Think Oral Sex Is Safe? Think You Don’t Need Condoms? Think Again: There’s More to Guard Against Than Just HIV

Condoms, by Trec-Lit

Ever since AIDS came to live among us, condoms have been the principal defence against infection. Used properly, they stop transmission of the virus with near total certainty. But no-one likes them.

And so, as the years have gone by, and the disease has become more manageable, we have gotten sloppy.

Unprotected sex – sex without a condom – is like Russian Roulette. ANY single unprotected sex act can get you infected, but the level of risk varies. Here’s some estimates, according this Canadian website  .

Anal Sex

  • The risk of bottoming is estimated at 1.4%. (1 transmission for every 71 exposures.)
  • The risk of topping is estimated as 0.11% (1 transmission per 909 exposures) for circumcised men and 0.62% (1 transmission per 161 exposures) for uncircumcised men.

Vaginal sex

  • The risk of HIV transmission through receptive vaginal sex is estimated to be 0.08% (to 1 transmission per 1,250 exposures).
  • The risk from insertive vaginal sex is estimated to be 0.04% (1 transmission per 2,500 exposures).

Those look like pretty long odds, even for the riskiest encounters, so you can understand why people have become casual about protecting themselves.

The least risky option has always been thought to be oral sex. The best estimate is that the risk of HIV transmission from oral sex is “very low, but not zero”.

The result has been a worldwide rise in oral sex. Blowjobs have become the new normal for many of us.

Especially if we don’t care for, or simply cannot use, condoms. And no-one uses condoms for a blowjob, right? Now we may have to rethink that attitude.

Because you can get infectious gonorrhoea in your throat from oral sex, and show no symptoms. You could be passing it around unawares. And gonorrhoea is rapidly becoming untreatable.

Gonorrhoea – “the clap” – has been around for most of recorded history. Since the invention of antibiotics, it’s been little more than a nuisance, easily cured with an injection, or a short course of pills. But like many other bugs we thought we had beat, the disease is rapidly developing resistance to everything we can throw at it.

The US Center For Disease Control says:

 Since antibiotics were first used for treatment of gonorrhea, N. gonorrhoeae has progressively developed resistance to the antibiotic drugs prescribed to treat it: sulfonilamides, penicillin, tetracycline, and ciprofloxacin.

Now we are down to one drug, usually given in combination with other drugs, as the last line of defence. One which has already been breached in parts of the world:

 In 2010 a Swedish man contracted gonorrhea from a woman he met on a trip to Japan. He required four times the standard dose of cefitriaxone to eradicate the bacteria.  The following year, Japanese researchers announced that a sex worker in Kyoto was infected with a “highly resistant” strain that was cured only after multiple intravenous antibiotics. A similar case was reported in France.

There is no vaccine against gonorrhoea, and there are no new antibiotics being developed. So unless you like the taste of rubber, blowjobs may have to come off the menu.

But it doesn’t end there. There’s another bug showing up in people’s throats more and more as oral sex increases in popularity. It’s our old friend the Human Papilloma Virus (HPV).

HPV can cause cervical cancer in women, anal cancer in both men and women, as well as genital warts. Now it’s been linked to cancer of the head, neck and throat.

Oesophageal cancer (the oesophagus is the tube that runs from your throat to your stomach) is up 600 per cent in the last 40 years and is now the fastest-growing malignancy in the western world.

According to Professor Shan Rajendra, University of NSW (UNSW) researcher at the Ingham Institute, HPV is present in a significant proportion of pre-malignant oesophageal tissue (Barrett’s dysplasia) and oesophageal cancer.

 “Apart from obesity, smoking and diet, the rise in oesophageal cancer is linked to oral-genital transmission of HPV, as has been the case with head and neck tumours. Previous hypotheses have also revealed that the virus can also be transmitted via the oral route (deep kissing) and, less likely, skin contact,” he said.

There’s an interview with the Professor here. In other words, unprotected blowjobs can lead to cancer. Because almost everyone carries HPV. The good news is, you can get vaccinated. The vaccination is most effective in young people who haven’t been exposed to the virus, but it also offers some protection to adults.

 HPV infection is extremely common; most sexually active people will be infected with HPV at some point in life. HPV infection usually causes no symptoms, but can cause genital warts and anal cancer in both women and men.

In women, HPV infection can cause cells in the cervix to grow abnormally. In a small fraction of women, these HPV-induced changes will develop into cervical cancer. About 12,000 women are diagnosed with cervical cancer each year and about 4,000 women die from the condition.

The HPV vaccine prevents infection by the HPV types responsible for most cervical cancers.

Which brings me back to the grandaddy danger of them all, HIV. There is no cure for HIV, only maintenance treatment. And while Pre-Exposure Prophylaxis (PrEP) – taking anti-retroviral medication every day for the rest of your life – may protect you against getting HIV, it won’t stop you getting untreatable gonorrhoea, or HPV.

So don’t throw away the condoms just yet. And start getting used to the taste of latex.

About the author

Veteran gay writer and speaker, Doug was one of the founders of the UKs pioneering GLBTI newspaper Gay News (1972) , and of the second, Gay Week, and is a former Features Editor of Him International. He presented news and current affairs on JOY 94.9 FM Melbourne for more than ten years. "Doug is revered, feared and reviled in equal quantities, at times dividing people with his journalistic wrath. Yet there is no doubt this grandpa-esque bear keeps everyone abreast of anything and everything LGBT across the globe." (Daniel Witthaus, "Beyond Priscilla", Clouds of Magellan, Melbourne, 2014)