1. Feedback about the excellent job from Dr Hook to transmit confidence to me about my doubts and relieving my anxiety.  Finally I decided to do a 4th gen test and it was negative as he anticipated it would be.

2. Share with other people who consult this forum how my anxiety made me somatize “symptoms” and oversized some daily small pains and discomforts I have, thinking they could be signs of ARS.

3. I would like to better understand the rationale of insertive oral sex risk for my own future decision of risk taking.

From the questions and answers here in the forum, I understood the experts consider insertive oral sex as zero risk due to non documented cases os such transmission. How are HIV transmission reported and generate documentation? Might be some cases hard to prove if lots of information is needed to assure the way of transmission? Could you please bring more light over it?

Additionally, some infectologist doctors in other forums affirm that saliva is not an infectious fluid, and therefore it is not able to transmit HIV even in contact with mucous membranes in the penis. Do you agree with that? 

Thanks and regards

The data on exposure risks for HIV are pretty simple. That the risk is extremely low from oral sex is based primarily on the observation that among people with HIV, few or none say s/he only received oral sex during the few weeks before HIV was acquired. In other words, all persons with sexually acquired HIV have had vaginal or anal sex, and none had only oral exposures. 

In addition, CDC has conducted studies that asked infected persons how and when they thought they were infected and their partners' HIV status, plus data on the prevalence of HIV in the kinds of partners they had. From that analysis, based on the few males who thought it was by receiving oral sex, the risk was calculated at 1 in 20,000 if the oral partner was infected. That's equivalent to receiving BJs by infected partners once daily for 55 years before transmission of the virus would be likely. None of this proves the risk is zero, but obviously such transmission is very rare. (The same analysis found a higher risk in the other direction, i.e. for the oral partner in fellatio -- one chance in 10,000. However, even that is equivalent to daily exposures for 27 years.)

The biological reasons for the low risk for oral exposure are not fully understood, but in the laboratory saliva inhibits or even kills HIV. Presumably this is a major contributor to the low risk, and also partly explains why kissing rarely transmits the virus.

I hope these comments answer your questions. Let me know if anything isn't clear.

HHH, MD

So CDC uses interviews to build the stats what I understand are not based on proven cases, are anecdotal. What must it be done to become a proven or documented case?

At the end we have some few reported interviews that blame insertive oral sex as the way of transmission but also there is not proven cases, and it seems to create this difference of positioning between very low and zero risk. Correct?

That the conclusions are largely "anecdotal" does not necessarily make them unreliable. There are no formal guidelines for a scientifically proved case, but I imagine it would require a newly infected person with a strong story that his only possible exposure in the preceding weeks was receipt of fellatio; documentation that that partner has HIV; and perhaps matching the HIV strains in both persons to document they are the same. As we have discussed, no such cases have been reported.