Is Oral Sex “Safe?”

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Q: I have problems in the bedroom department. I've never been in a relationship and never even have had a proper kiss, yet in the last year and a half or so I've hooked up with a few guys I met online for a little bit of "oral pleasure.” I don't really regret doing this – it was fun – but it would kill me if I had to have sex this way for the rest of my life. Is sex really that much more amazing when you do it with someone you love? Because I do consider myself a romantic person and just hooking up for the sake of hooking up just seems to be my way of filling that relationship void.

Anyway, I made the mistake last year of swallowing sperm, which made me feel cheap and scared of having contracted an STD, especially HIV. I got tested three months later, the result of which was thankfully negative. I haven't swallowed since, but the last guy I fooled around with had quite a lot of pre-ejaculate which I tasted very clearly. Now what exactly is the chance of contracting HIV from that? I’ve since learned the guy’s a real player. I've been reading quite a lot of different things online. Some say it's totally safe, others say it's not, even others say it depends on the guy's viral load. So what is the truly official position on this? What is safe and what not in the "oral department"? -- BelgianBoy

The Pigeon Guts Speak:
First, regarding sex with someone you love versus a casual fling. Is it better? There’s no clear-cut answer. For a lot of people, it is. Personally, the combination of being with someone you’re totally hot for and totally in love with … well, let’s just say those are the moments that make life worth living for me. And since you’re finding the experience of hooking up to be empty, I suspect this might be true for you too.

Like so many things in life, this is something that can’t be rushed. It’ll happen when it happens (but please do keep in mind that online hook-ups can be precisely the sort of trap that can make it difficult to find a lasting relationship, for reasons I’ve discussed in past columns).

Regarding oral sex, there’s no clear-cut answer here either – no “official” position, despite the fact that it’s been extensively studied. Unfortunately, it’s also an extremely difficult thing to study because it’s very difficult to isolate the precise sex act that infected someone with HIV, since very few people practice only one sex act.

Here’s what we know: HIV, the virus that causes AIDS, is present in both sperm and precum. We know the risk of transmission in oral sex is much, much lower than for anal sex. And we know that the risk, however small, is much bigger for the guy giving the blowjob than for the guy getting it.

What’s the exact risk? Well, one study of gay and bi men estimated the chance of infection for the receiving partner at about one in two thousand blowjobs (assuming ejaculation). Another estimate, based on different studies, says the risk is about one in ten thousand blowjobs – and that’s assuming the guy getting the blow job is always HIV-positive.

Basically, oral sex without a condom is probably safer even than anal sex with a condom (which can leak or break). Oral sex without ejaculation is even safer. Everyone seems to agree that if gay and bi men only practiced oral sex, new HIV infections would almost completely stop. And if you only practice oral sex, BelgianBoy, your personal chance of infection is very low.

Is that “no” risk? A lot of people say it is. Statistically speaking, they’re close to right. But trying telling that to the guy who became HIV positive through oral sex (I’ve met one, and he was very bitter about all the “oral sex is completely safe!” talk).

Sure, the risk is extremely low for any one blowjob. But how many blowjobs will you give over the course of a life? More than one, probably. A few thousand? Assuming that only, say, one in five of your partners is HIV-positive (which is the approximate infection rate in any given U.S. gay bar), that still means your lifetime risk of HIV infection from just unprotected oral sex could be … well, less than ten percent, but also more than zero percent.

And keep in mind that, yes, the infection rate also depends on the “viral load” of a HIV-positive guy (which is the amount of virus in his body). And unfortunately, a guy’s viral load is often very high right after infection, but before he shows up as HIV-positive in blood tests.

In other words, a guy is the most infectious when he’s least aware of it.

On the other hand, some of the above-mentioned studies were conducted before the widespread use of antiretroviral drugs, which do reduce the viral load in most of the HIV-positive guys taking them. So the typical HIV-positive guy who is getting treatment is probably less infectious than he was ten years ago, which would further reduce the chances of your infection.

This is one of the reasons why having sex with a HIV-positive guy who’s open and responsible and taking care of his health can actually be a lot safer than someone who can’t bothered to know his own status.

What do you do with all this information? That’s where the “no clear-cut answer” comes in. You have to decide for yourself.

Here are some things we can all do to make oral sex safer:

• Avoid putting the tip of the penis in your mouth.
• Don’t let the guy cum in your mouth, and if he does, spit or swallow right away (stomach acids supposedly kill the virus).
• Use a condom for oral sex, especially with guys who could be lying about or who don’t know their HIV status (i.e. random hook-ups). One method involves turning the condom inside out and placing the plastic ring just over the tip of the hard dick. The condom should stay firmly on during oral sex, although you obviously shouldn't reuse the condom after this.
• Practice good dental and “gum” hygiene, brushing and flossing regularly (but not in the hours right before sex, which can create openings in the gums).
• Avoid dicks with lesions or sores (these make the transmission of HIV more likely).
• Avoid oral sex when you’re sick or have allergies, or have sores in your own mouth.

Also, keep in mind that HIV isn't the only STD out there.

I have two more pieces of advice that apply to all safer sex:

First, unless you absolutely know otherwise, assume all your sex partners are HIV-positive – and act accordingly. Weirdly, a lot of gay and bi guys assume exactly the opposite: negative unless stated otherwise. But how would you feel if you learned someone you’d had sex with had recently tested positive (and they’re particularly infectious)? Because the fact is, if you’re a sexually active gay or bi man with multiple partners, this will probably happen to you at least once over the course of your life.

Second, consider carefully exactly who you’re having sex with. Talk openly and without judgment about your status, your past history, and the things you’re comfortable doing. If you don’t totally trust that a guy is being honest with you or is willing to respect your limits, don’t have sex with him.

Need life advice? Contact me here. (And be sure and include your city and state and/or country!)