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C. Oral Sex: Cunnilingus (Oral-Vaginal Sex)

There is a potential for transmission of HIV by insertive cunnilingus because vaginal fluid and blood can get in the mouth. Risk is increased if there are bleeding gums, cuts, sores, lesions, ulcers or burns in the mouth. Risk is also higher during menstruation. Using a latex barrier over the vaginal opening such as a condom or dental dam can reduce the risk. It is recommended that the insertive partner should wait at least thirty minutes after brushing or flossing teeth.

There are no well-designed studies offering evidence of transmission through cunnilingus. However, the extremely small number of case reports in which transmission has been attributed to insertive cunnilingus supports the classification of this activity as low risk.

With barrier: Negligible risk

With no barrier and outside menses: Low risk

With no barrier and during menses: Low risk

Receptive cunnilingus

With barrier: Negligible risk

With no barrier: Negligible risk

D. Oral Sex: Anilingus (Oral-Anal Sex)

Anilingus is not an efficient means of HIV transmission. Although there may be a potential for transmission by insertive anilingus if blood is present in fecal matter in the anus, the quantity of blood is likely to be extremely small. There is a potential for HIV transmission by receptive anilingus because of the possibility of contact between blood in the mouth and the rectal lining, but the small amount of blood likely to be involved again makes such an occurrence highly unlikely.

It should be noted, however, that anilingus is an efficient route of transmission for other sexually transmitted diseases such as syphilis, gonorrhea, hepatitis A and B and intestinal parasites.

Any risk from anilingus can be reduced by use of a latex barrier, such as a dental dam, or a new, unlubricated condom carefully cut open.

There have been no documented cases of HIV transmission through receptive or insertive anilingus.

Insertive anilingus: (licking the anus)

With barrier: Negligible risk

Without barrier: Negligible risk

With barrier: Negligible risk

Without barrier: Negligible risk