We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful sexual health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. No gender, sexual orientation, or question is off limits, and all questions remain anonymous. This week’s topic: the STDs you can get from giving or receiving oral sex.
Q: I have a question about safety and oral sex. I love giving going down on both men and women (I’m bi) but I don’t know how safe oral sex is STD-wise. I’ve heard all this different information — some people say you can’t get anything really from oral sex, while other people are telling me I should be using condoms or dental dams every time. That sounds like a lot of work, so which is it — and how big is the STD risk if I have unprotected oral sex?
A: That’s a very good question, and one we should discuss way more than most of us do. Lots of people think there’s no risk of getting a sexually transmitted disease (STD) from oral sex, but in fact, that is not the case. Oral sex is most accurately described as a low-risk way of getting most STDs, and low-risk is not the same as no-risk.
How Big Of A Risk Is Oral Sex In The First Place?
So, why is oral sex lower-risk than other types of sex? One answer is that your mouth is pretty expert at keeping itself clean. Your saliva breaks down a lot of potentially dangerous things before they can get into your system. Another answer is that many STDs prefer the climate of your genitals to that of your mouth and throat. Overall, it's proven extremely difficult to quantify exactly how risky oral sex is for specific STDs, because most people who engage in oral sex are also having fun in other ways that are riskier — like vaginal or anal sex. So the thing to keep in mind is that oral sex is a "low, not no" risk of STD transmission.
Let’s look into the STDs you can potentially get from giving or getting oral sex.
1. Human Papillomavirus
Human papillomavirus, or HPV for short, is a virus that is transmitted through skin-to-skin contact with someone who has been infected. There are around 40 strains of HPV that like to live in the genital region. Some of these cause genital warts, and others can cause your cervical cells to develop into cancer. Unfortunately there’s no medical cure for HPV, but fortunately if you get it, there’s a huge chance your body will get rid of it for you within two years (before it gets anywhere close to the cancer stage).
Giving: You can get HPV by giving oral sex to someone who has genital HPV. This results in oral HPV — HPV warts in your mouth area. Also, if you get a cancerous strain in your mouth and your body doesn't clear it, it can develop into head or neck cancer. This is very rare.
Receiving: If you’re getting head from someone who has HPV warts or a cancerous strain of HPV in their mouth or throat, it can be transferred to your genitals.
Risk: Researchers don't agree on how likely HPV transmission is through giving or getting oral sex. However, studies have found that seven percent of Americans have oral HPV, with only one percent having the type that results in head or mouth cancer. Men are about three times more likely to have this oral STD than women.
2. Herpes Simplex
Herpes simplex (which we usually just call herpes) is a virus that affects your nerves. It’s incurable, although you can manage it with medication. There are two strains of this virus — HSV-1 and HSV-2. Both of these can live either in your genital region or on your mouth, which (you should be thinking) are the two places involved in oral sex. In either place, this virus periodically flairs and causes painful blisters that last for a couple weeks and then go away. It is transmitted by skin-to-skin contact with someone who has it.
Giving: The herpes virus can hop from one place you have it (aka your genitals) to the other place it likes to live (aka your mouth). You can actually infect yourself by, for instance, licking your hand and then touching yourself, but you can also end up with herpes on your mouth (which we most often call cold sores) if you go down on someone who has genital herpes.
Receiving: If you are receiving the delightful thing that is oral sex from a mouth that is infected with this virus, you can end up with a genital outbreak.
Risk: While HSV-1 prefers the mouth area and HSV-2 the genitals, each are perfectly happy to move into their less preferred region. This means that if you are having oral sex with a partner who has one of these viruses, there's a good chance you can get it too. And while herpes is definitely transmissible when your partner is having an outbreak (in which you'll be able to see the herpes sores on their mouth or genitals), you can also get it between outbreaks. This is actually how most people transmit HSV-1 and HSV-2 — many people have it and never have symptoms, but still spread it to others. This explains its high prevalence: in the United States, about 1 in 4 women have HSV-2 compared to almost 1 in 8 men.
Gonorrhea is a bacterial infection that usually shows up in semen or vaginal fluid, which is why we call it an STD. However, it can also live in your throat. Gonorrhea is not a fun one to have, because it can feel not-great and also because it can cause pelvic inflammatory disease, which can result in pain during sex as well as fertility challenges. Most people, though, won’t have symptoms from this STD, so you have to get tested to be sure. Luckily, this bacteria can be pretty easily cleared up with antibiotics (mostly — some strains are becoming resistant to existing treatments, yikes!).
Giving: If you give oral sex to someone who has a gonorrhea infection, you can end up with the oral version of gonorrhea. You're more likely to get this STD if you're licking a penis as opposed to a vagina, but it can happen with both.
Receiving: If your partner has gonorrhea in their throat, they can transfer it to your genitals and then you’ll have genital gonorrhea.
Risk: Researchers don't know the precise level of risk of oral transmission of gonorrhea, but they know it does exist. Luckily, this bacteria doesn't love living in throats and in most cases it goes away on its own within three months, with many getting cleared in just a week.
Chlamydia is another bacterial infection, and it can also result in pelvic inflammatory disease and fertility problems if left untreated. Like gonorrhea, you can be asymptomatic for it. Also like gonorrhea, it can be cured with antibiotics — and as of right now, there are no superstrong strains of chlamydia that are resistant to these medications.
Giving: It is possible to get chlamydia from giving oral sex, which would mean you would end up with chlamydia in your throat. However, it’s not all that common because chlamydia very much prefers your genitals to your mouth. Giving a blow job has a higher risk than going down on a vagina.
Receiving: Good news (finally)! You can’t get chlamydia from receiving oral sex.
Risk: Giving oral sex is a low-risk activity for getting chlamydia. One study found that four percent of sex workers who gave blow jobs were positive for oral chlamydia — which isn't much, but it's not nothing, either.
Human immunodeficiency virus (HIV) is a virus that is currently incurable, although there is treatment for it. If left untreated, it takes down your immune system, leaving you vulnerable to all manner of diseases. Luckily, there are now great medications you can take if you have HIV that keep you healthy for years and years!
Giving: It’s not common, but there have been cases of people getting HIV by giving oral sex. This super low-risk activity gets a bit higher risk if you have cuts or sores (like herpes sores) in your mouth. Also, if you happen to be licking someone on their period who has HIV, then you’re at higher risk — because menstrual fluid has blood in it, and HIV lives in blood.
Risk: Oral sex is an extremely low-risk activity for getting HIV. However, if you have sores in your mouth or they have any on their genitals, you have bleeding lips or gums, or either of you has another STD that causes sores or blisters, that increases the risk.
Syphilis is a bacterial infection that can result in sores, which can show up either on your mouth or genitals. These sores are filled with pus, which can transmit the infection to either a mouth or vagina that comes into contact with them. If you catch syphilis early, it’s easily treatable with penicillin. However, if left untreated, it can result in heart or brain damage and ultimately kill you. So it’s definitely a good idea to know your syphilis status so you can get treatment and stay healthy!
Giving: If the genitals you have in your mouth have syphilis sores on them, you can get a syphilis infection in your mouth.
Receiving: If your partner has syphilis sores on or in their mouth and they go down on you, there’s a chance you could end up with a genital syphilis infection of your very own.
Risk: While the exact rate is unknown, the CDC has found that a substantial proportion of people with syphilis got it through oral sex.
While we don’t usually think of a yeast infection as an STD, you can actually transmit this infection sexually. A yeast infection is an overgrowth of the fungus candida, which is present in bodies of all genders although we hear of it most often in terms of vaginas, because yeast infections plague this anatomy more than any other. However, you can also get a yeast infection in your mouth, we call this thrush. Yeast infection is pretty easy to cure with over the counter medications, home remedies, or (if you have a really hard-to-kick case) antifungals that your doctor can prescribe you.
Giving: If you go down on someone who has a yeast infection, there’s a chance you could end up with thrush.
Receiving: If your sexual partner has thrush and goes down on you, they can give you a genital yeast infection.
Risk: Researchers haven't been able to quantify the precise risk of oral sex on getting thrush, but they know it contributes to more thrush cases.
The Bottom Line
No sex is 100 percent risk free, and that includes oral sex. However, oral sex is a far less risky way to get most of these STDs than penis-in-vagina sex, penis-in-anus sex, or sharing toys. At the end of the day, it’s up to you to decide what to do with this information. You could curl up into a ball on your floor and decide never to look at another human’s genitals ever again. You could decide that you don’t care and not do anything to protect yourself or your partners while you’re having oral sex. Or, you could end up somewhere in the middle — doing the best you can to be safe while still having the time of your life. It’s up to you!
It’s a good idea to consider what those of us in the health world call a harm reduction approach. Taking a harm reduction approach means minimizing your risk for things you don’t want (in this case, an STD), while still doing the thing that you like doing (in this case, oral sex). Some ways to practice oral sex safely are to use condoms or dental dams. Some people don’t like the taste of latex and aren’t going to do this, so another way to be safer while you’re having oral sex is to know your STD status and share that with your partner(s).
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