Question
What is the risk of HIV transmission through oral sex?
5 February 2018. Related: All topics, HIV transmission, South Africa.
First of all my thanks to everyone at i-Base!
I have a question regarding transmission. I am HIV positive and have a low viral load (under 250) and am not yet on medication. I always use condoms for anal intercourse but my questions relate to oral sex.
From what I’ve read, the risk increases:
• if the insertive partner has a high viral load.
• if the receptive partner has infections in the mouth or cuts, gum disease, has had recent dental work etc
• if the receptive partner takes semen in the mouth
Also, if the HIV positive receptive partner has blood in the mouth – could they possibly infect a negative partner
I can only find terms such as ‘low risk, very low’ but this all seems subjective. Low compared to the risk of unprotected intercourse doesn’t really mean much. Does that mean that with an undetectable/low/mid/high viral load that condoms should always be used or that if you avoid the higher risk scenarios unprotected oral sex is considered safe? I guess it all relates to the level of risk someone is willing to accept so I was hoping you might have some data e.g. percentage risk per act etc.
I read that there was a Spanish study reporting no seroconversions from 19,000 exposures over 10 years in serodiscordant couples and other reports saying that up to 5% of infections could be attributed to oral sex. Are there any recent studies to clarify the level of risk and also which reports would you regard as the most accurate?
I’ve recently met a great guy and it’s come to the point that I want to disclose my status. I’m hoping this might allow us both to put the level of risk into perspective.
Many thanks in advance and best wishes
Answer
Thank you for your question.
HIV is not easily transmitted by oral sex – and it probably needs ALL the factors you listed. For example, the positive partner would have to have a very high viral load AND the negative partner would have to have oral concerns like bleeding gums or recent dental work.
There are no cases of people catching HIV from receiving oral sex (from a person who has blood in their mouth). This is zero risk.
Your viral load is currently very low, which make any risk incredibly low. If your viral load was undetectable on treatment, the risk would be zero for all types of sex.
In 2018, HIV treatment is routinely recommended for anyone who is HIV positive. This, together with the evidence that undetectable viral load prevents transmission has dramatically changed more discussions about HIV risk. A review of this evidence is at this link:
https://i-base.info/htb/32308
This booklet has more information about sexual transmission, including a section on oral sex:
https://i-base.info/guides/testing
For any further information please contact us via the website, e-mail or through the treatment information phoneline (Mon-Wed 12-4pm).
Best wishes for the future with your new partner.
Note: This answer was updated in February 2018 from a question first posted online in April 2010.
Hi Jem, there is no risk of transmission from this exposure.
As your partner is on treatment AND they have a viral load below 200 there is no risk of transmission. When below 200, their viral load is considered undetectable and U=U can apply.
This means that the treatment is suppressing HIV that they cannot pass on HIV via sex even without using a condom.
U=U: https://i-base.info/u-equals-u/
Hey doc i have somethng to ask i recently exposed to hiv positive person with 176copies ml hes on med under 5 years kinda worried about the blip coz hes recent check of viral load was august 1 and was exposed on aug 31
Hi Anonymous, no you can’t get HIV like this. This is not how HIV is transmitted.
For more information please see here: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Can u get hiv from a hiv female who gives u a handjob and she use her saliva for lube until u cum in her hand. Please help can’t sleep at night.
Hi Dave, this is not a risk for HIV. Please see here for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
I was with a sex worker 11 day ago. I had a condom over the tip of my penis but the sex worker put her mouth over the part that was covered and touched my penis with her lips for a few seconds. I also fingered her for a few seconds as well as sucked her nipples. What are the risk of transmission?
I also took an RNA test yesterday. How accurate is that after 10 days?
Hi Alec, oral sex carries little to no risk of transmission. Saliva contains antiviral properties which makes it very difficult for HIV to be transmitted this way. There has never been a documented case of HIV transmission via oral sex.
Please see here for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
About 4 days ago, I received about 4 minutes of unprotected fellatio from a heterosexual female sex worker in Thailand. Her HIV status is unknown but I’ve read studies about high HIV prevalence amongst female sex workers in Thailand. No ejaculation in her mouth and no apparent blood on my penis. No other unprotected sex acts. I am now worried sick that I have HIV or another STD. No symptoms so far. Because it seems theoretically possible, I’m still extremely nervous. Is it possible that I could’ve been infected from this encounter?
Hi, I am very worried and can’t sleep or rest of the fear of catching HIV. Basically I was on holiday to a hot country and have arrived to uk at night and weather was very cold and when I went home I have catched little flu wasn’t bad. And I have ulcer in my mouth and that was all before I have had any oral sex. Then I have met someone and had oral sex. Now I am very worried as I have had oral sex without any protection and I have already had before ulcer on my mouth. I have read online that it’s risky because there’s a ulcer in mouth. But the flu and ulcer was before I have had any oral sex. I would appreciate to get an answer as soon as possible
Thank you
Hi Vitraan, please see here for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Oral sex carries little to no risk of transmission. There has never been a documented case of HIV transmission via oral sex.