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A systematic review included two studies which included cunnilingus in assessments of the risk per oral sex act. The very few case reports of HIV transmission are limited to people performing cunnilingus (rather than receiving it). CunnilingusĬunnilingus is considered very low risk. It is logical that if HIV cannot be transmitted through anal or vaginal intercourse when viral load is fully suppressed, the same will apply to oral sex. The risk of HIV transmission through vaginal or anal intercourse is effectively zero if a person with HIV is on treatment and has a fully suppressed viral load. Safer sex guidelines have sometimes suggested that recent brushing can increase the risk of infection through oral sex. These conditions could make the tissues more susceptible to infection and/or allow the virus easier access to the bloodstream and immune tissues – similar to the way in which STIs (especially ulcerative STIs) are known to increase the risk of vaginal and anal intercourse.īrushing the teeth and gums often causes mild abrasions and stimulates bleeding. The presence of genital piercings or lesions.Taking semen into the mouth – all but one of the credible reports of oral transmission note that ejaculation did occur into the mouth of the individual reported to have been infected.Inflammation caused by common throat infections, allergies or sexually transmitted infections (STIs) such as gonorrhoea.Bleeding gums, cuts or sores in the mouth.Factors influencing riskĬase reports of infections through oral sex suggest that factors which may increase the chance of HIV infection through oral sex include:
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Saliva contains numerous factors that have been found to inhibit HIV and stomach acid is likely to inactivate HIV in the same way as other viruses (Malmud). The mouth is therefore generally regarded as an unlikely route of HIV transmission. The tissue of the mouth and oesophagus is also very thick compared with genital tissues, and fluids stay in contact with it for a very short time because swallowing clears the mouth regularly. Only one cell type found in the mouth is vulnerable to HIV infection (Campo). HIV is not able to infect most cells in the mouth. How could HIV infect the mouth and throat? There are no reported cases of HIV transmission through kissing. There are no reliable reports of HIV being transmitted from the mouth to the genitals.Ĭases of transmission via cunnilingus are extremely rare, and the reliability of these reports is questionable.
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However, infection via insertive fellatio (‘having it done to you’) is probably exceedingly low risk.
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Infection via receptive fellatio (‘doing it’) is biologically plausible and may happen occasionally. Very few cases of transmission through oral sex have been reported amongst gay men despite the continued practice of oral sex (often with ejaculation into the mouth) by large numbers of men over many years. The latest news and research on sexual transmission If undamaged, the tissues of the mouth and throat are thought to be less susceptible to infection than genital or anal tissues, and an enzyme in saliva also acts to inhibit HIV. When HIV is not fully supressed, the risk of HIV transmission through the mouth is certainly smaller than through vaginal or anal intercourse. The PARTNER 1 and PARTNER 2 studies showed that HIV is not transmitted through condomless vaginal or anal intercourse when a person with HIV is taking antiretroviral treatment and has a fully suppressed viral load (Rodger).Īs the risk of transmission through oral sex is estimated to be much lower than for vaginal and anal intercourse in the absence of antiretroviral therapy, it is implausible that the risk of transmission through oral sex is not affected in the same way as other sexual transmission risks when effective treatment suppresses viral load.