Oral sex is still the most common type of unprotected sex. You should know about oral sex and HIV/STD infection. On this page we define oral sex as sucking cock (or getting sucked -- aka "head" or "fellatio") and rimming (mouth to anus contact aka "analingus").

Oral sex and sexually transmitted diseases

“How easy is it to get HIV and other STDs from Oral Sex?” 

“What are my chances of having sex with someone infected with HIV or another STD?” 

“What can happen to me if I get the disease?”

• Although there have been a few documented cases of people getting HIV from sucking and getting sucked, available research suggests that the risk of HIV from any kind of oral sex is very low.

• While there have been case reports of infection with another strain of HIV (superinfection), it appears to be rare.

• Animal models suggest that superinfection may be restricted to a short time period after initial infection.

• It is estimated that about 30% of gay men in San Francisco are HIV +.

As of May 2005:

• Only one published study has measured the risk of getting HIV from sucking. No HIV infections were found among 239 gay and bisexual men recruited from HIV testing sites who reported only having oral sex in the previous 6 months. In a recent update of this study, researchers reported that among 432 men in the study, there were still no HIV infections.

• A Spanish study conducted between 1990-2000, looked at 135 sexually active HIV negative male and females who only engaged in oral sex with their HIV positive partners. There were over 19,000 acts of unprotected orogenital sex (fellatio or cunnilingus) and no HIV infections.

Although HIV is in pre-cum and semen, the chance of transmission is much much lower than through unprotected anal intercourse because:

• Saliva contains enzymes that appear to neutralize the virus.

• The types of cells that HIV infects are much more common in the lining of the rectum than in the mouth.

• The lining of the mouth is tougher and more resistant than the lining of the rectum.

The following may increase your risk of HIV infection and/or transmission:

• Sores, cuts, and gum disease may make it easier for HIV to enter the body.

Easy

• Sores and blisters (usually on the lips, genitals, or anus) are extremely infectious.

• Easily passed by sucking/getting sucked, rimming, and licking/being licked.

• Blisters/sores can be extremely painful.

• Individuals with herpes usually have periodic outbreaks throughout their lives.

Yes

• Research suggests that having HSV-II can more than double your risk for HIV infection.

• The risk of HIV infection is greater for those with new HSV-II infections compared to those with long-standing HSV-II.

• Outbreaks increase the frequency and amount of HIV you shed and may make it easier to transmit HIV. 

• Studies among heterosexuals in Africa suggest that the risk of getting HSV-II from sex is about four times greater for HIV positive than HIV negative individuals.

High

• Nearly 7 out of every 10 Americans have oral herpes (HSV-I) often acquired non-sexually during childhood.

Very Easy if sores or mucus patches are present

• Easily passed through all types of oral sex from contact with open sores (commonly called chancres) on the penis, anus, or mouth.

• Also passed through contact with mucus patches in the mouth.

• Can be cured with antibiotics. 

• Left untreated syphilis can eventually cause brain damage, heart disease, blindness and death.

Yes

• Open syphilis sores or chancres provide an  easy entry and exit for HIV.

• Progression from primary to secondary to tertiary syphilis may be accelerated in individuals with HIV.

• Treatment may be different for HIV positive individuals.

• Syphilis can increase your viral load, as well as decrease your CD-4 or T-cell count.

Medium But Increasing

• Since 1998, syphilis cases in San Francisco have increased over 400% -- from 41 in 1998 to 522 in 2003.

Moderately Easy

• When passed through oral sex, gonorrhea is usually passed from the penis into the throat while sucking cock.

• Gonorrhea can cause burning with urination and/or discharge from the penis.

• Can cause a sore throat.

• Some people have no symptoms at all.

• Increased white blood cells and inflammation at the site of infection may make it easier for HIV to enter the body.

• Gonorrhea appears to increase the amount of HIV in semen and may make it easier to transmit HIV.

Medium/Low

• NGU can be passed from both sucking and getting sucked.

• NGU can cause burning when urinating and/or discharge from the penis.

• NGU of the throat can cause a sore throat.

Likely

• It does not appear that HIV infection affects symptoms or treatment of NGU.

Low

Unknown But Possible

• No reliable studies have been done that measure the risk of oral transmission.

• Chlamydia can be found in the throat.

• Chlamydia can cause burning with urination and/or discharge from the penis.

Yes

• It does not appear that HIV infection affects symptoms or treatment of chlamydia.

• About 4% of the men who have sex with men seen at SF City Clinic are infected.

• It is not known how easy it is to transmit the genital wart virus through oral sex. 

• Can be passed by all types of oral sex. 

• Warts usually appear on the penis or in the anus but may also occur in or around the mouth or lips.

• Different treatments are available but the virus stays in the body. 

• While most strains of HPV only cause warts, some strains cause anal cancer. 

• Although not an issue for oral sex, if you have anal sex talk to your doctor about regular anal pap smears.

• Studies have shown an increased rate of HIV infection for people with anal or genital warts who have unprotected anal sex. 

• Warts may provide an easy entry point for HIV to enter the body.

• Studies have found that HPV is more common among HIV positive individuals than HIV negative individuals. 

• With decreased T-cells, shedding of HPV appears to increase thus making it more infectious. 

• Anal cancer is 7 times more common among HIV+ than HIV negative MSM. Get checked regularly if you have had anal warts.

• Genital warts are one of the most common STDs. 

• Check for wart-like growths on the penis, anus, or lips of a sex partner. NOTE: Genital warts are sometimes too small to be seen.

• Intestinal parasites are easily passed through rimming. 

• Sucking and getting sucked are low risk unless you swallow fecal matter (shit) when sucking.

• Most intestinal diseases can be cured with medication.

• In 2004, rates for these diseases were low. 

• Most cases in San Francisco occur among men who have sex with men.

• Hepatitis A is very easily passed through rimming. 

• Sucking is low risk unless you swallow fecal matter (shit) when sucking. 

• Get vaccinated.

• Symptoms of Hepatitis A usually go away after several weeks.

• Some HIV drugs have toxic side effects that are harmful to the liver. Any disease like hepatitis that affects the liver may increase risk of liver damage.

• However, rates of Hepatitis A have been increasing in San Francisco and most cases in San Francisco occur among men who have sex with men.

• No studies have measured the risk of transmission from oral sex. 

• Transmitted primarily through unprotected anal sex. 

• Get vaccinated.

• 10% of adults infected with Hepatitis B become carriers of the virus. Long-term effects can include scarring and cancer of the liver.

• Symptoms can be different for HIV positive individuals. 

• Some HIV drugs have toxic side effects that are harmful to the liver. Any disease like hepatitis that affects the liver may increase risk of liver damage.

• The number of cases of Hepatitis B among gay men has decreased significantly since 1985 due to the adoption of safer sex practices for anal sex and vaccination.