HIV transmission from cunnilingus or from receiving oral sex?

Originally Published: December 1, 1994 - Last Updated / Reviewed On: March 27, 2013
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(1)

Dear All knowing Alice,

Both you & the Columbia AIDS manual note that the risk of AIDS transmission by unprotected cunnilingus is less (at least when the woman's not having her period) than via unprotected anal/vaginal intercourse. What I'd like to know is, how much less? Are there any statistics? Are there any documented cases of AIDS being spread this way? If so, how often does it seem to occur? It's difficult to know whether it makes sense to take my chances unless I know what the chances are.

Also, both you & the manual say transmission can't occur without contact with a mucous membrane. I have another AIDS brochure that says there's at least a small chance the virus could pass through tears around the cuticles of the hand. Is this the case, and if so, how great a risk is there in putting your fingers in somebody's vagina or anus for extended periods?

Thanks, — Needs the details

(2)

Dear Alice,

What are the risks of HIV infection for the passive partner of oral sex?

Signed, Happy but Worried

Dear Needs the details and Happy but Worried,

First, let’s clear up the cuticle confusion. Yes, transmission of HIV could occur via contact with a mucous membrane and it also can happen via contact with the blood stream. If someone is HIV positive, HIV would be present in both their vaginal fluids and bloodstream, which means it could be transmitted from vaginal fluids into a small cut or tear on one’s hand or cuticles, or from blood into the cut (if there is any blood in the vagina or anus of the recipient). Blood could be present from menstruation or just from the friction of the sex. More lube equals smaller chance of the latter.

Hopefully it will make you happier to know the risks of contracting HIV from oral sex are considerably lower than from vaginal or anal intercourse. Risks do still exist for both partners, however, particularly when it comes to transmission of other sexually transmitted infections (STIs). With reference to HIV specifically, the passive or receiving partner has little chance of contracting HIV because when you receive oral sex you are mainly exposing yourself to saliva, which has negligible concentrations of HIV. Keep in mind though that researchers have found it difficult to pinpoint the exact act during which HIV is transmitted because people rarely engage in only one type of sexual act. During fellatio (oral sex on a man), HIV could theoretically enter the recipient's body through the opening on the tip of the penis or through an open cut or lesion on the penis. Other STIs, like herpes or gonorrhea, can still be transmitted to the person receiving oral sex.

For a cunnilingus (oral sex on a woman) recipient, the chance of HIV transmission is also low, although the entire vagina is a mucous membrane through which, theoretically, the virus could be transmitted. A woman receiving cunnilingus is more at risk of getting herpes or gonorrhea from her partner than of contracting HIV. Also, a person giving oral sex to a woman may want to avoid doing so during her period, as menstrual blood can carry enough HIV to spread an infection.

The risk of contracting HIV infection is greater for the partner giving oral sex. Research presented at the 7th Conference on Retroviruses and Opportunistic Infections concluded that 8 of 122 cases in an HIV-transmission study were possibly attributable to oral sex, which implies that although going down on a man is less risky than other sexual behaviors, there's still a possibility for transmission. Of the eight infected people, some reported having had recent dental work or having cuts in their mouths, indicating that HIV transmission by oral sex may be associated with cuts, lesions, or irritation in the mouth.

For protection against HIV and other STIs during oral sex you can use condoms during fellatio; try out non-lubricated or flavored latex condoms for a safer and tastier experience. Dental dams, latex sheets, or even non-microwavable plastic food wrap can be used for protection during cunnilingus or rimming. With any type of sex, you and your partner can discuss what risks you are and are not willing to take and then come up with a safer sex strategy that works best for both of you. Using protection consistently and correctly for both oral sex and intercourse will help keep your sex life healthy and worry-free.

If you are a Columbia student on the Morningside campus, you can get tested for free. Just check-out the HIV drop-in testing hours at GHAP. If you are on the Medical Center campus, contact Medical Services to find out about HIV and other STI testing. For more information about HIV/AIDS or other STIs, visit:

Have fun while you're staying safe!

Alice