Q and A

Question

What is the risk of HIV transmission through oral sex?

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.

89 comments

  1. Nancy

    Hi,

    I’m a female. Can I get hiv if someone who is hiv positive sucked my nipple and we did not involved in any other kind of sex.

    Please advise.

  2. Josh Peasegood

    Hi Harry, please follow this link for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing

  3. Harry

    Hi, 5 weeks ago I received oral sex from a trans sex worker in Spain, this person was from Columbia.
    I ejaculated into the mouth twice. Since I have had a number of strange symptoms including burning sensation in my muscles mainly arms and legs, tingling burning sensation in feet and legs, shooting pains in arms, legs and stomach, upset stomach pains, burning sensation when urinating or ejaculating, an on and off dry cough, ulcer in my mouth, night sweats and fatigue.
    I am going to get tested shortly but I am so scared of the results as I’m sure I have HIV because of these symptoms. How likely do you think it is I have it?

  4. Josh Peasegood

    Hi Ajju, these are considered minimal to no risk encounters. There should be no reason to expect that you are HIV positive. Testing would only be good for your own mental health and to be sure of your status. Testing regularly is important for everyone.

    Please follow this link for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing

  5. Ajju

    Hi. I received oral from a man who says he is negative -twice last nearly a year ago .
    I came in his mouth once.
    I also had a dry rubbing encounter with a other man once where he came (no where near me) but I was fully clothe six months ago.
    I’m shit scared if HIV. Should I test?
    I was negative before these three encouters?
    How do I get myself the courage to test…if my results are positive I will likely kill myself.
    Thanks

  6. Josh Peasegood

    Hi Dave, oral sex carries minimal to no risk of transmission. This is not likely to be a cause of contracting HIV.

    If you wish to confirm your status, a 4th generation antigen/antibody test will be accurate from 6 weeks onwards.

    Please follow this link for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing

  7. Dave

    Hi Team,

    So I no need to get tested for HIV right?

    Since I (Male) had received oral sex (penis to mouth) from a sex worker(Female). It disturbs me a lot mentally.

    Thanks.

  8. Josh Peasegood

    Hi Dave, oral sex carries little to no risk of transmission. This is because saliva contains antiviral properties that prevent HIV transmission.

    This is why oral sex is considered low risk and not an exposure requiring PEP.

  9. Dave Din

    Hi Team,

    Are you sure that receiving oral sex have no risk of hiv transmission, and no reported cases around the world till date.

    Thanks.

  10. Simon Collins

    Hi Tom, thanks, if you are HIV positive there is a small risk that your partner could be at risk of catching HIV or another infection from you. If your viral load is undetectable on ART, then this is unlikely to be a risk.

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