What oral sex can’t be called, however, is safe sex.
Okay, but Do We Really Need to Use Protection During Oral Sex?
That’s right, oral sex is not synonymous with risk-free sex. Dr. Alexea Gaffney, a board certified Internist and Pediatrician with additional subspecialty training in Infectious Diseases, says this is a common but dangerous misconception:
"There may not be a pregnancy risk, but that doesn't mean oral sex is a much safer sex option."
And while it’s true that you can’t get pregnant from giving or receiving oral sex (#bless), “STIs can be still be spread during oral sex, both from the mouth to the genital or from the genitals to the mouth,” she says. STIs can also be spread to and from the anus during analingus (or mouth-to-anus contact).
Don’t worry, swearing off oral sex isn’t the only solution here. Below, find everything you need to know about oral STIs, the risks associated with oral sex, and your game plan for safer oral play.
Yes, Oral STIs Are Real
To be clear: it is possible to have a sexually transmitted infection (STI) in your mouth or throat. According to Dr. Alexea, chlamydia, gonorrhea, herpes and syphilis are the most common oral STIs, but Human Papillomavirus (HPV), Human Immunodeficiency Virus (HIV), and trichomoniasis can also be spread orally.
Just like genital and anal STIs, oral STIs don’t have a #lewk (if you aren't up on the hip lingo, #lewk means a signature physical trait)—rather, the most common symptom of an oral STI is no symptom at all. According to the CDC, when people do have symptoms it’s usually a sore throat that can’t be traced back to any sickness, a low-grade fever, or throat sores. Occasionally folks will also cough up mucus, which is said to have a different consistency than the mucus you might cough up when you’re congested.
Even if you’re not experiencing symptoms, if you have an oral STI and perform oral or analingus on your partner, there’s a risk of transmitting that STI to your partner’s genitals or anus.
Worth mentioning: while the risk is pretty low, some oral STIs—herpes, HPV, syphilis—can also be spread to your partners mouth during kissing. Dr. Alexea adds that even if kissing or oral sex don’t take place, if someone uses their spit as lubricant while having an oral STI, that saliva can transmit the infection to their partners genitals. (Also, let’s be honest saliva makes pretty crummy lube).
What That Means for Oral Sex
Whether it’s mouth-to-penis or mouth-to-vagina contact, the risk is a two-way street. That means not only can oral STIs get passed to the genitals, but genital STIs can get passed to the mouth.
What genital STIs can get passed to the mouth? According to Dr. Kim Langdon, an Ohio-based OB-GYN with Parenting Pod, both fluid-borne STIs and STIs spread through skin-to-skin contact can be transmitted through the mouth. She says that chlamydia, gonorrhea, syphilis, herpes, and HPV are the the STIs most commonly spread through oral sex. But the National Institute of Health notes that HIV, trichomoniasis, hepatitis A, B and C, and pubic lice, can also be spread.
The symptoms of genital STIs vary from infection to infection, but typically there will be no symptoms at all. However, funky discharge, painful urination, spots, bumps or lesions, fever, itchiness, and swollen lymph nodes may occur.
Whether you’re experiencing symptoms or not, if you have a genital STI and receive oral, your partner is at risk for contracting that STI orally.
“To get tested for an oral STI, you need to get a culture taken of the infected area,” explains Dr. Langdon.
How likely is STI transmission through oral sex? Data is limited. For starters, most folks who have oral sex also getting it on anally or vaginally, making it a bit of a chicken or egg situation. Further, while labs do tell the CDC how many results come back positive, they don’t specific what body part tested positive.
Theoretically, because the vagina is lined with mucous membranes—basically, porous tissues—the chance of a personal with an oral STI transiting that infection is slightly higher when the receiving partner has a vagina than when the partner has a penis. But there’s no quantitative data showing how much higher the risk. As Dr. Langdon says:
“Folks of any gender, genitals, or sexuality are at risk of STI transmission from oral sex.”
A Quick Note On Anal-Oral STI Transmission
Let’s be clear: STI transmission is also possible during analingus. In fact, like the vagina, the anus is lined with mucosal membranes. That means that analingus may be riskier than fellatio for folks with a penis.
E. coli and other bacteria are often seen around the anus, which means that analingus may also expose the giving partner to parasites and gastrointestinal illnesses. For this reason, washing the anus ahead of oral-anus contact is a must.
How To Have Safer Oral Sex
The only way to negate the risk of STI transmission entirely is to abstain from sex entirely. But here are ways to make oral sex safer. Below, you'll find your safer-sex plan of action!
1. Know Your Own STI status
Look, whether you’re Team T-on-P (tongue on privates, AKA oral sex) sex or not, you should know your own STI status. The CDC recommends folks with vulvas get tested at least once a year and gives the same recommendation to sexually active people with penises, who identify as gay or bisexual. (Note: there is currently no recommendation for penis-havers).
However most experts, recommend folks of all genders and sexualities get tested every six months and after every sex parter.
While it should be part of every routine primary care or gynaecological exam, most doctors aren’t asking their patients if they are engaging in oral sex or doing an oral swab of the folks who are.
Your move: tell your healthcare provider you’d like to be tested for oral (and ideally, also anal) STIs.
And make sure you’re being tested for everything. Many doctors don’t test for herpes, HIV, HPV, or trichomonas unless explicitly asked.
2. Talk To Your Partner About Their Status
If you have an STI, telling your partner you have it is imperative for consensual sex—oral sex included. But if you don’t, you should still share your STI status with your partner and ask them to share theirs too.
It bears repeating: you can’t tell if someone has a genital, oral, or anal STI just by looking at them!
A great way to initiate this conversation is to share your own STI-status, inclusive of when your last STI test was, if you’ve had sex of any kind since and what barrier methods were used, and information about your STI if you have one. An example: "Just so you know, I got tested last week and recently got my results back! I’d love to share them with you, and have you get tested and do the same."
Another option is to ask your partner to get screened together. You might say, "I love kissing you and would love to do more than that. But before we do, I’d love for each of us to get STI tested. Is that something you’d be open to doing either on your own or together?"
While some experts say this conversation is best in person, text or phone call is fine if you worry about disclosing your status will put you in danger or if you think you might get caught up in your partner's hotness. This also gives your partner some time to do research about your particular STI and how to reduce the risk of transmission (PrEP, condoms, dental dams, etc).
What if your partner hasn’t been tested recently (or ever!) or isn’t receptive to having this conversation? You might try explaining why it’s so important to you. If your partner continues to push-back, you should question whether or not you really want to engage with someone sexually who doesn’t care about your own or their own health.
Or you can move forward, operating under the assumption that they do have an STI and practice the safest sex possible.
3. Use Protection
If one or both of you test positive or you don’t know your partner's status, you need to use protection for oral sex and other types of sex too.
Note: If your partner has an STI that is curable (with a round of antibiotics for instance, like chlamydia or gonorrhea), the doctor may recommend abstaining from any kind of sex until they test negative for the STI. Likewise, if your partner is currently experiencing a herpes outbreak, their healthcare provider may recommend abstaining until the outbreak has passed. If possible, loop your own healthcare provider into this decision.
If your partner has a penis that means using a (lubricant-free) condom and if your partner has a vagina that means using a dental dam (or cutting open a condom)!
And STI-free or not, anytime analingus is performed, a dental dam should be used. (BTW: there's a sexual health myth that Saran Wrap can double as a dental dam. That's a myth! It's too porous to prevent infection transmission).
Are condoms and dental dams one-hundred percent effective? No, they’re not. They may not protect you from STIs spread through skin-to-skin contact. Dr. Alexea explains, “If your mouth comes into contact with an area of the genitals that the barrier doesn’t cover, risk is possible," and vice-versa for oral STIs.
These barriers aren’t perfect, but they do greatly reduce the risk of transmission and should be used anytime someone has an STI or when someone doesn't know their status.
4. Continue To Get Tested
STI testing is not a ‘one and done’ situation. Even if you’re having protected oral and penetrative sex every single time, you should continue to get tested after every new partner and every six months.
Gabrielle Kassel is sex writer for brands such as Cosmo, Health, Well & Good, Shape, Women’s Health, Greatist, and more. She can be found on Twitter and Instagram at @gabriellekassel.