- For many years it has been known that unprotected oral
sex carries a risk, albeit relatively small, of HIV transmission. Recent
work in the USA and in the UK has suggested that this risk may contribute
to 3-8% of HIV infections among men who have sex with men.
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- We also know that other sexually transmitted infections
(STIs), such as syphilis, can be transmitted through oral sex more readily
than HIV; for example, in a recent outbreak of syphilis in gay men in north
west England, oral sex was a significant mode of transmission. Unlike
HIV, syphilis can be cured if diagnosed and treated early, but it can have
serious consequences if left untreated, so it is better to prevent it than
to have to treat it. Oral sex is also known to transmit STIs like gonorrhoea
and herpes simplex.
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- This means that it is very important for people to understand
the risks associated with oral sex and decide for themselves what level
of risk they consider acceptable.
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- It is important to remember that unprotected anal intercourse
remains by far the biggest risk behaviour for HIV transmission among men
who have sex with men (the group at most risk for HIV infection in the
UK). The risks of HIV transmission are enormously reduced by consistent
and proper use of condoms for every occasion of anal intercourse where
one partner is HIV positive and the other is negative, or where either
partner's HIV status is unknown. This is why promoting condom use for
anal intercourse has been the focus of most HIV prevention campaigns with
gay men over the past two decades.
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- Oral sex poses a smaller risk of HIV transmission than
unprotected anal and vaginal sex, but this does not mean that it is risk-free.
The recent studies confirm that unprotected anal sex is clearly the highest
risk activity, accounting for over 90% of transmission in gay men in the
UK. Oral sex is much lower risk but may account for more infections than
previously thought.
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- Interpreting this information to provide clear public
health messages is difficult. Anecdotal evidence from other countries
like the USA suggests that people tend to reject messages advising them
always to use condoms for oral sex; indeed, such messages can, in theory
at least, put people off condom use altogether.
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- The basic public health messages are:
- Activities like unprotected anal intercourse or sharing
of injecting equipment are high risk activities for HIV transmission; always
use a condom when having penetrative anal or vaginal sex where one partner
is HIV positive and the other is negative, or where the HIV status of either
partner is unknown. Never share injecting equipment.
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- Oral sex is clearly a lower risk activity for HIV, but
does nonetheless pose some risk. People who practice oral sex need to
be aware of this risk so that they can make an informed decision about
whether, and how they practice oral sex. The transmission risk is obviously
dependent on the partners' HIV status. Where one partner is HIV positive
and the other is negative, or where the HIV status of either partner is
unknown, the risk can be minimised by using condoms during oral sex. Although
not ejaculating into the mouth of an uninfected person may also lessen
the risk of HIV transmission, it will not eliminate it totally as pre-ejaculatory
fluid is also capable of transmitting the HIV virus.
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- We know that other STIs are more readily transmitted
by oral sex than HIV, and people need to be aware of these risks as well.
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- The only way to practice sex without any risk would
be to refrain from penetrative sex altogether. For example, mutual masturbation
carries no known risk of HIV transmission. Many people however would find
such a recommendation unacceptable, and may be willing to accept a small
degree of risk associated with sexual activity.
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- All sexually active individuals should be informed about
HIV transmission risks associated with various types of sexual activities
so that they can make their own lifestyle choices. Communicating and explaining
these risks should, wherever possible, be done using simple and clear language
to increase understanding.
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- To summarise, in order to minimise the transmission risk
of HIV and other STIs associated with oral sex, people need to:
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- be aware of the risks of transmission via oral
sex,
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- consider how likely it is that a partner of unknown
status is in fact HIV positive or has another STI
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- and in the light of all this information, decide
what level of risk they consider to be acceptable.
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- Risk can be minimised by knowing whether you or
your partner has HIV or another STI, or by using a condom for oral sex.
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- For further information please contact the PHLS press
office on 0208 358 3002/3004. A set of frequently asked questions is available
from the press office and will be on the PHLS website later in the week.
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