Q and A

Question

What is the risk of HIV transmission through oral sex?

5 February 2018. Related: All topics, HIV transmission, Southern 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

Answer: Simon Collins

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.

176 comments

  1. Simon Collins •

    Hi Stefan – the links here answer your Qs:
    https://i-base.info/qa/11844

  2. Stefan •

    Hey there!

    I’ve got a handjob / scrotum licked and blowjob with condom . Please advise should i worry about HIV?

  3. Josh Peasegood •

    Hi Anonymous, this is not a risk for transmission.

    For more information about how HIV is transmitted please see here:
    https://i-base.info/qa/factsheets/hiv-transmission-and-testing

  4. Anonymous •

    Hi Team,

    I had a full body massage and my massue touches my penis tip from her lips for around 10-20 seconds and my foreskin was also not pulled. But I am little worry about what I have done.

  5. Josh Peasegood •

    Hi Pablo, is today the first time you have tested positive for HIV? and have you started treatment yet?

    Oral sex carries little to no risk of transmission but if you are not yet on treatment/have a high viral load, it would be recommended to use a condom to prevent any risk. When your viral load is suppressed by treatment and below 200, you will be able to have any type of sex without a condom as there will be no risk of transmission.

    This is called U=U: https://i-base.info/u-equals-u/

    Has your partner tested for HIV? If they are negative it would also be suitable for them to use PrEP while you are waiting for your viral load to be suppressed. This is a similar tablet to HIV treatment but is used to prevent HIV transmission. It also means that you could have sex without a condom though it would not prevent transmission of other STIs.

    PrEP: https://i-base.info/guides/prep

  6. Pablo •

    Hi! I have a question my status today was positive in HIV and also my partner is it okay to have a oral sex ?

  7. Simon Collins •

    Hi Kk – this is not a risk for HIV but pls read link here to learn more:
    https://i-base.info/qa/11844

  8. Kk •

    I am male and gave oral to a girl in massage center..I have no idea about her hiv Status..but I beleive vaginal fluid entered my mouth but I don’t have any cuts or wounds in my mouth …I am so afraid…can’t imagine what would happen

  9. Simon Collins •

    Hi Ceasar, thanks, it sounds like you had a nice connection – but none of this is a risk for HIV. Perhaps read about PrEP though, especially 2:1:1 dosing as this might be useful in the future.
    https://i-base.info/htb/47180

  10. Caesar •

    Hi.

    I have had a sexual encounter with a guy (of unknown status), where we both performed fallatio on each other. We also rubbed our penises (frottage) and came this way twice. Afterwards, I noticed a very small cut on my penis’ foreskin. No condoms were used.
    Also I have 5+ years asymptomatic HSV 2 (read this increased the risk of HIV transmission)
    Should I worry about HIV and take pep?

    Thanks