"How safe is oral sex?" This question has been on the tip of many a tongue (pun intended) for at least the last couple of decades. The evidence is that STDs/STIs (STDs) can be spread through oral sex. With STD rates on the rise, we all should be taking measures to ensure we keep ourselves safe and healthy in all aspects of sexual activity.
Safe oral sex is primarily an issue of prevention of STD transmission – not of pregnancy prevention. But just because it does not involve birth control doesn't mean we can get lazy about it. Safe sex practices are important regardless of the kind of sex. Here we offer some information on STDs that can be, or are suspected to be, transmitted orally -together with some suggestions on how to make Oral Sex safe.
Oral Sex and STDs
HIV / AIDS
Reports vary, but there is significant evidence that HIV cannot easily be transmitted orally. Dr. Jeffrey Klausner specializes in STD transmission and made some interesting findings during his work in the San Francisco area (USA). Dr Klausner holds that HIV is very difficult to transmit orally. After a study performed on 239 gay/bisexual men, 28% of whom knew their partners were HIV positive, not one reported transmission of the virus. From this study Dr. Klausner concluded that HIV is next to impossible to be transmitted orally.
Further research in Spain followed 110 women and 25 men who were all healthy (HIV-negative) and who had HIV-positive partners for 10 years, and not one of them reported transmission. It appears from this research that HIV is not a significant risk with oral sex. It is important to note however that HIV has reportedly been transmitted through anal sexual contact, making oral-anal contact suspect, especially if open sores or lesions are present.
HPV (Human Papilloma Virus)
This infection has been shown to be transmitted orally, as it is highly infectious when active. It will generally form what look like warts on or near the genitals of both sexes. They may be more difficult to identify on women than men because they may appear on the cervix (inside the vagina) of women. They can also develop around the anus, making anal-oral contact questionable. HPV has the potential in some cases to develop into or precede cancer. Although there is little clinical evidence of oral transmission, the warts shed the virus and any form of contact with them should be avoided if possible.
This bacterium often causes pelvic pain and fluid discharge (from the urethra or vagina, for men and women respectively). It is often carried by women without any symptoms at all and, although not common, it has been reported to have been transmitted orally. As yet, research is inconclusive as to how virulent it may actually be orally.
This group (Hepatitis A, B, and C) are most often transmitted between intravenous drug users, but there is limited evidence that they may be orally transmissible as well. Hep B is the most worrisome, and can cause chronic liver damage and disease. Hep A is more commonly found and is usually not serious, but is more likely transmitted through oral-anal contact rather than oral-penis/vaginal sex.
While most experts agree that there is a risk of transmission of syphilis through oral-genital contact, it is difficult to quantify at this point. Ulcers or chancres are present when the disease is active, so if any open sores are visible around or near the mouth or genitals, once again, even oral sexual contact should be avoided.
Herpes Simplex Virus (HSV)
This group has become more common in recent years relative to other STDs. It is the most likely cause of ulcers in the genital area (small blisters on the penis or vulva). It has occasionally been reported to have been transmitted by oral sex, but is much more commonly transmitted through penis-vagina sexual contact. When open ulcers are present, transmission risk becomes far greater.
This disease is another without adequate study to conclude its rate of transmission via oral sex. The disease looks different for men and women. To women it can look like pelvic infection or fertility issues, with outside symptoms showing at a minimum or not at all. To men it involves pain and fluid discharge (leaking fluids) from the urethra. Again, there is little evidence thus far of infection by oral sex, but the pathogen has been isolated in the throats of both men and women, so if symptoms appear, it is probably better to avoid all sexual contact until it is looked at by a physician.
Bacterial infections in the gastro-intestinal tract
There is small evidence that various other organisms including Salmonella, Shigella, and Campylobacter have been transmitted by oral to anal contact. While not often serious, these infections can be painful and require the use of heavy antibiotics to clear from the body. While there has been the occasional fatality from Salmonella and Shigella, the vast majority of cases are quickly recovered from. If you suspect a problem, see your physician.
So the basic message is that safe sex practices are still important with oral sex, as with penis-vaginal sex. And as you might expect, the precautions are much the same.
The most obvious method of protection is to avoid contact with partners (especially new partners) who have obvious breaks in the skin of their mouth or genitals. Any form of skin opening, wart, chancre, blister, or ulcer in either the mouth or pelvic region is a clear sign that something may be wrong, and that even oral should be avoided until it is looked into.
Furthermore, for both men and women the next best thing is use of a condom (for fellatio) or dental dam (for cunnilingus). Many people agree that a flavored condom makes a better choice, rather than the taste of straight latex rubber. Dental dams are not nearly as available as condoms, but a condom can be modified for the purpose.
Making a dental dam out of a condom is an easy process. Cut the top and bottom off the condom, leaving the middle section intact and looking like a tube. Cut up one side of the tube and you have a cheap, easy dental dam of decent quality (depending on the brand of condom).
For analingus (oral-anal contact) you can also use a dental dam. Especially with this form of oral you need to be extra careful about cleanliness, so gentle cleaning before engaging in sexual activities is recommended. The key is to be very gentle so as to prevent micro tears in the skin.
In the absence of the above mentioned barrier methods, men can avoid ejaculating into their partners' mouths to help reduce any risk.
Some have suggested that brushing teeth and flossing before oral sex may help; however, this myth is potentially dangerous. The current thought is that although you may have better breath, flossing or brushing can cause tiny fissures in the mouth that may actually increase exposure to viruses.
Further precautions include avoiding deep or aggressive thrusting into the mouth, as this may cause similar tears in the soft tissues of the throat.
Conclusions about oral sexual safety
Although oral sex is arguably (and now also clinically) safer than traditional sexual contact, there are still the inherent health risks associated with close physical sexual contact. The simple fact is that you need to be careful no matter what you do, who you do, and how you do it with them, so take the needed precautions!
You only get one body, so we encourage you to take care of it with proper safe sex practices.
(Note: Review our various articles for definitions and tips on the various types of Oral Sex – Fellatio, Cunnilingus and Analingus.)