if infected blood from oral sores or bleeding gums comes in contact with vulvar or vaginal cuts or sores.

Documented Risk:The risk of HIV transmission during cunnilingus is extremely low compared to vaginal and anal sex. However, there have been a few cases of HIV transmission most likely resulting from oral-vaginal sex.

Oral-Anal Contact (anilingus)
Theoretical Risk: Anilingus carries a theoretical risk of transmission for the insertive partner (the person who is licking or sucking the anus) if there is exposure to infected blood, either through bloody fecal matter (bodily waste) or cuts/sores in the anal area. Anilingus carries a theoretical risk to the receptive partner (the person who is being licked/sucked) if infected blood in saliva comes in contact with anal/rectal lining.

Documented Risk: There has been one published case of HIV transmission associated with oral-anal sexual contact.