Oral sex includes contact between the mouth and a penis, vagina, or anus. Although oral sex cannot lead to pregnancy, oral sex can and does lead to the spread of sexually transmitted infections (STIs). Oral barriers, including condoms and dental dams, prevent direct contact between the partners’ skin and any bodily fluids, significantly reducing the risk of STI transmission.¹ Using different varieties and flavors of oral barriers can make protection a fun and sexy part of your sexual routine.

Common Infections Spread Through Oral Sex

Many STIs, including gonorrhea, chlamydia, herpes, human papillomavirus (HPV), and human immunodeficiency virus (HIV), can be transmitted through mouth-to-genital contact.² Although most bacterial pathogens (like gonorrhea and chlamydia) can be treated successfully with antibiotics, viral infections are generally more difficult to cure and often lead to serious health problems. The likelihood of contracting an STI through oral sex is correlated with the number of sexual partners a person has had. That is, the more sexual partners a person has had, whether they engaged in penile-vaginal sex or oral sex, the more likely they are to have contracted an STI.³

Human Immunodeficiency Virus (HIV)

Although the risk of contracting human immondeficiency virus (HIV) is higher when engaging in vaginal or anal sex, there is still a chance of contracting HIV when participating in oral sex.² Do not engage in oral sex if you or your partner has oral or genital sores or bleeding gums, as this increases the risk of HIV contraction. To reduce risk further, wait at least 45 minutes after brushing your teeth to perform oral sex so that the mucous membranes in your mouth can recover. Stomach acid and enzymes in the esophagus help kill the virus, so swallow or spit out semen rather than letting it sit in your mouth.⁴

Human Papillomavirus (HPV)

Thankfully, a vaccine exists to effectively prevent the spread of HPV. For unvaccinated individuals, however, the risk remains. People who are not vaccinated against HPV that engage in oral sex without a barrier method have higher rates of HPV than unvaccinated people who do use a barrier method.⁵ As oral sex has grown more popular among young people, adolescents who are too young for the HPV vaccine and/or are uninformed of the risks of oral sex are especially susceptible to contracting HPV and other STIs. This information highlights the importance of educating patients on the risks of oral sex, which health care professionals’ current models may not adequately emphasize.⁶

Gonorrhea

Oral sex is also a common mode of transmission for gonorrhea, an STI that often does not have visible symptoms and can lead to significant health complications. Esophageal cancer (cancer in the throat) is often a result of gonorrhea that went untreated. Gonorrhea can be spread through oral sex in a variety of ways. A person who performs oral sex on an infected penis is often at highest risk for contracting gonorrhea in the throat. Performing oral sex on an infected vagina or an infected anus, or receiving oral sex of any kind from a person who has gonorrhea in the throat are also ways in which gonorrhea can be passed during oral sex.³ Thankfully, using a barrier method during oral sex reduces incidence of gonorrhea significantly.⁷

Chlamydia

Similarly to gonorrhea, chlamydia often does not display symptoms initially but can cause greater health complications later on. In women, chlamydia can lead to Pelvic Inflammatory Disease (PID) if left untreated. It can also cause epididymitis in men. Chlamydia is transmitted via oral sex in the same ways that gonorrhea is – that is, from oral-genital contact in which either the person performing oral sex has the infection in their throat or the person receiving oral sex has the infection in their genitalia.³

Herpes

Herpes on the genitalia or mouth is one of the most common infections transmitted through unprotected oral sex. Though the strain of herpes known as HSV-1 is typically found around the mouth while the HSV-2 strain is typically found around the genitalia, people with herpes who engage in oral sex without a barrier often spread the viruses to the opposite area from which they originated. For example, a person who has HSV-1 around the mouth and performs oral sex on their partner’s genitalia is likely to spread HSV-1 to their partner’s genitalia even though HSV-2 is the strain more commonly found around the genitalia.⁸

A Link between Human Papillomavirus (HPV) and Oral Cancer

Though rates of most head and neck cancers have been declining since the 1970s due to decreased smoking rates, a particular type of oral cancer linked to the human papillomavirus (HPV) is on the rise due to the growing popularity of oral sex. HPV is one of the most common STIs in the United States. While most HPV infections are asymptomatic and clear up on their own within two years, some infections can cause long-term problems. These problems include the development of genital warts along the lining of the vagina, cervix, anus, mouth, tongue and throat. Cervical, penile, anal and oral cancers can also result from HPV infections. Oral cancers caused by HPV are more curable than other types of oral cancers, however they can still result in long-term side effects and serious health complications.⁹

Young adults (ages 11 through 26) of both sexes can receive vaccinations against HPV to help prevent the spread of the virus. HPV most often has no symptoms, but in some cases, HPV can cause genital warts. Any concerns about HPV and other STIs should be communicated to a doctor promptly.

Common Barrier Methods

A variety of barrier methods exist to ensure the safety and peace of mind of all parties engaging in sexual activity. Aside from abstinence, a barrier method such as a or dental dam is the most effective way to prevent the spread of STIs during sexual activity.

Male Condoms

When used properly, male condoms are very effective against STI transmission. Male condoms are generally made of latex and should be used when oral sex is being performed on a male.² There is a variety of condom flavors for individuals who dislike the taste of latex. To incorporate the use of oral barriers into an oral sex routine, the male can ask his partner to roll the condom on for him rather than doing it by himself. By practicing this activity together, the couple will learn not to view condoms as an awkward interruption. A couple can also incorporate fun methods of condom application; for example, a male can guide his partner’s hand or mouth in putting on the condom. “It can be made part of the erotic experience. You don’t just hand a condom to a guy and say, ‘Here, put this on. I don’t want a disease.’ You’ve gotta not make it clinical, you’ve gotta make it sexy and fun,” says Norma Jean Almodovar, sex worker rights activist.

Dental Dams

Dental dams are another method available for protection against STIs. Dental dams are essentially small rectangular pieces of latex or silicone that are applied over the female genitalia and the female or male anus prior to oral sex. To properly put on dental dams, individuals must place them on the outside of the vulva or anus. Once individuals correctly fit the dental dam over the region, they can add a lubricant to increase the region’s sensitivity. Like male condoms, dental dams also come in a variety of different flavors; flavored gels can also be used. Although dental dams are an important barrier against STIs during oral sex, these devices can be difficult to find in drugstores and convenience stores. Safer sex shops, Planned Parenthood centers, and online markets are the most typical dental dam providers. Fortunately, dental dams can also be easily produced by altering a male condom or by using plastic saran wrap from your kitchen.¹⁰

Concluding Remarks

Despite the common misconception that oral sex is “safer” than penile-vaginal sex, engaging in oral sex still presents risks for various infections. Therefore, using some form of barrier method during oral sex allows everyone involved to both enjoy themselves and have peace of mind.

References

1. Fridlund, V., Stenqvist, K., & Nordvik, M. K. “Condom use: The discrepancy between practice and behavioral expectations.” Scandinavian Journal of Public Health, 2014. 42(8), 759–765.
2. Edwards, S., & Carne, C. “Oral sex and the transmission of non-viral STIs. Sexually Transmitted Infections.” 1998. 74(2), 95-100.
3. Centers for Disease Control and Prevention. “STD Risk and Oral Sex – CDC Fact Sheet.” Last Updated 1 December 2016.
4. “Can I get HIV from oral?” San Francisco AIDS Foundation. San Francisco.
5. Gupta A, Perkins RB, Ortega G, Feldman S, Villa A. “Barrier use during oro‐genital sex and oral Human Papillomavirus prevalence: Analysis of NHANES 2009–2014.” Oral Dis. 2018;00:000–000.
6. Gerbert, Herzig, Volberding, & Stansell. “Perceptions of health care professionals and patients about the risk of HIV transmission through oral sex: A qualitative study.” Patient Education and Counseling. 1999. 38(1), 49-60.
7. Chan, R., & Koh, D. “Promoting condoms for oral sex: Impact on pharyngeal gonorrhea among female brothel-based sex workers.” Sexually Transmitted Diseases. 2002. 29(6), 311-318.
8. Auslander BA, Biro FM, Rosenthal SL. “Genital herpes in adolescents.” Semin Pediatr Infect Dis. 2005;16:24–30.
9. LeWine, Howard. M.D. “HPV transmission during oral sex a growing cause of mouth and throat cancer.” Harvard Health Publications. Updated 29 November 2016.
10. Brown, Nancy. PhD. “Dental Dams.” Sutter Health Palo Alto Medical Foundation. Last Updated: October 2013.

Last Updated: 07 February 2019.