Infection risk and oral sex

Reviewed by Dr David Delvin, GP and family planning and sex specialist

Hepatitis A

Hepatitis A is a common viral infection that can cause jaundice and abdominal pain. It is not usually life-threatening, although sufferers can feel very ill.

The virus is found in faeces in high concentrations and will almost inevitably be present on the apparently clean anal skin of infected individuals. It can be transmitted by oro-anal contact.

Several epidemic outbreaks have been reported among gay men, but heterosexual couples practising oro-anal contact are just as likely to be at risk.

Hepatitis B

Hepatitis B is a viral infection. It is common in hot countries and around the Mediterranean. It used to be rare in the UK, but rates are rising. It is particularly common among people who have had a previous sexually transmitted disease, and among drug users. It can cause a very serious, potentially fatal, liver disease and chronic liver damage. It is most commonly transmitted by inoculation of infected blood, by sharing needles for injection, needlestick injuries and the medical use of infected blood products. Virus particles are found in semen, stool and saliva, as well as blood. There is clear evidence that it can be transmitted through vaginal and anal intercourse, but it is unproven whether it can be transmitted through oral sex. Certainly, there is a theoretical risk of transmission.

Hepatitis C

Hepatitis C is a viral infection transmitted in a similar way to hepatitis B, and so usually affects drug users. Some people with hepatitis C infection were infected with blood products, such as transfusions, prior to adequate screening procedures in the 1980s. There is limited evidence that hepatitis C may be transmissible through receptive oro-genital contact.

Worms

Threadworms, and probably other worms, can be transmitted by oro-anal contact or by fellatio after anal intercourse.

What about herpes?

Herpes simplex virus (HSV) infection is the commonest cause of genital ulceration. There are two types of the virus. Type 1 affects mainly the lip – causing 'cold sores. Type 2 causes blisters on the genitals.

In the past, it was thought that genital herpes was caused almost exclusively by Type 2, but in recent years it has become clear that many herpes ulcers on the penis or vulva/vagina are actually caused by the Type 1 virus.

Genital herpes is characterised by recurrent bouts of vesicles (small blisters), either on the penis or vulva, or other parts of the female genital tract. These rapidly break down to form small, painful ulcers. The first episode is usually associated with an acute feverish illness, which may be quite severe. It frequently recurs, although recurrent bouts are usually associated with a milder illness.

HSV can also cause pharyngitis, an inflammation of the throat with similar ulcer formation. HSV is highly infectious and usually sexually transmitted. It is certainly transmitted by penetrative intercourse but there are several reports of transmission through oral sex. Virus particles are shed profusely from ulcers, either oral (including cold sores) or genital, and infection is far more likely when these are present. Transmission is unlikely, but not impossible, in the absence of ulcers.

If you have a cold sore on your lip, do not give anyone oral sex!

Risk reduction

Please note we are discussing 'risk reduction' and not 'risk prevention'. Avoiding oral sex is the only way of preventing infection by the oral route, but as it is an important and enjoyable part of most couples' sexual repertoire, this advice is impractical. Overall, oral sex seems to carry a lower risk of transmitting infections than penetrative vaginal or anal intercourse.

Limiting the number of your sexual partners and not being pressured into 'casual' sex with an unfamiliar partner is an important way of reducing infection risk. Consider whether your partner may have, or have had, other sexual partners, and what their infection status might be, before putting yourself at any risk by giving them oral sex - or receiving it.

It is perfectly possible to enjoy oral sex using some form of protective barrier. For fellatio, there are a wide variety of flavoured and scented condoms available, ranging from strawberry to curry, and from whisky to lager and lime! For cunnilingus and oro-anal sex, a dental dam - a thin plastic film - can be used.

Remember that condoms can burst and dental dams can slip, so don't think that their use offers absolute protection. These products can be obtained from most pharmacies and many supermarkets. They can also be obtained by post from the Family Planning Association. Write to them to request their catalogue, at FP Sales Ltd, The Whitbread Centre, Rhymney, Gwent, Wales, NP22 5XD.

If you are concerned that you have, or might be at risk of having a sexually transmitted disease, it is important to seek medical advice as soon as possible. Effective treatment is available for most diseases, including HIV. Early treatment is not only important for your own health, but in order to protect your partner from infection.

If in doubt, ring the nearest large hospital to ask where the genitourinary medicine (GUM) Clinic is. Then go along and have a check-up.

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