If you’re living with HIV or AIDS, you may worry about spreading the virus to partners through sex. You may also wonder whether different types of sexual activity are “safer,” or less likely to cause HIV, than others. In particular, myHIVteam members and other people living with HIV often question whether oral sex can transmit the virus to partners.
Despite these concerns, many people with HIV/AIDS want to safely have intimate sexual relationships. If you’re unsure whether it’s safe to have oral sex after being diagnosed with HIV or AIDS, read on to learn the facts about HIV and oral sex, as well as tips for safer oral sex. Talk with your doctor or HIV care team if you have questions about oral sex, your sexual health, or your partner’s sexual health.
It’s technically possible to transmit HIV through oral sex, but, compared with other types of sex, the risk is low — very close to zero. In fact, some studies have determined zero risk of oral transmission, regardless of whether the HIV-positive person is on any type of therapy or if their partner is taking PrEP (preexposure prophylaxis — medications to help prevent getting HIV). Researchers say that the chances of transmission lie somewhere between zero percent and 0.04 percent (a 4-in-10,000 chance).
Some researchers believe that number may be slightly higher. HIV experts in the UK estimate that 1 percent to 3 percent of HIV cases result from oral sex.
Either way, the odds are lower than the chances of transmission through other sex acts, such as anal or vaginal sex. Although the exact risks of transmission through these routes are unknown, the percentages are higher than those for oral sex.
It’s important to note that, in these statistics, biological sex doesn’t seem to matter. It may be that oral sex transmits HIV so rarely that too few cases can be studied to determine such details. At this time, research suggests that transmission via oral sex is very unlikely whether the HIV-negative partner is biologically male or female.
A few situations do make it more likely to transfer HIV in the exchange of bodily fluids during oral sexual contact.
For example, oral sexual activity with an HIV-positive partner who has a detectable viral load makes transmission more likely. Regular testing can show whether a person has a detectable or undetectable viral load.
Transmission is also more likely if an HIV-positive male ejaculates into their partner’s mouth during oral sex, according to the Centers for Disease Control and Prevention (CDC). Transmission is also more likely if either partner has another oral sexually transmitted disease (STD) or sexually transmitted infection (STI), like gonorrhea, chlamydia, syphilis, or herpes of the mouth, lips, or throat.
If the HIV-negative partner has open sores or ulcers in their mouth or an illness causing sores or inflammation in the throat, transmission is more likely. Further, according to the CDC, sores, infections, or inflammation on the penis or in the vagina (or elsewhere on the genitals) can make it more likely that HIV will pass from that partner to the HIV-negative partner, including via oral sex.
Performing oral sex on someone who is HIV-positive and menstruating also raises the risk of transmission through blood in their vaginal fluids, though only very slightly.
HIV treatments known as antiretroviral therapy (ART) help keep the virus under control. There are several varieties of these HIV medicines, and your health care provider can help you find the one that works best for you with the fewest side effects.
Over time, these drugs should lower the amount of the virus in the body (viral load) to a very low or even undetectable level. At these levels, a person’s chances of transmitting HIV to a partner through sex — whether oral, anal, or vaginal — are basically zero.
Preexposure prophylaxis is a type of drug given to help uninfected people from getting HIV. Someone who is HIV-negative can take PrEP to significantly lower their chances of contracting HIV.
No studies have specifically looked at the use of PrEP in preventing transmission during oral sex. However, based on the way the medications work to prevent infections from other causes, medical experts believe these drugs would also stave off transmission via oral sex. These researchers go as far as to say that there would be no possibility of transmission with the proper use of PrEP.
PrEP helps many couples stay physically intimate with each other well after an HIV diagnosis. One myHIVteam member shared that their partner said that they would “go on PrEP. We will always love each other with your HIV meds and me being on PrEP.”
Postexposure prophylaxis (PEP) is generally less effective than PrEP and must be taken within 72 hours of exposure to HIV to work. No published study findings address the effectiveness of PEP specifically taken only after oral sex.
Physical barriers can also help prevent the risk of HIV transmission during oral sex. If an HIV-negative partner does not take PrEP, the positive partner has a detectable viral load, or if you want to take extra precautions, these approaches can help prevent HIV transmission during oral sex.
People with penises should use condoms, as it is very difficult for HIV to pass through latex. Partners who want additional protection can use dental dams — square pieces of latex that are placed over the partner’s anus or vagina during oral sex. You also can cut a condom lengthwise and use it in the same way as a dental dam for similar protection.
These methods offer the bonus of protecting both partners from other sexually transmitted diseases, too.
If you have been diagnosed with HIV and want to have sexual relationships, talk to your doctor about how to do so safely. They can provide you with the health information that’s right for you and your partner. Between HIV treatment for you and PrEP for your partner, as well as taking care in other ways, you should be able to continue being sexually intimate.
You may need to wait for your antiretroviral treatment to work or for PrEP to take effect. For instance, according to the New York State Department of Health, a woman who is HIV-negative and wants to have vaginal intercourse with an HIV-positive partner will need to take PrEP for 20 consecutive days to be considered protected.
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Are you living with HIV and want to learn more about how the disease is transmitted? Are you concerned for your sexual partners, or do you want to learn more about HIV and oral sex? Ask your questions or share your thoughts in the comments below or by posting on myHIVteam.