Question

Can my HIV negative husband give me oral sex?

9 June 2011. Related: All topics, HIV transmission.

I am a female and have been undetectable now for several months and would like to know what are the risks of me passing the virus to my husband through oral sex? (him giving the oral sex to me). My husband is negative. We practise safe sex otherwise.

I am asking as I read somewhere that even though my blood is showing undetectable levels of the virus that this may not be the case in the vagina and I could still infect him through oral sex.

Is it safe for us to engage in oral sex? I do not want to put him at any risk.

Thank you for any information.

Answer

Answer: Simon Collins

Hi

Thanks for your question which covers a couple of important issues.

The first is about viral load, the risk of transmission and whether the time you have been on treatment is important.

After starting treatment viral load goes down very quickly in blood. Depending on how high your viral load is when you start treatment. This can be as quickly as 4 weeks and usually within 3-4 months. Because it may take slighter longer for viral load to drop in other body compartments, some guidelines refer to an undetectable viral load for six months to ensure the lowest risk of transmission. This is a cautious approach.

Secondly, the risk of oral sex is generally very low, especially when viral load is undetectable, but any risk is related to making sure your partner has good oral hygiene. This means not having oral sex if he has bleeding gums or any open cuts, and not brushing his teeth for the couple of hour before sex, to minimise the risk of tiny cuts to his gums.

When oral sex has been reported as a risk of transmission, this has almost entirely been related to a negative person performing oral sex on an HIV positive man. The risk for a negative man to catch HIV from an HIV-positive women are very low, and if the woman has an undetectable viral load then this risk probably approaches zero. An obvious caution is not to have oral sex during your period when blood is likely to be present.

Dental dams (small squares of thin latex or rubber) can be used if your partner is very worried, or until your viral load has been undetectable for a few months longer, if this is something you want to try. In general, because dental dams or condoms reduce the please and sensitivity of oral sex for both partners for an activity that is already low risk, they are rarely used for oral sex.

Otherwise the risk is likely to be far lower than, for example, regularly using condoms for penetrative sex before you started treatment.

As an indication of the level of risk from public health perspective, is that if a man gives oral sex to an HIV postive woman, this would be too low a risk post exposure prophylaxis (PEP) to be prescribed.

PEP is when a course of HIV drugs are prescribed to reduce the chance of infection after a potential exposure.