[Question #11082] Follow up to question 11025

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17 months ago
Good Drs:
When you say there are a tiny instances of people acquiring HIV through the performance of cunnilingus and know documented cases of hiv being acquired through receptive fellatio - are you simply saying it is a possibility it can occur through performance of cunnilingus on an infected female or there are there actually documented cases where this has occured? 
The reason for my questions is I have reviewed both of your responses in regards to cunnilingus - both of you have said you have not had a patient acquire HIV in this manner where only cunnilingus was performed and there are no documented cases. I understand that no documented cases does not mean it could not be acquired this way. I am assuming these tiny instances are self reported and obiviously such a rarity that there is simply no such conclusive studies in regards to this matter.  Would this be accurate or had the science changed ?
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H. Hunter Handsfield, MD
17 months ago
Welcome back but I'm sorry you found it necessary. You are overthinking all this.

Of course it is "possible" cunnilingus can transmit HIV; neither Dr. Hook nor I ever has said it cannot happen -- only that if it does, it is exceedingly rare. The CDC estimate is once for every 20,000 exposures to a known infected partner (the 1 in 10,000 figure is for the oral partner in fellatio, i.e. for penile to oral transmission). As Dr. Hook said, these are very rough guesstimates, but they reflect the rarity of such events. (One in 20,000 is equivalent to cunnilingus with an HIV infected partner once daily for 55 years before getting infected would be likely. And also is exceedingly unlikely a partner like yours was HIV infected.) Dr. Hook has referred me to a single case report of HIV transmission between two women -- of which I was previously unaware -- but they were regular partners with multiple sexual exposures with one another for 6 months. Whether the virus was transmitted by cunnilingus, kissing, genital apposition, sex toys, or some other particular exposure is not known or knowable. But one case? Reported 12 years ago? Should that worry you for some reason? Of course not. I would still advise you that your risk of HIV during the event you described to Dr. Hook (two threads ago) was zero risk, or very close to zero; and would advise no need for testing.

I hope this settles the issue for you. Let me know if anything isn't clear.

HHH, MD
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17 months ago
Thanks Dr. Handsfield as well as Dr. Hook:
Seems like the chance of getting hit by lighting in any year is 1 in 500000. There is always a possibility that it could happen but what is the probability?  If less than 1 and 1000 women have HIV and the range for performance of cunnilingus range is  1 and 10000 or 1 in 20000 - then its 1 in a million or 1 in 2 million. I realize you can never say never in science - but I assume it so rare one should not be concerned. As for documented cases - it such a rarity - adequate studies have not nor probably will ever be known. Yes thanks for your work and your response. 
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H. Hunter Handsfield, MD
17 months ago
Your figures are in the right ballpark and it is correct that "it so rare one should not be concerned"; and there are no documented cases.---