A CDC report reminds that it can be dangerous -- but the risks are more complicated than we think.
Oral sex with a condom or dental dam: It’s one of those things things
that sexual health educators preach but which people rarely practice. A
reminder of that came earlier this week with the release of a CDC report
noting that “adolescents perceive fewer health-related risks for oral
sex compared with vaginal intercourse” and, as a result, young people
may “be placing themselves at risk of STIs or HIV before they are ever
at risk of pregnancy.”
My immediate reaction to that was: Well, but there
are fewer health-related risks, right? Then I came across this remark in HealthDay from
Christopher Hurt, a professor in the Division of Infectious Diseases at
the University of North Carolina at Chapel Hill: “I would say that the
risk of STD transmission through oral sex is underappreciated and
underestimated. As part of sex education programs, kids need to be made
aware of
that fact that oral sex is not a completely risk-free
activity.” But, I wondered, just how dangerous is it?
It turns out
that putting a solid figure on the danger is difficult. Nikki Mayes of
the CDC’s media office says, “As far as I’m aware, no studies have
quantified the exact risk for all STIs [through oral sex],” and the CDC
doesn’t gather data on STIs contracted through oral sex. It’s difficult
to attribute infections to any single sex act — most people who contract
STIs engage in a variety of potentially risky sexual practices.
But
we can look at what we know about the transmission risks of particular
STIs, starting first with the one that scares people the most: HIV. The
greatest danger when it comes to oral sex is believed to be with
fellatio for the “receptive partner.” (Now here’s a mind fuck: In
clinical lingo, “receptive oral sex” refers to performing oral sex on
someone — or “giving head,” as the kids say — not to “receiving it.” You
can think of it this way: The receptive partner is
receiving the penis or vagina in their mouth.) The website of AVERT,
an international HIV and AIDS charity, explains that transmission can
occur when “sexual fluid (semen or vaginal fluid) or blood (from
menstruation or a wound somewhere in the genital or anal region) [gets]
into a cut, sore, ulcer or area of inflammation somewhere in their mouth
or throat.”
A University of California, San Francisco,
study put the per-contact risk of transmission through “receptive”
fellatio with an HIV positive partner at 0.04 percent. (For perspective,
consider that the same study found a much higher per-contact risk of
0.82 percent for unprotected receptive anal sex.) The researchers
calculated the rate of HIV transmission to be 4 out of 10,000 acts of
fellatio. Without ejaculation in the mouth, though, some experts have
called HIV transmission via performing fellatio “extremely low risk.”
As
for the danger of having someone perform unprotected oral sex on you:
“The only risk in this scenario would be from bleeding wounds or gums in
the HIV positive person’s mouth or on their lips, which may transfer
blood onto the mucous membranes of the other person’s genitals or anus,
or into any cuts or sores they may have,” according to AVERT.
(I hope that all makes sense — my brain still hurts from trying to understand the concept of “receptive oral sex.”)
Now
that we’ve addressed people’s worst fear, let’s turn to the most
realistic worry: herpes. It presents the biggest threat of transmission
through oral sex, and barrier methods don’t always prevent it. Most
risky is the transmission of HSV-1, which typically shows up as sores
around the mouth but which can be transmitted from the mouth to the
genitals. One study
found that women who received oral sex but didn’t have vaginal
intercourse were more than nine times as likely to contract the virus
than sexually inactive women. (That’s compared to women who only had
vaginal intercourse, which were at a lesser risk.) HSV-2 can also be
transmitted from genitals to mouth, although it’s rarer.
The other leading risk through oral sex is gonorrhea, says Hurt. STD clinics have reported that 5 to 10 percent of patients have gonorrhea of the throat. Scarier still: Cases of antibiotic-resistant oral gonorrhea are on the rise (meaning these cases are harder to treat but not incurable).
Chlamydia and syphilis are in the second tier of risk through oral sex. A Chicago study
found that 13.7 percent of syphilis cases were attributed to oral sex.
Generally, though, it’s believed to be uncommon. As for syphilis, that
seemingly antiquated infection, it’s “easily transmitted” during oral
sex — “if a person’s mouth comes into contact with an open sore or a
skin rash caused by the infection,” according to AVERT.
As for
HPV, Hurt says, “We really don’t know what the risk is … but it clearly
can infect in and around the mouth, as well as in the genital tract.” One study
described the risk as “small.” You’ve probably seen the scary headlines
about oral sex causing cancer, but as I reported in the past, oral
cancers linked to HPV are very rare: Approximately five per 100,000
people. (And most oral cancers are tied to HPV 16, and we have a vaccine
for that now).
Further down the list of risk are Hepatitis A, gastrointestinal infections, and parasites, among others — fun times, y’all!
One
takeaway is that — sorry, fellatio fans — blow jobs tends to be riskier
than cunnilingus. “Across all STIs and all sex acts, generally the
receptive partner is the one at greater risk for STI and HIV
acquisition, the idea being that wherever ejaculate winds up, that’s
also where the greatest burden of infectious material will also wind
up,” says Hurt. But that hardly means that cunnilinguists are in the
clear: He also says that the risk of contracting syphilis, herpes or HPV
by performing oral sex on a woman is “arguably just as high” as with
fellatio “since these infections can occur both inside the vagina and on
the skin surface.”
There’s a yawning gap between sexual health experts’ recommendations and people’s actual behaviors: A 2004 survey of U.S. adults found that 82 percent of sexually active participants never used a condom or dental dam during oral sex. A U.K. survey of
16 to 18 year olds found that only 2 percent of those who had
experienced fellatio consistently used condoms. “It’s pretty uncommon
for people to actually use condoms or dental dams when performing oral
sex,” says Hurt. Flavored condoms and dental dams help to encourage the
practice, but “they can only go so far towards making [oral sex] through
latex or polyurethane a pleasurable experience for either partner.”
So,
you see, it’s hard to nail down the exact risk of unprotected oral sex,
but Hurt says, “The most important point is that it’s all relative, and
oral sex isn’t risk-free.”
