Oral Sex Update

January 1997

Fifteen years into the AIDS epidemic, oral sex transmission of HIV continues to be a controversial subject locally and nationally. Many factors have contributed to this, including: 1) confusion and controversy regarding the interpretation of available data; 2) unclear, anecdotal, or non-existent public policy around sexual issues; 3) differences among individuals (including professionals) in their assignment of meaning to such terms as low risk and high risk; and, 4) differences among individuals (including professionals) regarding how they value oral sex.

After a review of the professional literature and discussions with experts from around the United States, the Seattle-King County Department of Public Health's AIDS Prevention Project has developed a set of recommended messages concerning the transmission of HIV through oral sex (see below). These messages were developed to encourage and guide health care providers and HIV/AIDS prevention education workers to formulate and deliver clear, accurate, and consistent messages regarding the risks and prevention of oral sex transmission of HIV.

Recommended Messages: ORAL SEX

1.	The surest way to avoid infection with HIV (& other STDs and parenterally-transmitted diseases) is to abstain from all sexual and injection drug-using behavior. The next surest way is to limit sexual contact to one partner who is known to be HIV uninfected.
2.	The consistent and correct use of condoms for oral sex probably reduces the risk of HIV transmission during oral sex to near zero. The careful use of other barriers (e.g., plastic wrap) and other safer sex techniques during oral sex should also reduce the risk of HIV transmission.
3.	Even without condoms, oral sex presents a lower risk than anal or vaginal sex for HIV transmission. Some people do get infected with HIV from engaging in oral sex with an HIV-infected person; however, in the absence of other STDs (e.g., herpes, syphilis), gum infection (gingivitis), abrasions, and sores, HIV transmission by oral sex is inefficient. It appears that the oral mucosa is a better barrier than the vaginal and anal mucosa and that substances within saliva may help to neutralize HIV.
4.	HIV is found in different body fluids at different concentrations. Blood, semen, vaginal secretions, and breastmilk have the highest concentrations and are considered the most infectious. Preseminal fluid (pre-cum) contains HIV and is also considered infectious; however, since the volume of preseminal fluid is generally only a few drops, the likelihood of infection from preseminal fluid appears low. Saliva is considered non-infectious; it generally does not contain HIV or contains only scant quantities of the virus. Nevertheless, infectious blood can be present in the mouth as a result of inflammation/infection, flossing/brushing, abrasions, etc.
5.	For a variety of reasons including malnutrition and poor oral hygiene, those who inject drugs and/or smoke crack cocaine have a high prevalence of oral sores. In addition, crack cocaine smoking can cause blisters, sores, and cuts on the lips and in the mouth. Sores, blisters, and cuts can facilitate the oral transmission of HIV.
6.	Oral sex is known to transmit other STDs (e.g., herpes, gonorrhea) which can in turn increase the risk of transmitting HIV through oral sex.
7.	During oral sex, it is the individual whose mouth is on an HIV infected partner's genitals (and thus who might be receiving into their mouth that person's semen, preseminal fluid, or vaginal/cervical secretions) who has more risk of acquiring HIV than an individual whose genitals are receiving oral sex from an HIV infected partner. However, even those people whose only risk has been receiving oral sex on their genitals from an HIV infected partner have become infected (rarely) through oral sex.
8.	If an individual who does not have HIV infection decides to engage in unprotected oral sex, there are precautions that can be taken to reduce the likelihood of infection with HIV.

Messages for the person who is using their mouth:

Consider/try using a condom/barrier for oral sex in order to reduce/eliminate your risk;
Avoid getting blood, vaginal/cervical secretions, semen, and pre-cum in your mouth or throat;
Avoid flossing or brushing just before or after unprotected oral intercourse;
Avoid unprotected oral sex when you have gum infection (gingivitis) or other infections or sores involving the mouth, throat, or lips;
Avoid unprotected oral sex when your partner has sores, ulcers, sexually transmitted diseases, or other infections involving their genitals;
Avoid having unprotected oral sex with a partner known to be HIV-infected, especially if that person has a high viral load (e.g., partners who have been newly HIV-infected, or have a diagnosis of AIDS).

Messages for persons whose genitals are receiving oral sex:

Consider/try using a condom/barrier for oral sex in order to reduce/eliminate your risk.
Avoid letting persons with gum infection (gingivitis), or other infections or sores involving their mouth, throat, or lips give you oral sex without a condom or other protection;
Avoid having unprotected oral sex if you have sores, ulcerations, penile drips, sexually transmitted diseases, or other infections involving your genitals;
Discontinue unprotected oral sex if your genitals become abraded (e.g., from teeth) or if you feel a stinging sensation (indicating an abrasion) on your genitals during oral intercourse.
Avoid having unprotected oral sex with a partner known to be HIV-infected, especially if that person has a high viral load (e.g., partners who have been newly HIV-infected, or have a diagnosis of AIDS).

For someone who already has HIV infection, the precautions listed above will also decrease the chance of passing HIV infection to a partner during oral sex.