I was hoping to get clarification about kissing and HIV risk. In #4488 from 8 months back that Dr. Handsfield mentioned "There are a very few reported cases of HIV transmitted by kissing, but it is rare." In question #3416 from 16 months back Dr. Handsfield mentioned "I'm unaware of one case of HIV scientifically documented to be acquired by kissing." I believe in the numerous other threads on this form regarding kissing and HIV risk, both Dr. Hansdsfield and Hook mention no known cases and risk is zero even with extensive deep kissing with cuts, bleeding gums, oral sores, etc.

Was the response in question #4488 in reference to reported but not proven cases? Sorry if this question is very nitpicky, but from a scientific curiosity standpoint I was wondering. I feel it is important to have the distinction, particularly with other sources like the CDC calling kissing low risk but do not flat out say zero risk. I think mentioned by Dr. Hook before  - the CDC tend to give overly conservative statements which can cause unnecessary anxiety in people. I do think that calling something low risk vs no risk is a huge difference and wish the CDC would declare publicly how many proven cases there are with each sex act - for the sake of clarity and to eliminate doubts. Another example would be receipt of fellatio which has currently no proven HIV transmission cases but CDC won't say no risk. Am I correct in this understanding and sentiment?

Thank you.

Welcome to the Forum and thanks for your question.  Dr. Handsfield and I do not read each others' replies and I had not read his response to question 4488 until just now.  Dr. Handsfield is unavailable for a few days so I cannot check with him but to my knowledge, neither of us has ever seen or heard of a case of HIV transmitted when kissing, even deep kissing with mouth sores of blood has led to acquisition of HIV.  It is, of course theoretically possible- there are very small quantities of HIV present in saliva but it is also theoretically possible you'll be struck by lightening while reading my reply.  Neither is something to worry about (not trying to be cavalier here, just realistic).  It's just that there is no such thing as "no risk".

As far as the CDC is concerned, you are correct. In my (our) opinion(s), they are overly conservative and this creates concerns for anxious folks.  The same is true for acquisition of HIV from receipt of oral sex.  For both kissing (or any sort) and receipt of fellatio, there are no reported cases of HIV acquisition as a result of the process and there have been literally millions and millions of such exposures.  It is not something to worry about.

I will discuss responses to 4488 with him when Dr. Handsfield is available and report back.  While I cannot do anything about the CDC's overly conservative stance, I can check with him.  Stay tuned.  EWH

From your expertise, is there a recommendation for periodic testing for HIV and STI, if the only sexual activities are deep kissing and mutual masturbation, even if having had more than one partner over time? 

I am a single straight man and I decided to stop having vaginal sex with any new partner until I am in a truly committed relationship. But being in the dating scene I have engaged in deep kissing and mutual masturbation with more than 1 partner. I had HIV and STI testing last month (negative results). Moving forward, I am thinking that because I am restricting activities to just kissing(including deep kissing) and mutual masturbation, testing should not be needed if I am abstaining from penetrative sex until being in a relationship. Is this medically correct and can I move forward with this perspective? 

Before I address your follow-up question, let me report to you that I spoke with Dr. Handsfield who agree with me.  While there is HIV present in small concentrations in saliva, there are no proven cases in which HIV was transmitted though kissing, or by receipt of fellatio.  Thus while this remains a theoretical possibility, given that millions and millions of times persons with HIV have kissed or performed oral sex on an uninfected person, it should be considered a no risk event with no need for testing.

Regarding your second question- if your exposures are limited to deep kissing and mutual masturbation, there is no risk of HIV or, for that matter, other STIs and therefore no need for testing.  EWH

I have confidently considered deep kissing no risk over the years, but when I saw that particular thread I wanted to find out if something had changed and it was no longer considered no risk. But it sounds like over the years, nothing has changed with respect to deep kissing and being no HIV risk. In fact with oral transmission, over the years of the epidemic, oral transmission risk assessment from mouth to penis and cunnilingus changed from previously 1/10000 to zero with no proven cases. Penis to mouth remains very very low, possibly zero, with only a handful potential cases. This is all true, correct?

I do understand that theoretical risk exists - but figure this would take truly bizzare circumstances - i.e. two people deep kissing with abnormally profuse active oral bleeding (like >hundreds of mL of fresh blood from both people) and one person is HIV+ with the highest of viral loads. If this happens, then maybe there might be a small chance of transmission. Is this the correct thinking?

I am aware this is the 3rd follow up I am allowed and want thank you for the incredible work you do. As somebody in the medical field myself, I can attest that even basic sexual health knowledge can get muddled and stigma can be tagged when it comes to clear and honest discussion. It is so valuable to have experts like you, Dr. HHH and Ms. Warren to provide clarity for so many that have a need for accurate sexual health knowledge. In fact, I wish this level of understanding could be broadcasted to the broader population as a whole! (In my humble opinion)

Your summary is correct.  As far as penis to mouth transmission, there are a very few cases in which persons have acquired HIV from performing oral sex on an infected partners.  These cases are so very rare that they cannot be systematically studied and are a scientific curiosity but they do happen.  OTOH, there are no documented cases of HIV which have been acquired as the result of the receipt of oral sex (fellatio) or performing cunnilingus on an infected female.  The "official" risks cited by the CDC reflect their conservativism and fear of being wrong more than anything else.  Similarly, in matters such as these, the internet is not your friend and will lead you astray.

Regarding the risks of deep kissing, please understand that virtually every weird and strange thing that might have occurred probably has, yet there are no documented transmission events.  Thus, just as it is "theoretically" possible that your could be struck by a meteorite falling from the sky while reading my response, in real world terms is just not a big enough possibility to worry about.  

Finally, thanks for your thanks.  We do our best and hearing that we are at least sometimes effective is a reward in its own.  EWH