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 SD, it is good that they are checking for any resistance.
Has your RNA test been confirmed with an antibody test? RNA tests are not used for diagnose as they can be positive for other reasons e.g., other infections or recent vaccines.
As you had protected sex with your partner and only a blowjob without a condom, your risk is minimal. More so as you have been taking PrEP daily there should be no risk of HIV. When did you last have a confirmed negative result?
I recently had protected anal sex with a guy who tested positive. He gave me unprotected blow job. I am also on daily prep. I tested positive on rna test. Any help is highly appreciated. They are now checking if my hiv is resistant to prep.
Hi Khan, for information about transmission please see here: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Oral sex carries little to no risk of transmission. Saliva contains antiviral properties making it difficult for HIV to be passed on via this route. There has never been a documented case of HIV transmission via oral sex.
Using a condom will prevent transmission for penetrative sex.
Hi, I have had sex with a girl. So I put my penis in her mouth for five to 10 seconds and then removed it. But for sex I used a condom. Can I get a virus transfer due to a little bit of oral?
Hi Jan, no you are not at risk for HIV. Using a condom means there is no risk from vaginal sex.
Oral sex carries little to no risk. There has never been a documented case of transmission via oral sex – saliva contains antiviral properties which prevents HIV being transmitted.
For more information please see here: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hi, I performed oral sex on a girl (cunninglus) for atleast 3-5 mins. We also had protected vaginal sex (with condom). Am I at risk for hiv?
Hi Adrian, no there is no risk to your partner.
PEP: https://i-base.info/qa/factsheets/pep-faq
Hi,
I’m on PEP medication since two weeks because i had a sex with not knows status person. After week of taking PEP i perform oral sex on my partner (cunnilingus) and my partner made me a rimjob. Is there any risk of my partner getting infected with potential HIV in this scenario?
Hi Rick, there is no risk of transmission. Oral sex already carries little to no risk of transmission – there has never been a documented case. Saliva contains antiviral properties that would kill HIV before transmission.
Furthermore as your parter has been on treatment for 27 years and undetectable it is impossible for them to pass on HIV. This is called U=U: https://i-base.info/u-equals-u/
The fact that you are also on PrEP means you are not at risk of HIV transmission regardless of other circumstances.
Hi, I performed oral sex on a person who told me after that he has been undetectable for over 27 years and on effective treatment. I have been taking daily PrEP and worried. He did cum in my mouth slightly and i took his dick out and spat out. There wasn’t too much of cum. I don’t have no open sores, ulcers and bleeding gums and on daily PrEP for over months now. Please advise, I am panicking as I have never been in this situation