Question
Risks from oral sex with undetectable viral load?
6 July 2016. Related: All topics, CD4 and viral load, HIV transmission.
I have HIV and I’m on treatment for almost a year, my blood tests show an undetectable blood viral load.
I’ve met a guy a month ago, and we hit it off straightaway, we started having sex in which I was the passive part, the anal sex was always protected, but oral, in either way, was not, but we never ejaculate in each other’s mouth. And we were involved in very deep kissing, with loads of saliva swap, but I’m still anxious if my partner might have caught the virus from me.
What’s the risk for him?
Answer
Hi – thanks for your question.
Ths short answer is that this risk is zero when viral load is undetectable.
One of the important bits of information that you included, is that you have been on treatment with an undetectable for the last year or so. This may be reducing any risk as much as the different type of sex you have.
HIV is not infectious in saliva, which makes kissing safe, even deep kissing.
By using a condom when you have anal sex, you are cutting out the highest risk factor.
Most cases of HIV transmission from oral sex are probably explained by two factors. The HIV-positive partner having extremely high viral load (often in the millions during the first weeks of infection), or often over 10,000 copies/mL when not on treatment.The second factor is oral hygiene and/or dental problems in the HIV-negative partner.
Otherwise, oral sex is very low risk, if your partners mouth is in good shape, especially as your viral load is so low. It is important that your partner doesn’t have bleeding gums or ulcers, or brushes his teeth just before. It is probably still better not to come in your partners mouth but if you did it is very unlikely to make much difference to the risk of HIV.
A group of Swiss experts recently estimated the risk from one exposure from an HIV-positive man to an HIV-negative woman – for example from a broken condom – to be perhaps 1 in 100,000 – so long as the man had undetectable viral load for the last six months, was taking his HIV meds on time, and had no sexual infections.
I see the most useful interpretation of this, to be to continue to use condoms, but not to worry too much if one breaks occasionally. For oral sex, which is already a much lower risk than not using a condom for anal sex, I think this is getting pretty close to zero.
More recently, other studies, including the PARTNER study, have reported that wehn viral load is undetectable, the risk from sex is likely to be zero. This is for any type of sex, even when condoms are nt used.
If the risk is zero for fucking without a condom, it is definitely zero for oral sex.
Note: This answer was updated in July 2016 from a question first posted in May 2008. The update was to include results from the PARTNER study that report zero HIV transmissions when an HIV positive partner has an undetectable viral load.
Hi Josh,
What your friend is telling you is true. Please see the results of the PARTNER study for more info why:
http://i-base.info/qa-on-the-partner-study/
I met a men one week ago and then we have sex together. I do oral sex and then we have sex, I’m the on the bottom. Two days later he calls me and tell me that he is HIV+ and has been in treatment for almost two years. He said that he uses medicine and he has an undetectable viral load and told me to not be worried about. I was so scared at the time, but he tried to calm me down, and explaiend that someone who has an undetectable viral load will not transmitted the HIV. I do believe it and we continue to have sex but not oral sex, only anal sex for three times in a day.I asked him to not ejaculate inside me. My question is, is there any possibility that I will get HIV? Do I need to go to the doctor? Thank you so much.
Hi Carlos,
Please see quesiton one here:
http://i-base.info/qa/what-are-the-most-asked-questions
So a week ago I gave oral to a man I didn’t know was undetectable at the time. He ejaculated in my mouth and I swallowed it right away. Over the past 3 days I’ve had a fever and a sore throat. This morning I woke up with a blister on my tongue. Should I be scared? I know it’s too early to start assuming I have HIV but I’m still very concerned.
Hi Philippe, thanks for your feedback which is always appreciated. If you could include a link to the typo this would be easier for us to fix.
The Q&A service is run by HIV positive people and we generally individually reply to more than 20+ comments and questions each day on a less than half-time post. It would be nice if we had a proofreader – and if you are volunteering to help this would be appreciated.
It is easy to overestimate the resources that established HIV organisations have, especially if they provide a large number of services. Hopefully the credibility of our answers is based on the accuracy of our references to the latest guidelines and research, and that our replies are translated into easy to understand language.
In an ideal world all text would be perfect, but as a publisher I see proof commonly see proof errors in national newspapers and peer-reviewed scientific journals, both of which have far more extensive budgets than i-Base.
Thanks for this consideration.
It would be nice if someone took the time to proofread your answers before posting them. It would give your response more weight and credibility.
Thanks!
Please read the updae answer to the main question above – the risk is zero.
Hey last 4 weeks I meet a guy who has an undectable viral load for 2 years we open mouth kissed and I guess you can say we used our tougne. In between he gave me oral and I came in his mouth we stopped kissing after I came . After that i started to freak out and he told me that because he is on meds the risk is reduce and what he did was a non risk because I’m the one getting oral . He didn’t have any cuts or sores or anything I didn’t see blood.
Thanks, I know this is a difficult area. Although there is very little solid data, I agree this is probably underestimated and perhaps 5% of sexually transmitted HIV may be through oral sex.
Anything that can inflame or cause tiny abbrasions in your mouth could explain how HIV reached your bloodstream, though I dont know if a gel could have caused this. The infectiousness of your partners (their viral load) could have made oral sex high risk for you, if their viral load was very high and they had recently been infected.
Viral load is likely to be one of the most important factors in transmission.
With response to the question i have recently been diagnosed as positive, i was very sexualy inactive ie no anal sex at all but did have oral sex frequently but with no ejaculationand i do have good dental hygine, though i must point outh that i was using teeth whitening gel which i believe had a factor, i feel that the risk of oral sex is being greatly underestimated