BODY & MIND
Oral Info: A Gay Men's Primer on Oral Sex and STDs
By Elizabeth Boskey, Ph.D. M.P.H. C.H.E.S.
Most of the safer sex information targeted at gay men these days focuses on just saying no to bareback sex. And with good reason: The majority of new HIV cases among men who have sex with men are transmitted via unprotected anal sex. While the primary message about safer anal sex is pretty clear—don't have unprotected anal sex if you don't want to contract HIV and other STDs—messaging around oral sex has traditionally been murkier. Want to cut through the fog and find out exactly what you can and can't catch from oral sex? Read on.
A lot of people equate unprotected oral sex with "safe" sex, but they're wrong. Although oral sex is certainly far safer than anal sex in regards to transmission of HIV, it is definitely not an infection-free ride. Many sexually transmitted disease pathogens are perfectly happy to jump from the mouth to the genitals and vice versa. While the majority of gay men choose not to use condoms for oral sex, it is nevertheless important to separate fact from fiction to help you make informed decisions.
HIV
Is HIV transmission through oral sex an urban myth propagated by men who don't want to admit they had unprotected anal sex? Maybe, maybe not. Although oral sex is a much lower-risk behavior than anal or vaginal intercourse, some studies have concluded it is possible to transmit HIV through oral sex. It's far from common, and several health departments consider it a low to moderate risk activity, but it is possible. In other words, don't panic, but don't assume you could never get HIV from oral sex.
The risk of HIV transmission via oral sex is increased if the person performing the oral sex has cuts or sores in his mouth, if the person receiving oral sex has other sexually transmitted diseases, or if ejaculation takes place in the mouth. This risk is primarily for the person performing the oral sex—saliva alone is extremely unlikely to transmit HIV, and so, unless the person performing oral sex has lots of blood in his mouth from dental surgery or other trauma, oral sex is a low-risk activity for the receptive partner. While many gay men do not use condoms for oral sex (or dental dams for rimming), it's important to note these are effective ways to even further reduce the low chance of transmitting HIV through oral sex.
Gonorrhea and Chlamydia
Both gonorrhea and chlamydia can be transmitted by oral sex, and, unlike with HIV transmission via oral sex, the risk of these two bacterial diseases really does go both ways. Unfortunately, physicians rarely test for either pharyngeal (from oral sex) or rectal (from anal sex) cases of these two bacterial STDs, so they often go undiagnosed and untreated. If you regularly have unprotected oral or anal sex, you should speak to your doctor about getting additional tests for gonorrhea and chlamydia in your throat and anus, but it is important to know that using a condom should be essentially 100 percent effective at preventing these two diseases.
If you are diagnosed with either gonorrhea or chlamydia, it is very important that you take your medication exactly as prescribed. Drug-resistant gonorrhea is increasingly becoming a problem in gay men, and it is possible that, if the number of resistant strains continues to rise, eventually one may develop that's untreatable. Don't be part of the problem—if you contract one of these diseases, take your pills like the doctor tells you to.
Herpes
Despite the fact that, in general, different variants of the herpes virus are responsible for oral (cold sores) and genital infections, it is possible for the viruses to jump from location to location. HSV-2, the virus most often responsible for genital infections, can spread from the genitals to the mouth during oral sex, and HSV-1, the virus most often responsible for oral infections, can spread in the other direction. In other words, it is possible for the herpes virus to be transmitted during oral sex no matter which partner is infected. Although the use of condoms during oral sex reduces the risk of transmission, the herpes virus spreads skin to skin, so they may not be fully protective. You should also know that the herpes virus can be transmitted even in the absence of an outbreak, and that although treatment with medications such as acyclovir reduces the chance of transmission, it does not prevent it entirely.
Syphilis
Syphilis is on the rise in gay men across the United States. There is a body of research that suggests that that may be, in large part, due to unprotected oral sex, since very few men realize that syphilis can be transmitted in that way. There are areas of the world in which nearly half of the syphilis seen in men who have sex with men can be attributed to oral sex. Although syphilis is only contagious in the primary and secondary stages when symptoms are present, the sores often go unnoticed. You cannot assume that your partner does not have infectious syphilis just because you have not noticed the presence of a sore. Syphilis sores in the mouth may be particularly difficult to detect, and secondary syphilis in that area sometimes presents as something as seemingly innocuous as tonsillitis. If you have unprotected oral sex, getting tested for syphilis should be a regular part of your health checkups.
Hepatitis
Hepatitis A can be passed during oral-anal sex (rimming), and it's possible that Hep B may be transmitted that way as well, although the data is less clear. Similarly, the research is mixed as to whether Hep B and Hep C can be transmitted via oral-genital contact. Some studies have shown transmission for individuals with extremely large numbers of sexual partners, while others have shown no association with oral sex at all. Fortunately there are safe and effective vaccines against both Hep A and Hep B, and they are easily available. Both vaccines are recommended for all men who have sex with men who weren't vaccinated as children.
HPV
HPV is best known as the virus responsible for causing the vast majority of cases of cervical cancer. This fact leads many men—and gay men in particular—to assume that human papillomavirus (HPV) infection is nothing they need to worry about. They're wrong. In addition to causing genital warts, HPV can cause penile and anal cancers as well as oral and throat cancers. HPV can definitely be transmitted from the penis to the oral cavity during oral sex, and it's possible that it could be transmitted the other way as well. Although very little research has been done in that area, at least one study has shown that one of the best predictors of having an oral HPV infection is having a regular partner with an oral HPV infection; the virus is very easy to transmit.
Sources:
A lot of people equate unprotected oral sex with "safe" sex, but they're wrong. Although oral sex is certainly far safer than anal sex in regards to transmission of HIV, it is definitely not an infection-free ride. Many sexually transmitted disease pathogens are perfectly happy to jump from the mouth to the genitals and vice versa. While the majority of gay men choose not to use condoms for oral sex, it is nevertheless important to separate fact from fiction to help you make informed decisions.
HIV
Is HIV transmission through oral sex an urban myth propagated by men who don't want to admit they had unprotected anal sex? Maybe, maybe not. Although oral sex is a much lower-risk behavior than anal or vaginal intercourse, some studies have concluded it is possible to transmit HIV through oral sex. It's far from common, and several health departments consider it a low to moderate risk activity, but it is possible. In other words, don't panic, but don't assume you could never get HIV from oral sex.
The risk of HIV transmission via oral sex is increased if the person performing the oral sex has cuts or sores in his mouth, if the person receiving oral sex has other sexually transmitted diseases, or if ejaculation takes place in the mouth. This risk is primarily for the person performing the oral sex—saliva alone is extremely unlikely to transmit HIV, and so, unless the person performing oral sex has lots of blood in his mouth from dental surgery or other trauma, oral sex is a low-risk activity for the receptive partner. While many gay men do not use condoms for oral sex (or dental dams for rimming), it's important to note these are effective ways to even further reduce the low chance of transmitting HIV through oral sex.
Gonorrhea and Chlamydia
Both gonorrhea and chlamydia can be transmitted by oral sex, and, unlike with HIV transmission via oral sex, the risk of these two bacterial diseases really does go both ways. Unfortunately, physicians rarely test for either pharyngeal (from oral sex) or rectal (from anal sex) cases of these two bacterial STDs, so they often go undiagnosed and untreated. If you regularly have unprotected oral or anal sex, you should speak to your doctor about getting additional tests for gonorrhea and chlamydia in your throat and anus, but it is important to know that using a condom should be essentially 100 percent effective at preventing these two diseases.
If you are diagnosed with either gonorrhea or chlamydia, it is very important that you take your medication exactly as prescribed. Drug-resistant gonorrhea is increasingly becoming a problem in gay men, and it is possible that, if the number of resistant strains continues to rise, eventually one may develop that's untreatable. Don't be part of the problem—if you contract one of these diseases, take your pills like the doctor tells you to.
Herpes
Despite the fact that, in general, different variants of the herpes virus are responsible for oral (cold sores) and genital infections, it is possible for the viruses to jump from location to location. HSV-2, the virus most often responsible for genital infections, can spread from the genitals to the mouth during oral sex, and HSV-1, the virus most often responsible for oral infections, can spread in the other direction. In other words, it is possible for the herpes virus to be transmitted during oral sex no matter which partner is infected. Although the use of condoms during oral sex reduces the risk of transmission, the herpes virus spreads skin to skin, so they may not be fully protective. You should also know that the herpes virus can be transmitted even in the absence of an outbreak, and that although treatment with medications such as acyclovir reduces the chance of transmission, it does not prevent it entirely.
Syphilis
Syphilis is on the rise in gay men across the United States. There is a body of research that suggests that that may be, in large part, due to unprotected oral sex, since very few men realize that syphilis can be transmitted in that way. There are areas of the world in which nearly half of the syphilis seen in men who have sex with men can be attributed to oral sex. Although syphilis is only contagious in the primary and secondary stages when symptoms are present, the sores often go unnoticed. You cannot assume that your partner does not have infectious syphilis just because you have not noticed the presence of a sore. Syphilis sores in the mouth may be particularly difficult to detect, and secondary syphilis in that area sometimes presents as something as seemingly innocuous as tonsillitis. If you have unprotected oral sex, getting tested for syphilis should be a regular part of your health checkups.
Hepatitis
Hepatitis A can be passed during oral-anal sex (rimming), and it's possible that Hep B may be transmitted that way as well, although the data is less clear. Similarly, the research is mixed as to whether Hep B and Hep C can be transmitted via oral-genital contact. Some studies have shown transmission for individuals with extremely large numbers of sexual partners, while others have shown no association with oral sex at all. Fortunately there are safe and effective vaccines against both Hep A and Hep B, and they are easily available. Both vaccines are recommended for all men who have sex with men who weren't vaccinated as children.
HPV
HPV is best known as the virus responsible for causing the vast majority of cases of cervical cancer. This fact leads many men—and gay men in particular—to assume that human papillomavirus (HPV) infection is nothing they need to worry about. They're wrong. In addition to causing genital warts, HPV can cause penile and anal cancers as well as oral and throat cancers. HPV can definitely be transmitted from the penis to the oral cavity during oral sex, and it's possible that it could be transmitted the other way as well. Although very little research has been done in that area, at least one study has shown that one of the best predictors of having an oral HPV infection is having a regular partner with an oral HPV infection; the virus is very easy to transmit.
Sources:
- Papp J.R. et al. "The use and performance of oral–throat rinses to detect pharyngeal Neisseria gonorrhea and Chlamydia trachomatis infections" Diag. Micro. Infect. Dis 2007; 59:259–264
- Kent C.K. et al. "Prevalence of Rectal, Urethral, and Pharyngeal Chlamydia and Gonorrhea Detected in 2 Clinical Settings among Men Who Have Sex with Men: San Francisco, California, 2003" Clin. Infect. Dis. 2005; 41:67–74
- "Can I get HIV from oral sex?" from the CDC. Accessed 2/15/08.
- "Transmission of Primary and Secondary Syphilis by Oral Sex --- Chicago, Illinois, 1998-2002" MMWR 53(41):966-968 Accessed 2/17/08.
- Petermana T.A. and Furnessa, B.W. "The resurgence of syphilis among men who have sex with men" Curr Opin Infect Dis 20:54–59.
- Edwards S. and Carne C."Oral sex and the transmission of viral STIs" Sex. Transm. Inf. 1998;74;6-10
- Edwards S. and Carne C."Oral sex and the transmission of non - viral STIs" Sex. Transm. Inf. 1998;74;95-100
- Kreimer A.R. et al. "Oral Human Papillomavirus Infection in Adults Is Associated with Sexual Behavior and HIV Serostatus" J. Infect. Dis. 2004;189:686–98
- Lafferty, W.E. et al. "Herpes Simplex Virus Type 1 as a Cause of Genital Herpes: Impact on Surveillance and Prevention" J. Infect. Dis. 2000; 181:1454–7
SCIO wrote:
I am a SCIO practitioner and have had great results helping people fight STDs. The best way still to fight it, is be safe and avoid risky practices.
Apr 26 12:51 PM
Boy0826 wrote:
Thanks I real appreciate the information.
Mar 06 1:43 PM
flako07 wrote:
I hate STD's, I'm quite young and also really afraid about that... we have to be responsable about that! PLAY SAFE!
Mar 06 5:30 AM
eb925guy wrote:
I'm with dern foley, scared sexless! Seriously, thanks for providing the info, I think it's something that we can never hear enough to ensure we're educated on some very important issues. Thank you!
Mar 03 1:59 AM
highlander1161 wrote:
Quite the informative article. Stuff my doctor recently told me after a major scare in January. Blood work testing for everything was done - came back with flying colors. But...do we become celibate, walk around in a full body rubber suit or keep intelligently informed, live life the best we can & know that everything we do comes with a risk.
Mar 02 6:47 PM
kew1 wrote:
epstein barr & mononucleosis.1st is the virus,2nd the illness.
Mar 02 8:25 AM
bigguysf wrote:
Thanks for a great article. There are many who will still call it "nonsense", but I'm glad it's being brought to life in this high profile way. I don't think we need to over-react and panic in any way, but we should always recognize the risks. Because of past experiences I'm personally more concerned with contracting a non-HIV std from casual oral sex, so I have pretty good boundaries around that. But in fact I do personally know someone who seroconverted from oral sex activities (bottom) only. So these aren't just hypotheticals... they are very real.
Mar 02 3:30 AM
gasman wrote:
from my remote medicalschool days epstein barr is related to or silimar to mononucleosis. ie kssing disease. therecan be mild or severe. but not usually fatal
Mar 02 12:14 AM
WhatIsUp wrote:
hehe, well said dern_foley... give it ayear or two and we will be advised to use rubber gloves. don't we just love this generous world? ;-)
Mar 02 12:03 AM
Fitnessguru wrote:
Thanks for your words. As an educator of HIV/AIDS prevention you hit a lot of points that are brought up to me during my seminars. I always just tell my audience to know your partners before engaging in sex. That is why advocating "dating" is key in our commmunity. I am Personal Trainer and Fitness Writer who have contributed to this site and it is so refreshing to read an article that is part of fitness. While many readers will not make that equation health is health and knowing how not to put yourself at risk for STD's make the individuals fitness goals that much easier. I really appreciated your article as I have published many such articles here in New York with different health magazines and sites. It is also great to see that Jeff has had someone like you on staff to bring this awareness on board. Have a great day Giovanni
Mar 01 10:10 PM
jonpal wrote:
I have Epstein Barr Disease - not sure how I got it - do not do anal = bb - so would it be kissing - or oral sex = mouth/not rimming ? Not even sure of the effects? Heard CHER was so sick from it that she almost died. This has really freighten me! Originally was told it was the "adult" kissing disease, like Teen Momo, so I wasn't too concerned = is it contagious ? Thanks if anyone can offer me help - info - or sources that I can read. Thanks all !
Mar 01 6:58 PM
TheFreeman wrote:
I'm pretty sure I've just been scared sexless.
Mar 01 5:57 PM
Caslon6000 wrote:
Thanks RJ for this article to cover the oral sex topic!
Mar 01 5:04 PM