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 Jordan, please see the links here for info on HIV risk and testing.
https://i-base.info/qa/11844
I’m a male I had protected vaginal sex with another female but had unprotected oral sex, now I saw a sore in my mouth after about 2 weeks, I did an HIV test after 18 days, it came out negative, the sore is healing do I need another test
Hi Pavi, to confirm your status you need to wait 6 weeks after the date of exposure and test with a 4th generation antigen/antibody test. Testing before this will not be conclusive.
Please see here for more information about testing and transmission: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
I had protected vaginal sex and had unprotected oral sex with a FSW. I tested negative for hiv ab rapid test after 34 days. Do i need to retest again for hiv infection. Also any other STI’s should i test for ??
Hi Aj, no you do not need to be worried about HIV.
For more information about HIV transmission please see here: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hi Josh,
So I gave oral sex to another man. I didn’t use a condom, but did at the end. I also noticed he was pre Cumming. Also, i have a cold sore, very small on my inside gums (i think it was when i ate spicy food) .Should I be concern with HIv. I am fully aware of other sti’s, but should I be concern with hiv since the guy appeared to be precumming
Hi, oral sex carries little to no risk of transmission – there has never been a documented case of oral transmission for HIV. Saliva contains antiviral properties making this a very difficult route of transmission.
Do you know the status of this person?
As you have started PEP within 5 hours your risk is minimal to none. In most cases PEP would not have been advised due to how low the risk is.
For more information about transmission please see here: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hello,
I am so worried, I got oral sex without condom from a transgender, she put my penis in her mouth and gave me blow job and i ejaculated in her mouth. I started PEP with in 5 hours after this exposure, today is 15th day of PEP. What are the chances of hiv transmission? Am I at risk?? I am so depressed after doing this. Also i am worrying since she was commercial sex worker, if she would have given oral sex to someone else also before me. And what if that ejaculation present in her mouth?? Can someone please help me.
Hi Anonymous, did you have a question?
Hi