Protected anal vs. Unprotected Oral

[Austin]

Which is more likely to transfer STDs? I'm just curious, really. It seems people find anal sex to be more risky than oral sex, but oral sex typically doesn't use condoms, does it? I would think anal sex was less risky when protected.

[Mogget]

It depends on which STDs you're talking about. Chlamydia, gonorrhea, syphilis, and oral herpes can be transmitted during unprotected oral, but are unlikely (with the possible exception of genital herpes) to be contracted through protected anal. However, HIV is rarely if ever contracted through unprotected oral. Basically the only way you can contract HIV via unprotected oral is if you have cuts or sores in your mouth which is why brushing and flossing should be avoided prior to oral sex.

This chart gives a good rundown of the risks of transmission from different sex acts.

[Chip]

Protected anal sex, in general, is safer than unprotected oral. But there is a risk of condom breakage during anal sex (more than one person has written about it here at EC) so it's not risk-free. There's no question that it is easier to transmit HIV (and practically any other STI) via anal (unprotected) than via oral (unprotected) but any protected sex is going to be safer than any unprotected sex.

The risk of HIV transmission during oral sex is low, but not nonexistent; there are definitely reports of HIV transmission orally, though it's hard to know for sure if the self-reports are totally accurate. Additionally (not to be graphic), there is some data indicating a fairly high risk of transmission of HIV if semen gets in one's eye, which can happen under some circumstances that I'm sure some of you are aware of

[KaraBulut]

In this forum somewhere is a discussion that happened a couple of years ago about oral sex and whether condoms were recommended. At that time, one of things that I commented on was that while condoms probably weren't necessary for oral sex because of the low risk of HIV transmission, there might be a change to that recommendation based upon some of the early research I had seen about human papilloma virus (HPV) and oral cancers.

Today, the findings of some of those studies were released by the National Cancer Institute (NCI).

The NCI studies confirmed something that we've been seeing in oral, head and neck cancers- that the patients are getting younger. And now we know why. Prior to the 1960s, head and neck cancers were almost always related to alcohol and tobacco use. Now that we've cut smoking rates, we're seeing more cancers in younger people who don't smoke.

Why?

In the 1980s, about 15% of oral cancers tested positive for HPV. Since 2000, that number has gone up to where over 70% of oral cancers are testing positive for HPV. We now believe that HPV transmitted via oral sex is responsible for the increase in oral cancers in young people.

Once upon a time, we used to recommend that people reduce the number of sex partners they had as a means of reducing their chance of HIV. After we developed an HIV antibody test, we started emphasizing condoms. We may be headed back in the other direction- where we recommend that, if you don't want to use condoms for oral sex, that you reduce the number of partners that you have unprotected oral with.

And - if you have not been sexually active- you should get the HPV immunization before you become sexually active. It doesn't cover all strains of HPV but it does cover some of the strains that we know tend to cause oral, anal and cervical cancers.

[Zontar]

Originally Posted by KaraBulut

In this forum somewhere is a discussion that happened a couple of years ago about oral sex and whether condoms were recommended. At that time, one of things that I commented on was that while condoms probably weren't necessary for oral sex because of the low risk of HIV transmission, there might be a change to that recommendation based upon some of the early research I had seen about human papilloma virus (HPV) and oral cancers.

Today, the findings of some of those studies were released by the National Cancer Institute (NCI).

The NCI studies confirmed something that we've been seeing in oral, head and neck cancers- that the patients are getting younger. And now we know why. Prior to the 1960s, head and neck cancers were almost always related to alcohol and tobacco use. Now that we've cut smoking rates, we're seeing more cancers in younger people who don't smoke.

Why?

In the 1980s, about 15% of oral cancers tested positive for HPV. Since 2000, that number has gone up to where over 70% of oral cancers are testing positive for HPV. We now believe that HPV transmitted via oral sex is responsible for the increase in oral cancers in young people.

Once upon a time, we used to recommend that people reduce the number of sex partners they had as a means of reducing their chance of HIV. After we developed an HIV antibody test, we started emphasizing condoms. We may be headed back in the other direction- where we recommend that, if you don't want to use condoms for oral sex, that you reduce the number of partners that you have unprotected oral with.

And - if you have not been sexually active- you should get the HPV immunization before you become sexually active. It doesn't cover all strains of HPV but it does cover some of the strains that we know tend to cause oral, anal and cervical cancers.

The risk of HIV via the oral route is low enough not to recommend condoms?

[Mogget]

The risk of HIV via the oral route is low enough not to recommend condoms?

It's a really, really low risk. There's anecdotal cases, but I don't think there've been any conclusive studies showing you can contract HIV via oral unless you have cuts or sores in your mouth.

[KaraBulut]

Originally Posted by Zontar

The risk of HIV via the oral route is low enough not to recommend condoms?

The official guidelines will tell you to use condoms for oral sex to prevent exchange of body fluids. There has been documented cases where HIV transmission was believed to have occurred from oral sex. But it's very rare, though. Most cases of HIV in gay men in the US are tied to unprotected anal sex or IV drug use, not oral sex.

And nobody likes the taste of latex.

So, in the past, we've said to use condoms for oral sex with casual partners but if you have a regular partner, the two of you have been monogamous and you've had STD testing, then condoms for oral probably aren't necessary because of the low risk of HIV transmission from oral sex. We've tried to be practical- the point of oral sex is for both people to enjoy doing it and if there's low risk of HIV transmission from oral, a condom is just putting a bad taste in your mouth.

The HPV risks may make that more complicated because we don't have a test for HPV. So, we don't have a way to assure you that you won't get HPV from oral sex.

But it brings up the bigger question, "Why am I blowing someone who I don't know well enough to the point that I'm worried about STDs?". In the end, maybe the better strategy is pick your sexual partners wisely and don't have casual sex with people whose sexual history you don't know.

Originally Posted by KaraBulut

The official guidelines will tell you to use condoms for oral sex to prevent exchange of body fluids. There has been documented cases where HIV transmission was believed to have occurred from oral sex. But it's very rare, though. Most cases of HIV in gay men in the US are tied to unprotected anal sex or IV drug use, not oral sex.

All the information seems incredibly confusing. I had a respected sexual health professor once say that 1 in 10 people with HIV likely got it from oral sex. But then there have been few documented cases and the documented cases that there are seem to be more anecdotal.

[KaraBulut]

Originally Posted by LostandFound

All the information seems incredibly confusing. I had a respected sexual health professor once say that 1 in 10 people with HIV likely got it from oral sex. But then there have been few documented cases and the documented cases that there are seem to be more anecdotal.

It's a bit beyond anecdotal- it's documented in the literature but it's based upon the patient's statements regarding their sexual history.

There are probably people who have never had anal sex and have only had oral sex. But because so many HIV+ people haev had multiple sexual practices, it's hard to be sure to exactly which act was the source of the infection.

1 out of 10 is not supportable in any of the reputable sources- he's off by a couple of decimal points.