[Question #128] Risks of STIs/ protected vaginal sex vs oral sex

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105 months ago
I abused the board last time by asking too many questions so this time I paid for a little extra I hope to make up for that.

1.  Is it more is it  MORE risky to get any of the STis from protected vaginal sex than from giving or receiving oral sex?  Which ones? How risky is protected vaginal sex?

2,  Is it correct that HPV is rare to get from oral sex (both ways)?

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H. Hunter Handsfield, MD
105 months ago
Welcome back. Directly to your questions:

1. There are no data on the relative risks of these practices, and the answer might be different for different STDs. Condoms aren't perfect, and are inherently more effective against infections transmitted through genital fluids (e.g., gonorrhea, chlamydia, HIV) and somewhat less so for those transmitted skin to skin (syphilis, herpes, HPV). The important things are a) you should always use condoms for vaginal or anal sex with new or potentially unsafe partners; and b) it is optional to use condoms for oral sex, because the overall risk of all STDs is low -- and it's zero (for all practical purposes) for some, including HIV. In any case, it seems pointless to worry about differences in risk when both practices are very low risk, if not quite zero.

2. Yes, it's true:  HPV is rarely transmitted by oral sex, in either direction.  But there are no data on which to base a numerical estimate of risk. I would just say it's low enough so that risk of HPV should never enter into a decision about oral sex nor should be a worrisome consequence of it. I'll also point out that new HPV infections are rare at your age (55); that you have undoubtedly been infected with HPV before now, perhaps several times, and another one won't make any dfference; and that getting a new HPV infection usually has no health consequences anyway.

Best wishes=--  HHH, MD