[Question #2778] Oral sex and STIs

42 months ago
Hello,  from time to time over the last several years I have checked in with you about oral sex and STIs.  Your constant answe has been that there really was not much risk of getting an sti from oral sex.  Not zero risk, but little risk even though virtually every sit out there ( including this one in the introductory information) says there is (our discussion was that sites say that out of an abundance of caution).  I KNOW you ar the experts and I trust your judgement...so thank you in advance.

There has been a lot of press lately about the increase of STIs. 

I am having sex with women 20 to 30 and occasionally with an escort.

Thank you.
42 months ago
My question is has your opinion changed in any way about the risks of getting an STI from oral sex...I am a man...both ways.
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Welcome to the Forum and thanks for your question.  As this epidemic progresses, we continue to learn about how HIV is transmitted and are better able to comment on the risk of various sorts of sexual exposures.  Knowledge about oral sex, as for other routes of exposure, has continued to evolve.   Oral sex, in its various permutations, remains the lowest risk sort of penetrative sexual activity when compared to genital or rectal exposures.  Here is the current status:

1. There are no cases of HIV which have been proven to be acquired from receipt of oral sex (fellatio)
2.  There are no cases of HIV proven to have been acquired by cunnilingus.
3.  There are a small number of cases of HIV which have been acquired through performance of fellatio on an infected male.

As you point out, most governmental websites tend to have to provide generalized information and are in the position of feeling that they must never be wrong.  As a result, their statements tend to be conservative, "no risk" statements.  The U.S. CDC estimates the risk for giving and receiving oral sex as being about 1 infection per 10,000 exposures to an HIV infected partner who is not on treatment - i.e. like performing oral sex on an HIV infected, untreated partner daily for over 27 years.  Personally, I suspect that this figure might be in the right ballpark in terms of performing fellatio on an infected partner but think it is too high with respect to receipt of oral sex.

Finally, I should point out however that there are other STIs which can be transmitted in the context of oral sex.  Ongoing and evolving research suggest that gonorrhea and chlamydia can both be acquired through oral sex although these infections are both far less common than for genital contact.  Similarly, if a partner has syphilis or herpes, the infection is potentially transmissible through DIRECT oral contact . 

I hope this information is helpful.  Take care.  EWH
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42 months ago
So it seems that the evolution of knowledge indicates a higher risk of the more common STIs than  previously thought.  Isn't syphalis pretty uncommon making that risk pretty low!  And when you say DIRECT contact do you mean when there is a visible outbreak.  Also, although I am older I have had the hpv injection. 

But in general is the risk a little bit lower with oral sex than vafinal, modratly lower or a lot lower.  I know it is hard to quantify but your best guess would be appreciated.

It seems there is more risk with younger women.  

From all I have read I am not too worried about HIV..

THANKS AGAIN.
42 months ago
Also, Ms. Warren has said that HPV 2 "does not like the mouth". Is that opinion still  believed?  I have had HPV 1 since I was a child..
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Yes, syphilis remains rather uncommon, particularly among heterosexual men and women. 

I agree that your isk is relatively low.

Direct contact means touching and infectious site.

I think you mean HSV (herpes simplex virus, the virus that casues cold sores and genital herpes), not HPV.  If you mean HSV, then yes, HSV-2 rarely causes oral infections.  EWH


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42 months ago
Thank you...I always have resp c the d your candor and honesty.  I did mean HSV.