HIVTransmission
Taking PrEP can help prevent HIV transmission if you're at high risk of contracting it.
nito100/ Getty Images
  • HIV transmission through oral sex is rare, though not impossible.
  • Having another STI, open sores in the mouth, or extenuating circumstances can increase the risk of contracting or spreading HIV through oral sex.
  • Using condoms, getting tested regularly, and taking PrEP (if you’re at high risk for contracting HIV) can help prevent its transmission via oral sex. 
  • Visit Insider’s Health Reference library for more advice.

Though 38 million people are living with human immunodeficiency virus (HIV), there’s still stigma and a lot of misinformation about how it’s spread. HIV is transmitted by coming in contact with the body fluids of an HIV-positive person. These include blood, vaginal fluids, semen and pre-seminal fluid, rectal fluids, and breast milk.

The transmission occurs when the HIV from the fluids gets into the bloodstream through open cuts or wounds, direct injection, or by coming in contact with a mucous membrane in the mouth, vagina, tip of the penis, or rectum. Mother-to-child transmission also occurs.

HIV does not reproduce outside a human host and cannot be transmitted through saliva, tears, or sweat. It is a common misconception that sharing dishes, shaking hands, or hugging can transmit HIV, says Anne M. Neilan, MD, MPH, Infectious Disease Physician at Massachusetts General Hospital.

Generally, it’s unlikely that you will contract HIV from oral sex. However, there are some circumstances in which this could happen, though uncommon. This article will discuss the likelihood of getting HIV through oral sex and how to avoid contracting or transmitting it.

What is the likelihood of contracting HIV from oral sex?

Oral sex is the stimulation of a partner’s penis (fellatio), vagina (cunnilingus), or anus (anilingus) using the mouth, lips, or tongue. “The likelihood of acquiring HIV from oral sex is far lower than vaginal or anal sex,” says Neilan. The risk is so low that scientists have not established a conclusive statistic, but a 1999 study estimates a 0.04% risk among male sexual partners. 

Saliva contains secretory leukocyte protease inhibitors that inactivate the virus. Because of this HIV inhibitor, the virus reproduces less than it would in the blood cells. 

Although the risk is low, unprotected oral sex still carries the risk of transmitting HIV, as well as sexually transmitted infections (STI). "Protection against HIV does not mean protection against all sexually transmitted infections," says Neilan.

A person without HIV may contract the virus by giving or receiving any type of oral sex to or from a partner with HIV. Some risk factors increase the likelihood of contracting HIV through oral sex, which include:

The risk of HIV from oral sex may be minimal, but it's still important to know how to avoid contracting and transmitting the virus.

How can you prevent contracting HIV during oral sex?

Using dental dams, male and female condoms during oral sex reduces the likelihood of contracting HIV, but you must use them correctly, says Neilan. Refraining from oral sex when risk factors are present, and avoiding seminal or vaginal fluids in the mouth also lessen the risk, but does not completely eliminate it.

STIs like gonorrhea or syphilis can cause sores on the mucous membrane, increasing the chances of getting or transmitting HIV, so get tested regularly and seek treatment if needed. 

"Having you and your partner tested for HIV and other sexually transmitted infections also reduces risk. Many people with sexually transmitted infections don't know that they have them because they often have no symptoms," says Neilan.

For long-term prevention of contracting HIV, take pre-exposure prophylaxis (PrEP), though this is only necessary in circumstances where risk of HIV transmission is high). It is a highly effective prescription drug that lowers your HIV risk, but its efficacy depends on strict adherence and consistent use. The only FDA-approved medications for PrEP use are Truvada and Descovy.

How can you avoid transmitting HIV to a partner?

For a person living with HIV, the best way to prevent transmitting it to others is by taking antiretroviral therapy (ART). The medicine reduces the amount of HIV particles in the blood to the point that a test can't detect it anymore, which is known as having an undetectable viral load. ART prevents HIV from multiplying and makes it a more manageable condition.

"Someone with HIV who takes their medications and is virologically suppressed won't transmit HIV to sexual partners," says Neilan. It is possible to get the virus under control within six months. With proper treatment, people living with HIV can live long and healthy lives.

There are plenty of FDA-approved antiretroviral drugs to treat HIV, says Neilan. Some of the most common side effects are nausea, diarrhea, and fatigue, but it varies for each individual. Here are the types of HIV medicines that reduce viral load:

  • Nucleoside reverse transcriptase inhibitors (NRTIs) - Medicines like Emtriva, Retrovir, and Videx block the actions of reverse transcriptase, an enzyme that HIV needs in order to replicate.
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) - NNRTIs act on the same enzyme as NRTIs, but they function differently. Some examples include Rescriptor, Viramune, and Edurant.
  • Integrase inhibitors - HIV sends its genetic material into targeted cells through an enzyme called integrase. Drugs like Tivicay and Isentress inhibit it.
  • Protease inhibitors (PIs) - The enzyme protease is necessary for HIV to replicate. It is blocked by drugs like Norvir, Invirase, and Reyataz.

Some individuals are prescribed multi-class drug combinations that require them to take more than one drug. Other types of HIV medicines do not inhibit certain enzymes and instead, interfere with the virus' ability to infect immune system cells.

Insider's takeaway

HIV can only be contracted if the virus from the blood, vaginal fluids, semen, rectal fluids, and breast milk of an HIV-positive person with a detectable viral load gets into your bloodstream. It cannot be transmitted through saliva, tears, or sweat.

Though the likelihood is low, a person without HIV can contract the virus by giving or receiving oral sex to or from a partner with HIV. To minimize risks, get tested for STIs and HIV, use condoms and dental dams correctly. If you suspect you may be consistently exposed to HIV, take PrEP consistently. 

For a person living with HIV, the best way to avoid transmitting it to a partner is by taking antiretroviral medicines that help keep an undetectable viral load.

Read the original article on Insider