Literally, a person who performs fellatio. Of course, the main usage is idiomatic: basically, someone who is unpleasant, distasteful, or has insulted or wronged you. One of George Carlin's Seven Words you can Never Say on Television.

The word is quite a serious insult. Usually.
One of my former roommates and his friend would often, and loudly, address each other as "cocksucker", " motherfucker", and such. They did this playfully, almost affectionately. It must have been one of those slapping each other on the back macho guy camaraderie things.

A friend of mine worked for a while as a peer counselor for a college's anonymous (telephone) student counseling service. One evening, a guy calls, explaining how his boyfriend is always mean to him and verbally abusive.

"For instance?"

"Well, sometimes while I'm going down on him he calls me names, like "bitch" or "cock-sucker".

My friend murmurs understanding, then mutes the phone for a moment to talk to her supervisor, who's listening next to her.

<deadpan>"Now, let me clarify here -- he's sucking cock; does that not, in fact, indeed make him a cock sucker?"</deadpan>

3/4 Butterscotch schnapps
1/4 Irish Cream

Pour the schnapps in a shot glass first, then add the Irish Cream on top.

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