What is the risk of transmission of sexually transmitted infections (STIs) from oral sex, specifically from female to male?

From the Guidelines

The risk of transmission of sexually transmitted infections (STIs) from oral sex, specifically from female to male, is significant, with infections like HPV, herpes, gonorrhea, syphilis, and chlamydia being transmissible through oral-genital contact. According to the study by 1, HPV is the most common sexually transmitted infection in the United States, and its transmission is highly correlated with sexual activity, including early onset of sexual activity and increasing number of lifetime sexual partners. The study also notes that oral HPV infection is 2 to 3 times more likely in men than in women, which may be due to various factors such as men having more lifetime sexual partners, differences in mucosal epithelium, and yet-to-be-defined sex-based differences in the natural history and cofactors of HPV infection.

Some key points to consider:

• HPV can infect the basal keratinocytes of stratified squamous epithelium, which is found in the cervix, anus, penis, vulva/vagina, and upper aerodigestive tract 1.
• The transmission of oral and genital HPV appears to be highly correlated with sexual activity, including early onset of sexual activity and increasing number of lifetime sexual partners 1.
• Oral infection also appears to be correlated with increasing number of oral sexual partners and possibly with open-mouth kissing 1.
• There is an increased risk of transmission of HPV associated with higher-risk behaviors, such as current tobacco use, marijuana use, and alcohol use 1.

To reduce the risk of transmission, using condoms during oral sex provides effective protection against most STIs. Dental dams can be used when performing oral sex on women. Regular STI testing is recommended for sexually active individuals, especially those with multiple partners. Symptoms like sores, discharge, or pain should prompt immediate medical attention, though many STIs can be present without symptoms. The transmission risk varies based on factors including the presence of cuts or sores in the mouth, dental work, gum disease, and the viral or bacterial load of the infected person. Most bacterial STIs like gonorrhea and syphilis can be treated with appropriate antibiotics, while viral infections like herpes and HIV can be managed but not cured.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Risk of Transmission from Oral Sex

The risk of transmission of sexually transmitted infections (STIs) from oral sex, specifically from female to male, is a significant concern.

• Oral sex can transmit oral, respiratory, and genital pathogens 2.
• The oral cavity may function as a reservoir for future spread of these infections 3.
• Certain STIs, such as gonorrhea, can be transmitted through oral sex, and the risk of transmission is increased if there are lesions or unhealthy periodontal status in the oral cavity 2, 3.

Factors Influencing Transmission Risk

Several factors can influence the risk of transmission, including:

• The type of oral sex practice (e.g., fellatio, cunnilingus) 2
• The presence of oral health issues, such as cuts, bleeding gums, or lip sores 2
• The use of protection, such as condoms or dental dams 4
• The prevalence of STIs in the population 5

Prevention and Protection

To reduce the risk of transmission, it is essential to:

• Use protection, such as condoms or dental dams, during oral sex 4
• Practice good oral hygiene and maintain healthy oral health 2
• Get regular STI screenings and follow treatment guidelines if infected 5
• Educate oneself and others about the risks and prevention of STIs 3, 5