is cunnilingus safe sex?

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good morning, doctors. I know that this issue has been addressed a bit in some questions, but i
wanted to get expert feedback on my current situation.

I really enjoy 'going down' on a woman and recently have gone on a bit of a cunnilingus spree with multiple
partners. I have dated about 8 women over the past few months and have not had insertive intercourse, but
have performed cunnilingus on each of them numerous times. Probably in the neighborhood of four or so
times on each woman.

I have some understanding that it's considered safe sex, but i wanted to learn more about actual risk.
I read a post by Dr. Handsfield that indicated he didn't see vaginal to oral transmission of HVSII or HIV
in his clinic over all these years. I just wanted to verify that I am reading/understanding correctly.
I know that bacterial agents and possibly hpv can be transmitted, but the chances of me transmitting hpv
to from my throat to a vagina is very very rare.

can you give me an accurate risk and statistics on HSVII transmission to my mouth? HIV transmission to myself?
And any other comments that you can share. Can you also paste a few older threads from your prior discussions with other patients to your answer.

Thanks!

[Edward W Hook, MD]

I've seen tens of thousans of patients and been consulted on still more.  I do not keep track.  You are getting onto the realm of "what if" questions which are of little use, as I sai.  Brief follow-up answers, then that will be all:

1.  See above.  It has happened- very rarely.  Unless you have symptoms, you have no reason for concern.  If you have symptoms, you should have asked irectly.

2.  The risk is too uncommon to have been effectively and reliably studied.    HSV-2 does not tend to infect the mouth an lips.

Time for us both to move on. EWH

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thank you for elaborating above. I am a little bit confused still, though, and my apologies for that. here are my follow ups

1) in your career, how many times have you see HSV II transmitted from genital-to-oral focusing on the mode of cunnilingus?

2) I understand what you stated about cunnilingus being at the lowest risk for insertive intercourse, but what exactly is that risk? Does HSV II 'like' the musoca of the mouth/lips?

thank you.

[Edward W Hook, MD]

Welcome to the Forum.  We receive many questions from clients regarding STD-related risks.  Within the larger category of different sorts of sexual exposures, I would place cunnilingus at the very bottom of risks related to insertive sexual behavior.  

To elaborate, first let me distinguish between STDs transmitted through mucosal exchange of fluids (I put gonorrhea, chlamydia, trichomonas, and HPV in this category) and those transmitted by direct contact (herpes, HPV, syphilis).   My further comments will be limited to those that are transmitted through exchange of mucosal fluids beyond the following statement about the direct contact transmissions- these infections are transmitted by direct contact between a site that is infected and a site that is not.  All contact does not lead to transmission, in fact, most does not.  Transmission may be enhanced when friction, minor trauma (such that occurs following the friction of intercourse and involved.  Duration of exposure and the numbers of organisms one is exposed to also impact the probability of transmission.   I will not say more about these infections in this reply.

As for the STDs transmitted through exchange of mucosal secretions, anatomy impacts the effectiveness of transmission by affecting the duration of exposure to a partner's genital secretions. Thus the following hierarchy reflects the anatomic considerations that impacts transmission probabilities:  receptive partners are more likely to become infected than insertive partners.  Rectal receptive contact may be more or is at least as likely to result in infection as receptive vaginal sex although there are not formal comparative studies.   After that, insertive rectal and vaginal sex are next more likely to lead to transmission.  Oral sex is least likely to lead to STD transmission and of the sorts of oral sex that might occur, cunnilingus is least likely to result in acquisition of infection.  It is hard to judge whether fellatio or analingus is more likely to lead to transmission.

I hope these generalizations are helpful.  Cunnilingus is, as I said, probably the lowest risk insertive sexual contact a person can have. That however does not mean it is no risk.  I have seen gonorrhea both acquired and transmitted through cunnilingus although only once or twice in my entire career.  I hope my comments are helpful.  If not you may ask one or two follow-up questions about specifics but I will not engage in a prolonged exchange of "what if" or "has it ever" happened questions.  This is not a good use of my time or yours.  EWH