[Question #9047] Oral sex safety

36 months ago

Hello Doctors I hope you're well.
I take my sexual health seriously, I am vaccinated against HPV and take Prep. I use condoms for all sexual acts, but take prep as I have had a condom split in the past.

My question is on the safety on fellatio both giving and receiving and its safety. I have seen on these forums that it says oral sex is much safer sex than vaginal/anal penetration. I currently always use condoms for both giving and receiving, but I would like to try it without. Most of my partners are escorts so have multiple partners. I just want to understand the risks a little more before I make a decision.

Also I have read that STI's in seaman don't live outside the body well. Is this the case? would it be safe a few seconds after my partner has cum to lick or taste it?

Thankyou for taking the time to read my question.

H. Hunter Handsfield, MD

36 months ago

Welcome to the forum. Thanks for your confidence in our services, and congratulations for taking sexual safety seriously. (I started to comment on HIV PrEP being unnecessary, but I see a past question in which you had receptive anal sex with a transexual partner. Assuming you continue sex with anatomically male partners, it's great you're taking PrEP.

I'm not entirely clear on whether you plan to receive or give oral sex, or both -- or what proportion of your partners are cis-female or anatomic males. Feel free to clarify this for perhaps more specific advice on risks. For now, I'll just say there has never been a reported case of scientifically documented transmission of HIV by fellatio, i.e. mouth to penis; and only rare cases of transmission to the oral partner. (CDC has published risk estimates of one in 10,000 for the oral partner and 1 in 20,000 for the penile partner in fellatio -- equivalent to giving or receiving oral sex once daily with HIV infected partners for 27 or 54 years before getting HIV might be likely.

There are few data on whether or not STI bacteria and viruses "live outside the body", despite common statements online and elsewhere that they die promptly on exposure to air. Probably they do not instantaneously become non-infectious. But it really doesn't matter. What IS clear is that nobody catches HIV or other STIs by hand-genital contact or by contact with fluids or blood in the environment. So even if there are surviving (infectious) organisms, transmission doesn't occur. Brief oral exposure to semen or pre-ejaculate or vaginal fluids are risk free, or close to it.

In addition to , since you're taking PrEP, your risk of infection from either type of exposure would be a hundred fold lower, i.e. zero for all practical purposes.

I hope these comments are helpful. Let me know if anything isn't clear. As I said above, I'd be happy to discuss further if you'd like to clarify the information about your partners and specific sexual practices.

HHH, MD

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36 months ago

Hi Doctor thankyou for your response.

I am mainly concerned with giving oral sex to anotomic males.

Then also receiving oral sex from anotomic males and cis females.

I know the risk from HIV is extremely low:

My question is about other STIs and what the risks are of contracting those.

It seems from reading this forum the risks from other STIs is also very low, but I would appreciate your expert opinion.

H. Hunter Handsfield, MD

36 months ago

Thanks for the additional information. Assuming some or most of these events may be unprotected, the main risk of importance is gonorrhea, both urethral and pharyngeal (throat). Nongonococcal urethritis can occur from insertive oral sex, probably usually from entirely normal oral bacteria and harmless. Herpes is a possibility, either genital HSV1 or oral HSV2 (although this last is rarely). Oral HPV also is possible. Syphilis is statistically a lot less likely than all these, but still of concern because of how serious it can be. However, the risk of all of these is essentially zero if condoms are used consistently.

You should be tested from time to time for gonorrhea (urine plus throat swab) and have a syphilils blood test, especially if some exposures are condomless. (Chlamydia probably will be included automatically with all gonorrhea tests, as they usually are routinely done at the same time, but with these exposures chlamydia is very unlikely.) HIV is unlikely for the reasons discussed above, but because of its seriousness, testing should be included whenever you have STI testing. How often you should be tested depends on frequency -- anywhere from once every 3-4 months to once a year. In general, I would not recommend testing for HSV unless you develop symptoms that suggest herpes.

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