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Is Oral Sex Safe Sex?
Oral Sex and STDs
By Elizabeth Boskey, Ph.D., About.com Guide
Updated July 06, 2009

About.com Health's Disease and Condition content is reviewed by our Medical Review Board

It's all very well and good to say that oral sex is not safe sex, but how much of a risk are you actually taking if you choose to practice unprotected oral sex? What sexually transmitted diseases can be transferred from genitals to mouth, and vice versa?

HIV

Although oral sex is a relatively low-risk activity, particularly when compared to vaginal or anal sex, it is possible to transmit HIV through oral sex. Using latex or polyurethane condoms, female condoms, or dental dams is an effective way to reduce your chances of contracting the virus when engaging in oral sex. If you don't choose to use protection for oral sex, you should know that the risk of HIV transmission increases if the person performing the act has cuts or sores in his/her mouth, if ejaculation takes place in the mouth, and if the individual receiving oral sex has any other sexually transmitted diseases. The risk is primarily for the person performing the oral sex. Unless a partner has significant amounts of blood in his/her mouth, such as from dental surgery, oral sex is unlikely to expose the receptive partner to HIV.

Herpes

Although genital herpes and oral herpes are usually caused by different strains of the herpes virus, HSV-2 and HSV-1 respectively, it is possible for either virus to infect either site. Therefore, it is possible to transmit herpes during oral sex, and the virus can spread from either partner. Herpes is contagious even when symptoms are not present. Even though prophylactic medications, such as Zovirax (acyclovir), can reduce the likelihood of both outbreaks and transmitting the herpes virus to your partner, they can not eliminate the risk entirely. Although they should greatly reduce the risk of herpes transmission, condoms are also not completely effective in preventing transmission of herpes during oral sex, since the virus can spread from skin to skin.

HPV

It is possible to spread HPV through oral sex, and it is in fact thought that HPV acquired while performing oral sex is a major risk factor for throat cancer. HPV can also appear in the oral cavity through vertical transmission (transmission from mother to child during birth). As with herpes, it seems likely that the use of condoms or dental dams during oral sex should reduce the risk of infection, but they will not necessarily eliminate it entirely since HPV spreads via skin-to-skin contact.

Gonorrhea

In recent years, teenagers with throat infections caused by gonorrhea have often been in the news. Gonorrhea can be transmitted in both directions when oral sex is performed on a man, and throat infections with gonorrhea are notoriously difficult to treat. There is limited research to suggest that it may be possible for someone to acquire a gonorrheal throat infection while performing oral sex on a woman, but transmission in the other direction is relatively unlikely since the site of infection is the cervix -- a part of the female anatomy not reached during cunnilingus. Condoms and dental dams should be extremely effective in preventing transmission of gonorrhea during oral sex.

Chlamydia

It is possible to transmit chlamydia during fellatio, and both the recipient and the person performing the act are at risk. There has been little research on whether it is possible to transmit chlamydia during cunnilingus, but infection risk is probably similar to that for gonorrhea.

Syphilis

Syphilis is extremely easy to transmit via oral sex. In fact, in some areas of the United States, oral sex has been shown to be responsible for as many as 15% of syphilis cases. Although syphilis can only be transmitted in the presence of symptoms, during the primary and secondary stages of the disease, the painless sores it causes are easy to miss.

Hepatitis B

The research is inconclusive as to whether or not hepatitis B can be transmitted via oral sex. Oral-anal contact, however, is definitely a risk factor for hepatitis A infection, and it may also be a risk factor for hepatitis B. Fortunately both hepatitis A and B can be prevented by vaccines. If you practice rimming, you should talk with your doctor about getting vaccinated. Vaccination is a good idea in any case, and the hepatitis B vaccine is currently recommended for all children and many groups of adults.

The Bottom Line

In summary, unprotected oral sex puts you at risk for numerous sexually transmitted diseases. If you perform unprotected oral sex on your sexual partners, you should mention it to your physician. She may want to check your throat when she is screening you for other STDs.
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http://std.about.com/od/riskfactorsforstds/a/oralsexsafesex.htm

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And this...

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Oral Sex May Spread Common STD
Experts Say Infection May Spread Without Symptoms
By Miranda Hitti
WebMD Health News Jan. 6, 2006 -- Oral sex raises the risk of a common sexually transmitted disease (STD) called nongonococcal urethritis (NGU) in men, Australian researchers report.

NGU is a type of urethritis, an infection of the urethra, the tube that carries urine from the bladder to outside the body. One of the most common causes is Chlamydia trachomatis infection, yet it is underreported because a substantial number of people are not aware of their infection and do not seek testing, according to the CDC.

Other less common bacteria and viruses can also cause NGU.

Symptoms include:

Pain or burning during urination
A discharge from the urethra
A significant number of men do not experience symptoms; this can contribute the continued spread of the STD.

NGU is common among men and women. The Australian study only included men.

Oral sex was linked to less common infectious causes of NGU in heterosexual men and men who have sex with men. The researchers include Catriona Bradshaw, MD, and colleagues.

Bradshaw works in Australia's Melbourne Sexual Health Centre and the University of Melbourne.

The study appears in The Journal of Infectious Diseases.

STD Study
Bradshaw's study included 636 men -- 329 with and 307 without symptoms of NGU -- who were seen at the Melbourne Sexual Health Centre.

The men were about 32 years old, on average. They completed surveys about their sexual practices, gave urine samples, and got genital examinations. Those with NGU symptoms also got a urethral smear, a medical test done to detect pathogens that may cause the infection.

NGU was associated with receiving oral sex. It was also associated with unprotected anal sex and unprotected vaginal sex.

Several viruses were associated with NGU, including the herpes virus that causes cold sores (HSV-1). However, herpes sores weren't needed for NGU to spread. HSV-1 was strongly linked to giving oral sex and men who report having sex with men.

The HSV-1 virus was more strongly linked to NGU than another herpes virus, herpes simplex virus 2 (HSV-2).

Hidden Causes?
The researchers couldn't always identify a virus that caused NGU. There may be viruses that cause NGU that haven't been discovered yet, they write.

Treatment decisions should be based on signs and symptoms associated with urethritis, not just tests done with a microscope, note Bradshaw and colleagues.

The study is "a good interim step in understanding this common and often frustrating syndrome," but more work needs to be done to understand NGU, writes editorialist H. Hunter Handsfield, MD.

Handsfield works in Seattle at the University of Washington's Center for AIDS and Sexually Transmitted Diseases, as well as the university's department of medicine.

The findings raise the importance of oral sex as a source of bacteria and viruses as the cause of this STD and indicate that we should broaden our search for other infectious causes of NGU, the researchers conclude.
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http://www.webmd.com/sexual-conditions/guide/20061101/oral-sex-may-spread-common-std

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Too much sex is still not enough