Oral Sex, HIV and STIs

A common question asked by community members is about the risk of HIV from oral sex. 

To put it as simply as possible, there is much less risk in oral sex as there is for anal or vaginal sex, but it is not always risk free.  The level of risk is based on a number of factors that bring us back to the basics of HIV transmission.  For this reason, it is important for everyone to have a good knowledge around risk factors associated with HIV transmission, as well as other STIs.

HIV transmission occurs when body fluids that contain HIV (blood, semen, breast milk, vaginal fluids) are shared with the body fluids of another person.  This means there needs to be an exit point and an entry point into the bloodstream, this most commonly occurs through anal and vaginal sex without a condom.  HIV is not transmitted through all body fluids though, as fluids such as saliva do not contain sufficient levels of the virus to be passed on.  Therefore, a person living with HIV performing oral sex on someone who is HIV negative would be considered very low risk.  While oral sex performed on a guy living with HIV with ejaculation in the mouth is considered the riskiest type of oral sex, the odds are still low and are dependent on other factors.

Remembering that HIV needs an entry point into the bloodstream, semen in your mouth may not always be a risk at all.  Swallowing also doesn’t increase the risk of transmission, as your stomach acids will destroy any virus that is present.  Things that can increase the risk by creating the entry point is the presence of oral ulcers, bleeding gums and the presence of other STIs.  It is therefore recommended that people do not brush their teeth right before oral sex, because it is common that brushing tears the gums and causes bleeding.  However, gums do naturally heal quite quickly and the bleeding entry point will close up in a short period of time.  If you maintain good dental hygiene by brushing regularly and visiting your dentist, the likelihood of semen entering your bloodstream through your gums is very small.

Due to the other factors that can influence HIV transmission through oral sex, it is incredibly difficult to measure an exact risk.  While we cannot say the risk is zero, this is only because the risk of HIV transmission from oral sex is so small it is not measurable. 

In Australia, most people living with HIV are on highly effective antiretroviral mediations that reduce the amount of virus in their body, and lower the risk of transmission through sex, including oral sex even further. For many, the number of copies of virus in their body reaches an incredibly small level, called being undetectable. HIV is untransmissable through sex when someone living with HIV is undetectable.

HIV treatment is therefore an effective method in reducing and even eliminating the chances of HIV transmission, no matter the kind of sex.  The risk from oral is reduced even further if you don’t let the guy ejaculate in your mouth, an easy enough risk reduction strategy and probably more likely than performing oral sex with a condom, which is the recommendation.

While there use is not common, condoms are recommended for use in oral sex to prevent any STIs.  STI transmission through oral sex occurs very easily, with gonorrhea, herpes and syphilis being the most commonly reported.  These STIs, as well as chlamydia, are all on the rise in Australia and the numbers are particularly high amongst men who have sex with men.  If you don’t use condoms or dams for oral sex, it is really important you have a regular sexual health check up.  It is especially important because the presence of an STI causes inflammation, which can increase the chances of HIV transmission and it can also cause a blip in the viral load of a person living with HIV.

In the absence of blood, HIV transmission is incredibly unlikely to occur as a result of oral sex without a condom.  It is unfortunate that a clear indication of risk cannot be stated, but it is reassuring to know that this is only because the risk of HIV transmission is so low that it cannot be measured.  STIs are another story though, and if you are having any kind of sex, it is important for your own health and the health of your sexual partner, that you have regular sexual health checks.

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