[Question #10359] Oral Sex and HIV worrying

23 months ago

I met another guy and He performs oral sex for me (his mouth on my penis). after finished I noticed that he had a razor wound on his chin. he might have shaved earlier in the day and incurred this wound before our activity in the afternoon. The wound is approximately 2-3 cm in length, still red, and while it's not actively bleeding, it could potentially bleed if touched.
This left me feeling worrying. I'm not sure whether the blood from this wound could come into contact with my penis during oral sex as blood is the most concentrate of HIV. Could you please reassess the risk of HIV transmission from receiving oral sex, taking into account this specific situation, Will it differ from our previous discussion?

H. Hunter Handsfield, MD

23 months ago

Welcome back, but I don't understand the need. True this particular question isn't exactly like your two previous ones, but it's close. Exposure to a bit of blood carries no risk of HIV. Here's an example of how hard it is to catch HIV, even when blood is involved: If a male has unprotected vaginal sex with an HIV infected women (who is not being treated for HIV), his risk of being infected is one chance in 2,500. That risk is exactly the same if the woman is menstruating, i.e. if his penis is in direct contact with vaginal blood for 5-10 minutes. This being the case, what level of risk could possibly result from the minor possible blood exposure you describe? In other words, the quick answer to your question "Will it differ from our previous discussion" is no, it does not.

In a way, health educators and public health experts have done a poor job in educating the public about blood as a risk for HIV. Many sources just say things like "contact with blood" or "exposure to blood" as carrying a chance of HIV transmission. Typically such advice does not address the AMOUNT of blood exposure required, or the nature of the contact necessary. If you were to provide aid to a motor vehicle accident or gunshot victim and, with blood all over the place and you got lots of the blood on your hands or face, AND if that person happened to have HIV, you MIGHT be at RISK of catching it. Even in this circumstance, most people would not be infected.

Finally, going back to oral sex as your main practice with commercial sex workers: As discussed in your two previous threads, there has never been a scientifically proved case of HIV transmitted mouth to penis. And if you think about it, among the billions of such exposure that have occurred, obviously there was blood contact in some of them -- millions of times (like bleeding gums, cuts in the mouth, recent dental work, etc, etc). And still no known cases of proved HIV transmission. These facts do not mean oral sex can never result in HIV infection. As discussed last time, probably it can. But it's so rare that you can ignore it. You could continue to have the sorts of sexual exposures you have described once daily for your whole life, with or without a little blood involved, and never expect to catch HIV.

I hope this settle things for you, but let me know if anything still isn't clear.

HHH, MD

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23 months ago

Thanks, Dr.Hunter My primary need is to obtain confirmation that the razor wound on his chin, which is in the process of healing and appears slightly red but is not actively bleeding, does not alter the assessment of the HIV risk of Oral Sex as discussed in previous threads. the blood from his razor wound is my main concern. but your answer helps me a lot. So Can I summarize this way? 1) The risk of this exposure is very close to zero and No proven case before which I will not be the first ? 2)NO HIV test is needed from this exposure and I should not worry about it? 3) Should I take Prep before receiving an Oral Sex or more riskier event like Giving Oral Sex? it's an education system in my country that always tells that HIV is very risky, easy to contact, and stays away from Blood/Semen.

H. Hunter Handsfield, MD

23 months ago

I understood the reason for your question, but still it seems to me the absence of significant risk should have been clear in your previous two forum discussions.

Your first two summary statements are correct. As for PrEP, most experts would recommend against it for a sexual exposure with less than one chance in 10,000 of infection. Even that low risk is only if a partner has HIV. Assuming a 10% chance a partner is infected, the actual risk would be one chance in 100,000. Unfortunately, I can do nothing about the obviously mistaken educational information available in your country, but clearly you have online access to accurate information.

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