Can I have oral sex? Can I give oral sex?

Your HPV guide to giving and getting head

Oral sex is a very common subject of concern. So, I thought I’d put together a quick primer post for those who have been diagnosed with HPV infection or whose partners are affected. As a quick note, it feels like people obsess over oral because they believe using condoms for PIV is protective against STD (unfortunately only mitigates but doesn’t prevent transmission), and so oral presents a somewhat greater risk. The reality is more complex.

I have received a diagnosis.

Hi, welcome to the human race. Remember that 80%+ of people will get genital HPV at least once by age 45 – and most of them won’t know it. So, in some ways, you don’t need to feel particularly worried about anything you do or don’t choose to do. STDs are going to find you and your partners at some point. However, on a personal and individual level, STIs can bring a huge amount of anxiety, and understandably, we want to feel at least like we are doing our best to safeguard ourselves and our partners.

I have a cervical infection. Can I give oral sex?

Getting an HPV diagnosis through a cervical smear is the most likely method to discover you have an STD. Understanding that a cervical smear only provides information about your cervix is crucial. It cannot detect infections in other parts of the body. Therefore, you can have a concurrent oral infection (and remember, most oral infections are asymptomatic – a sore throat is more likely caused by another common infection like a cold or strep).

However, oral infections generally resolve fairly quickly (as shown here – 72% of oral infections in young men clear within 4 months). Therefore, detecting an infection on your cervix does not necessarily indicate an infection in your mouth.

Additionally, remember that any person your partner meets could have an oral STD infection right now and would have no idea. So, with these facts in mind, you and your partner might conclude that it’s not a particularly huge risk for you to give them oral sex, given that you most likely don’t have an STD test kit nearby. An oral infection is risky, but it’s not putting them at any more risk than anyone else they might meet.

Can I receive oral sex?

Test Estimates indicate that by 2030, the majority of all mucosal squamous cell carcinomas of the head and neck will be HPV-related. This significant increase in HPV-related OPSCCs primarily affects men (7.8 per 100,000).

Although the natural progression to oropharyngeal cancer is not fully understood, it is widely accepted due to extensive testing that a subclinical oral STD infection persisting for 10–30 years is a necessary precursor to most OPSCCs.

With this in mind, there is some risk to your partner (particularly if male) if they give you oral sex and contract your infection.

Interestingly: Some investigators suggest that performing oral sex on female genitalia (i.e., a mucosal surface) leads to a higher transmission rate of infection as compared to the transmission that occurred when performing oral sex on male genitalia because of the keratinised epithelium of the penis. Additionally, some tests suggest that the keratinised epithelium of the penis is more resistant to HPV infection than the epithelium of the cervix.

However, this risk will be lower if you are vaccinated (from the article). Variant 16 accounts for 70–80% of cases.

If you both get vaccinated, you may find that the relative risk remains low. Even better—both of you are vaccinated!

You may also decide to use barrier methods like condoms and dental dams for oral. There isn’t good data on how well these protect partners, but they would likely mitigate the risks.

I have a cervical HPV infection, and I have a long-term partner with whom I’ve been giving and receiving oral sex regularly.  

Do we need to stop?

People in regular partnerships don’t need to stop having sex. This is because you will already share your infection. This includes oral sex.

However, STD study tests show that using condoms for vaginal sex can help the body deal with cervical abnormalities because of a lower viral load. So, it’s theoretically possible this could also be the case when using barrier methods orally. If you have (or could have) HPV16, the riskiest kind when it comes to oral cancer. This might be one way to lower the viral load for your partner.

Could you encourage your partner to get vaccinated as well? Seroconversion is less likely in men, who are susceptible to catching the same strain more than once. If you have a vaccine strain, it is a good idea to safeguard it further.

I have genital warts. Can I give oral sex?

As above, visible warts on your genitals do not tell you anything about your mouth. Suppose you don’t have visible oral warts (which are about half as common as genital warts, anyway). In that case, again, you are the same as anyone else they might meet who could also have an asymptomatic oral infection.

Can I receive oral sex?

Your partner faces a risk of acquiring an oral HPV infection, according to tests. This doesn’t imply they will develop warts—they may never even know them. Most warts result from low-risk strains that do not cause cancer. However, in some instances, they may be caused by or co-infected with high-risk strains. So, consider using some safety methods (barriers and vaccination) mentioned above.

I’m never going to get oral sex again!!!!!!

It’s very likely that, no matter your situation, you can indeed get back to a full sex life, including oral sex, at some point soon.

Remember that test data reveals the majority of HPV infections are transient. However, we don’t fully understand transmission risks past immune control. Almost everyone has a prior infection, so nobody is any different to you. And that we are all exposed to HPV many times in our lives.

Partners can receive vaccination. You can use barrier methods and abstain for a time. Or partners may conclude that the relative risk is low enough that they don’t mind.

There are lots of ways to give your partner a mindblowing orgasm that doesn’t involve oral. So, if you decide to take a break, perhaps it’s an opportunity to experiment with these.