How to Avoid Spreading Disease During Oral Sex

A whopping 26 million new cases of sexually transmitted infections (STIs) emerged in 2018 alone, the Centers for Disease Control and Prevention (CDC) reported. This is a staggering number and one that costs the United States $16 billion annually in direct medical expenses.

Perhaps the scariest fact, though, is that 1 in 5 Americans—around 68 million people—currently have an STI.

According to a 2021 study published in the Sexually Transmitted Diseases journal, the numbers are high because of the human papillomavirus (HPV), and it's estimated that nearly 42 million Americans currently live with this STI. Second on the list is genital herpes, which has infected about 18.5 million people. HPV and genital herpes are the most common STIs in our society. Both are incurable but manageable with treatment.

While not as prevalent, trichomoniasis and chlamydia rank third and fourth with 2.5 million cases and 2.3 million cases, respectively. Both of these STIs are curable. Other STIs are much less prevalent: gonorrhea (209,000 cases), syphilis (156,000 cases), antimicrobial-resistant gonorrhea (107,000 cases) and hepatitis B (103, 000 cases).

How to protect yourself and your partner

Kyle Bukowski, M.D., an OB-GYN and the chief medical officer at Planned Parenthood of Maryland, recommended the following strategies to avoid becoming infected:

• Getting tested for STIs is important in reducing the spread of infections since many STIs show no signs or symptoms. Knowing your status, as well as your partner's status, is the best way to reduce your risk of infection. Talking openly to your medical provider and partner about testing is a great way to improve sexual health and maintain a healthier sex life.
• HPV vaccination can decrease the risk of contracting an HPV subtype, which may increase the risk of throat cancer.
• Using condoms and dental dams every time you have sex, even for oral sex. Both condoms and dental dams create a barrier that can prevent the spread of STIs during oral sex.

There is a perpetuating myth that an STI can't be transmitted during oral sex because there's no sexual penetration. This is untrue.

"In theory, almost all STIs can transmit via oral sex, but the transmission rate is usually lower than penetrative vaginal or anal sex because the saliva is designed to sterilize food and kill bacteria. We often see gonorrhea caught by men who have sex with men [MSM] if they have given OI [oral intercourse] with orgasm," said Laurence Gerlis, M.A., M.B., the CEO and lead clinician at SameDayDoctor, based in London and Manchester, England.

"Receiving OI is less risky, but gonorrhea and chlamydia can transmit both ways," he added. "For men who give OI to women, there is a small risk of catching oral gonorrhea and chlamydia. We have also seen men catch HSV [herpes simplex virus] this way. Meanwhile, BBV—blood-borne viruses, including HIV, hepatitis B and syphilis—rarely transmit via OI, but MSM can pass on HIV in this way."

He added that using protection for oral sex, not swallowing semen, washing the mouth out afterward, having a cup of tea or coffee, and washing the face and genital area before and after oral sex can help prevent STI transmission during oral sex and kissing afterward.

Speaking of the mouth, it also pays to practice good oral hygiene and avoid having sex if you're experiencing any oral health issues.

"Keep your mouth in good condition. Visit the dentist regularly, clean your teeth and see the dental hygienist," noted Deborah Lee, a medical writer for Dr Fox, an online pharmacy based in the United Kingdom. "Don't allow your gums to become inflamed or infected. Having said this, it's advisable not to brush your teeth or floss just before having oral sex as this can release bacteria and viruses into your mouth. Don't have oral sex if you have a sore throat or any mouth lesions."

Better safe than sorry

If you plan to receive or offer cunnilingus, anilingus or fellatio, you absolutely need to ensure you do so responsibly to minimize risk. Many STIs are asymptomatic, so the only way to know for sure if you have one is to get tested. Regular screening is a good idea for people with active sex lives and eliminates mood-killing thoughts about STIs, allowing for increased peace of mind in the bedroom.

"If you have an STI in your throat, some will complain that their throat feels sore," Bukowski explained. "If this happens and you think you have an STI, you should talk to your provider to get tested. It's important to be tested regularly to ensure any necessary treatment is taken early. Undiagnosed and untreated STIs can lead to serious health consequences, such as pelvic inflammatory disease or infertility in women."

It's also important to understand and remember that not all STIs are transmitted through an exchange of bodily fluids. Some, such as syphilis, herpes and HPV, can be acquired as easily as basic skin-to-skin contact. This fact should lead to the conclusion that even with a barrier, such as a condom or dental dam, there is still risk regardless of the measures taken.

Sexually transmitted infections remain prevalent in our society, and it's important to minimize your risk whenever possible. The most effective ways to mitigate potential risks are to undergo regular screening, use barriers (condoms and dental dams), get vaccinated, maintain oral hygiene, and limit or abstain from having sex with multiple partners.