Oral Sex: Using Your Head

For Men Who Have Sex With Men

Developed by: The STD Education Unit,
San Francisco Department of Public Health

See revised version in PDF [451K], May, 2005


HTML conversion by Nicolas Sheon

copyright / ordering information

 See also

Oral sex is now the most common type of unprotected sex.

You should know about oral sex and HIV/STD infection.

In this brochure, we define ORAL SEX as:

Sucking Cock, or Getting Sucked,
Mouth-Penis contact, "Head", "Fellatio",
Rimming, Mouth-Anus Contact, "Analingus"


ORAL SEX AND SEXUALLY TRANSMITTED DISEASES

There are different levels of risk, depending on the STD and the type of oral sex.

ORAL SEX AND HIV

There have been no studies measuring the risk of getting the AIDS virus through oral sex alone. Until better scientific information is available, the actual risk from oral sex is unknown. Meanwhile, available evidence suggests that:

(See chart for more information about HIV and each STD.)


Only you can decide what you will or won't do.

Consider the following questions when making that decision.

Once you've decided, talk to your partner.


Any of these methods can reduce your risk for STDs and HIV. Some are more effective than others.

FOR SUCKING AND GETTING SUCKED

IF YOU DON'T WANT TO USE CONDOMS:

FOR RIMMING



Determining The Risk: Oral Sex & HIV/STD's

(you will need to adjust the width of your browser window to be able to see the right side of this chart)

 STD "How easy is it to transmit through oral sex?" "What can happen to someone with this STD?" "Can having this disease increase my chances of HIV infection?" "What should I know if my
partner or I am HIV positive?"
"What are my chances of having sex with someone with this STD?"
 HIV/AIDS

   Probably Difficult

  • There have been no studies measuring the risk of HIV from oral sex
  • There have been documented cases of men getting infected from sucking
  • There have been no recorded cases of getting HIV from getting sucked
  • There have been no reported cases of getting infected from rimming
  • It is believed that most people infected with HIV will develop AIDS and die from this disease
  • Having a weakened immune system could make one more likely to get reinfected with different strains of HIV
  • Reinfection with another strain of HIV is possible
  • Many experts believe reinfection with other strains of HIV may result in a faster progression to AIDS

 High

  • It is estimated that 43-48%-nearly half-of the men who have sex with men in San Francisco are infected with HIV

 

Although HIV is in precum and semen, the actual risk from oral sex is unknown The chance for transmission is believed to be much lower than through unprotected anal intercourse because:

  • Saliva may neutralize the virus
  • The lining of the mouth is tougher and more protective than the lining of the rectum
  • A penis is not as likely to cause the same trauma to the mouth as it will to the rectum

The following may increase your risk of HIV infection and/or transmission during oral sex:

  • Sores, cuts, abrasions, gum disease and blood in the mouth can allow HIV to more easily enter the body
  • Similarly, the presence of white blood cells at the site of STD infections may provide an easy entry point for HIV
  • Prolonged deep throating may cause tears in the throat's lining making it easier for HIV to enter the body

Herpes

(Type I & Type II)

Easy if sores present

Difficult if no sores present

  • Sores and blisters (usually on the lips, genitals or anus) are extremely infectious
  • Easily passed by sucking/ getting sucked, rimming and licking/being licked
  • In some cases the herpes virus can be passed when no symptoms are present
  • Blisters/sores can be extremely painful
  • There is currently no cure for this STD
  • Infected people usually have periodic outbreaks throughout their life
  • Treatment can reduce the severity and duration of herpes outbreaks

Yes

  • Open herpes sores/blisters provide an easy way for HIV to enter the body
  • White bloods cells at the site of Herpes sores or blisters may increase susceptibility to HIV
  • Outbreaks occur more often, are more severe, and take longer to heal
  • Herpes outbreaks may stimulate replication of HIV in the body

High

  • Nearly 7 out of every 10 Americans have Oral Herpes, often acquired non-sexually during childhood (i.e. "cold sores")
  • At least 30 million Americans have Genital Herpes about 1 out of every 7 people
Syphilis

Very Easy if sores or mucus patches are present

  • Easily passed through contact with open sores (chancres) on the penis, anus or mouth
  • Transmitted through all types of oral sex
  • Also passed through contact with mucus patches in the mouth
  • The signs and symptoms of syphilis infection are not usually painful
  • Can be cured with antibiotics
  • Left untreated syphilis will eventually cause brain damage, heart disease, blindness or death in some people

Yes

  • Open chancre sores can provide an easy for way for HIV to enter the body
  • White blood cells at the site of infection may increase the chances for HIV infection
  • increase the chances for HIV infection
  • Syphilis may be more difficult to cure for HIV positive persons
  • Primary syphilis may progress to late stage syphilis (neurosyphilis) more rapidly

Low

  • Currently (August 1996) the rates for syphilis are low* in San Francisco, however, the highest proportion of reported syphilis cases is among men who have sex with men
Gonorrhea

Moderately Easy

  • When passed through oral sex, gonorrhea is usually transmitted from the penis into the throat while sucking cock
  • It also can be passed from an infected throat to a penis while getting sucked
  • It is believed that most people infected with HIV will develop AIDS and die from this disease
  • Gonorrhea can cause on urination and/or discharge from the penis
  • Gonorrhea can cause a sore throat
  • Can be cured with antibiotics
  • Left untreated gonorrhea can cause inflammation and swelling of the testicles which can result in sterility

Unknown for oral sex

  • White blood cells at the site of STD: infection relay make it easier for HIV to enter the body
  • While cervical infection can increase the chances of HIV infection, this has not been studied for the throat or penis
  • It does not appear that HIV infection affects transmission, symptoms or treatment of gonorrhea
  • However, any infection in an HIV positive individual impacts the immune system

Low

  • Currently (August 1996) the number of reported gonorrhea cases among men who have sex with men is low* in San Francisco
NGU

Probably Easy

  • No studies have been done measuring the risk of oral transmission However, doctors at SF City Clinic frequently treat cases of orally transmitted NGU
  • NGU can be passed from both sucking and getting sucked
  • NGU can cause burning on urination and/or a discharge from the penis
  • NGU can cause a sore throat
  • NGU can be cured with antibiotics
    Unknown for oral sex
  • Studies have shown an increased rate of HIV infection for people with anal or genital warts who have unprotected anal sex
  • Warts may provide an entry point for HIV to enter the body

Unknown for oral sex

  • White blood cells at the site of STD infection may make it easier for HIV to enter the body
  • While cervical infection can increase a female's chances for HIV infection, this has not been studied for the throat or penis
  • It does not appear that HIV infection affects transmission, symptoms or treatment of NGU
  • However, any infection in an HIV-positive individual impacts the immune system

Low

  • Currently (August 1996) the number of reported NGU cases among men who have sex with men is low* in San Francisco
Chlamydia

Unknown

  • No reliable studies have been done that measure the risk of oral transmission
  • Most doctors do not routinely test gay men for Chlamydia
  • Chlamydia infection in the penis can cause burning on urination and/or an unusual discharge
  • Chlamydia can be cured with antibiotics

Unknown for oral sex

  • White blood cells at the site of infection may increase the risk for HIV infection
  • While cervical infection CE increase the chances of HIV infection, this has no been studied for the throat or penis
  • It does not appear that HIV infection affects transmission, symptoms or treatment of chlamydia
  • However, any infection in an HIV-positive individual impacts the immune system

Unknown

  • Few medical facilities routinely test gay men to Chlamydia
  • Therefore, the actual number of cases is unknown

Genital Warts

(Human Papilloma Virus)

Difficult

  • It is possible but uncommon to transmit the genital wart virus through oral sex
  • Can be passed by all types of oral sex
  • Warts usually appear on the penis or in the anus but may occur in or around the mouth or lips
  • Spread through skin-to-skin contact or contact with warts
  • Warts can be treated, but the virus stays in the body
  • Treatment can be painful

Unknown for oral sex

  • Studies have shown an increased rate of HIV infection for people with anal or genital warts who have unprotected anal sex
  • Warts may provide an entry point for HIV to enter the body
  • Being HIV positive can make it easier for genital warts to grow and harder to treat

High

  • Genital warts are one of the most common STDs
  • Check for wart like growths on the penis, anus or lips of a sex partner NOTE: Genital warts are sometimes too small to be easily seen

Intestinal Parasites

(Cryptosporidium, Shigella, Giardia, etc.)

Easy

  • Intestinal parasites are easily passed through rimming
  • Sucking and getting sucked are low risk unless you ingest fecal matter (shit) when sucking
  • Symptoms include diarrhea, stomach cramps, bloating, increased gas, nausea
  • Most intestinal diseases can be cured with medication
NO
  • Can have serious consequences if you have a weakened immune system
  • Cryptosporidium can be fatal to HIV positive individuals
  • IF yew are immune compromised they may be more difficult to cure

Low

  • Rates for these diseases are currently low (August 1996)*
  • However, most cases in San Francisco occur among men who have sex with men
Hepatitis A

Very Easy

  • Hepatitis A is very easily passed through rimming
  • Sucking is low risk unless you swallow fecal matter (shit) when sucking
  • Hepatitis A can cause weakness, dark urine, jaundice and enlarged liver
  • Hepatitis A cures itself after several weeks
  • A new vaccine for Hepatitis A has been developed
NO
  • It does not appear that HIV infection affects transmission, symptoms or treatment of Hepatitis A
  • However, any infection in an HIV-positive individual impacts the immune system

Moderately Low

  • However, rates for Hepatitis A have been steadily increasing in San Francisco (August 1996), and most cases in San Francisco occur among men who have sex with men
Hepatitis B

Probably difficult

  • No studies have measured the risk of transmission through oral sex
  • However the risk is believed to be low
  • Transmitted primarily through unprotected anal sex
  • Hepatitis B can cause weakness, dark urine, jaundice and enlarged liver 10% of all people with Hepatitis B become carriers of the virus. Long term effects include cirrhosis and cancer of the liver.
  • A vaccine is available. All sexually active people should be vaccinated
NO
  • It does not appear that HIV infection affects transmission or treatment of Hepatitis B
  • Symptoms can be different for HIV positive individuals
  • However, any infection in an HIV positive individual impacts the immune system

Probably Low

  • Cases of Hepatitis B among men who have sex with men have dropped significantly in San Francisco since 1985 This may be due to increased practice of safer sex techniques for anal sex

*Note: It is important to note: the number of new cases of these STDs can easily increase within just a few weeks


This pamphlet is Copyrighted. It was developed by The STD Education Unit, San Francisco Department of Public Health ,with special thanks to Mike Pendo, Lisa Higdon, and staff of City Clinic and the STOP AIDS Project. Funding provided by the San Francisco AIDS Office and the Centers for Disease Control and Prevention.

Reproduced with permission from Paul Gibson, STD Education Unit.

Information on ordering the original edition of this pamphlet (with camera ready art):

September 1997

To Whom it Concerns,

Thank you for your inquiry about our new pamphlet, 'Oral Sex, Using Your Head: For Men Who Have Sex WithMen" We are not able to process print orders from agencies due to fiscal and logistical restraints of the City/County of San Francisco, and because of the staffing resources needed to process the large number of requests we are receiving.

However, If you are interested in obtaining the pamphlet, it will be available on a 'Macintosh-formatted zip disk", which most modern printing firms can use to create your own original camera-ready art, with a back panel of resources customized for your locality. Hopefully, we will have this available by mid-October.

The zip disk will probably cost ir, the neighborhood of $500 (that may seem expensive initially, but with the zip disk, you "own" and control the camera-ready art - you can print as few or as many copies as you desire, and you can change contact agencies/addresses as needed). In order to maintain the integrity of the content of the pamphlet, which is copyrighted, there will also be some stipulations and restrictions on adapting other panels of the pamphlet.

If you are interested in being contacted once the zip disk is available, please fax me (415-554-9636) a brief note expressing your interest on your agency letterhead' and I will contact you when we are ready and able to complete orders. If you have any further questions, feel free to call me at (415)554-8491.

Sincerely

Paul Gibson, MPH
STD Education Unit
STD Prevention and Control Program
1360 Mission Street, #401
San Francisco. CA 94103

 

[ Home Page ][ Site Map ][ Links ][ Feedback ][ Submit ][ HIV Prevention Services ]
[ Berkeley Free Clinic ][ Confession Box ][ Counselor Resources ][ Relationships ][ Theorizing Desire ]