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 FAQ Terrence Higgins Trust Oral Sex: Its Up to You by Dan Wohlfeiler, STOP AIDS Project Oral Sex Information for Counselors from California Office of AIDS How Safe is Oral Sex? adapted by Nicolas Sheon from a pamphlet by STOP AIDS Project

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"

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

• Having an STD can increase your chances of getting infected with HIV.
• STDs that cause sores and blisters (like syphilis and herpes) are easy to get from all types of oral sex - getting or giving.
• With gonorrhea, and NGU infection is possible from sucking and getting sucked.
• Hepatitis A, Intestinal Parasites, and Herpes can be easily passed through rimming without a barrier.
• It is easier to pass STDs when sores, blisters or discharge (drip) are present.

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:

• HIV is not easy to get from any kind of oral sex.
• Bleeding gums, gum disease, and sores in the mouth can make it easier to get infected with HIV through oral sex.
• There have been recorded cases of getting HIV from sucking or giving head.
• There have been no recorded cases of getting HIV from getting sucked.
• There have no recorded cases of getting HIV from rimming or getting rimmed.
• It is much easier to get HIV from sucking than from getting sucked.
• It is much easier to get HIV from anal sex without a condom than from oral sex.

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

Consider the following questions when making that decision.

• "How easy is it to get HIV and other STDs from Oral Sex?"
  • Not all STDs are easily passed through oral sex. Educate yourself on which diseases are more common and which are easier to spread through oral sex (see chart inside).
  • HIV is not easily passed through oral sex. However, bleeding gums, sores in the mouth, or cum in the mouth can increase your chances of HIV infection. Be informed about what may increase the risk of infection.
  • What are my chances of having sex with somone infected with HIV or another STD?"
  • To get HIV or an STD from oral sex, your partner must be infected with that disease.
  • Know what diseases you are likely to be exposed to and how they are passed.
  • For example, 45% of gay men in San Francisco are infected with HIV. Therefore, your chances of having sex with an HIV positive partner are high. On the other hand, syphilis rates are currently low, making it less likely that your partner will have this disease.
• "What can happen to me if I get the disease?"
  • Even though the chance of getting HIV from oral sex is low, the consequences of HIV are life threatening. You may decide that it isn't worth taking that chance and use protection. Or you may not feel that protection is necessary because the chance of transmission is low. The decision is yours.
  • Some STDs have more serious consequences than others. Know what these are when determining the level of risk that is acceptable for you.

Once you've decided, talk to your partner.

FOR SUCKING AND GETTING SUCKED

• For maximum protection, use non-lubricated latex condoms without spermicide. If you don't like the taste, try flavored condoms.

IF YOU DON'T WANT TO USE CONDOMS:

• Avoid taking cum in your mouth or cumming in someone's mouth. If you get cum in your mouth, spit it out.
• Avoid sucking or rimming if you have bleeding gums, sores, abscessed teeth, or have just gone to the dentist. These could make it easier for HIV and STDs to enter the body. Wait until they heal.
• Do not brush or floss your teeth right before or after having sex. For fresh breath, try chewing gum or rinsing with mouthwash.
• Look closely for sores or blisters on the genitals, mouth or lips. If sores or blisters are visible, avoid oral sex. Remember: It's not always possible to see sores or blisters.
• Avoid deep throating. This may irritate the lining of the throat, making it easier for HIV and STDs to enter the body.

FOR RIMMING

• Use a barrier like plastic wrap or a dental dam to prevent fecal matter (shit) from getting into your mouth. This can protect you from intestinal parasites and hepatitis A.
• Using a barrier may also protect you from herpes.

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

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

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