[Question #6545] Getting the latest info

13 months ago
Dear Doctors,

I have recently rejoined the dating world after a long stretch and wanted to make sure I was up to date on current thinking around safe sex and HIV, especially as a gay man who lives in a large city.  I know that kissing presents no risk and that unprotected intercourse is certainly a risk but I'm not clear on what the latest thinking is around performing oral on someone. Everyone on various sites seems to agree that giving a blow job is low risk but some people make it sound on par with being hit by an asteroid whereas others make it seem much more likely than a freak occurrence. (Everyone also seems to agree that GETTING a blow job is basically no risk, so I am only really concerned about giving one).

At this point, in 2020, what are your feelings about the likelihood of getting HIV from performing oral sex on a positive partner? 

Also-As someone with HSV2, I am aware that my risk of contracting HIV increases. My infection is genital but have always wondered if I might have type 2 in my mouth in addition to  my genital infection. I know having oral HSV2 is rare, but if hypothetically I was one of those few people who had HSV2 orally would that increase the getting risk HIV from giving a blowjob? Or is the increased risk of HIV for HSV2+ people only associated with herpes in the genital area. 

Thanks for you time and expertise!
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Welcome to the Forum and thanks for your confidence in our service, as well as your commitment to your own sexual health. I'll do my best to help. 

HIV risks.  There is clearly a hierarchy of risk for acquisition of HIV for sexual activity involving an untreated, HIV infected person.  For a male with other men as ex partners, the highest risk activity is unprotected receptive rectal intercourse where the risk for infection is about 1 infection for every 100 exposures on risk.  With unprotected insertive rectal intercourse the rate falls to about 1 infection, on average, per 1000 exposures.  Oral sex, giving or receiving is lower than that. The CDC lists for receptive oral sex and active oral sex as being "low" risk but do not provide a number.  In the past the CDC estimate was that performing oral sex on an infected partner led to infection in about 1 our of every 10,000 exposures and indeed, we are aware of occasional instances in which performing oral sex has led to infection.  OTOH, while I have to presume it is possible, neither of us on the Forum has ever seen or heard of a person acquiring HIV from receipt of oral sex. 

Two other important caveats related to sex with potentially HIV infected partners.  First, there appears to be virtually no risk for acquiring HIV through sex with an infected partner who is on effective HIV therapy and whose virus has become undetectable in the blood (only about half of persons on HIV therapy accomplish this).  Second and perhaps ever more important for you as you re-enter the dating scene is the pre-exposure prophylaxis (PrEP) with anti-HIV therapy is considered safe and reduces the risk for infection among persons having sex with HIV infected partners to virtually zero.  You may want to consider exploring PrEP with your own health care provider or a local HIV-prevention program.  I should emphasize however that PrEP does NOT prevent other STIs and for unprotected exposures, regular testing (most experts recommend every 6-12 months) for other STIs is important.

HSV.  Studies suggest that persons with HSV-2 infections are at somewhat (about 2-3-fold) increased risk for acquisition of HIV if exposed, even if lesions are not present.  The role of the location of HSV-2 infection is not clear but as you mention, oral HSV-2 infection is so very rare that I would not be too concerned. 

I hope that this information is helpful.  Stay safe. EWH

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13 months ago
Dr. Hook,

Thank you so much for your response and input! 

You mentioned that in the past the CDC listed the per exposure rate of performing oral sex on a pos partner as 1 in 10000. Is that still the case? In your opinion/experience does that 1 in 10000 number sound about right or do you think it might be something different?

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
The CDC no longer lists the 1 in 10,000 estimate on its website, having changed the assessment as "low" without quantification.  I suspect the 1 in 10,ooo estimate for acquisition of performing oral sex on an HIV infected person is in the right ballpark.  The are unquestionably cases in which persons have acquired HIV through performing oral sex on HIV infected partners.  EWH---
13 months ago
Thanks Again Dr Hook!
13 months ago
Dear Dr. Hook,

A quick update: After your response I was inspired to check out the CDC website and I was interested to note that they specifically referred to the oral sex/HIV risk this way:

'There is little to no risk of getting or transmitting HIV from oral sex'

And later in the site: 

'The chance an HIV-negative person will get HIV from oral sex with an HIV-positive partner is extremely low.'

And yet I know that you said there were  documented cases of unequivocally oral transmission. I guess that I (and probably a lot of people) am  having a hard time knowing just how nervous to be if someone I gave oral sex to was wrong (or flat out lied) about their HIV status. I have always, without fail, asked about HIV status before doing any act that has the word 'sex' in it, which Im sure probably lowers my risk, but not everyone is aware they are positive. Maybe this is simply an impossible question for you to answer with any further specificity. 

To my mind there is a big difference between 'low risk' and 'on par with getting struck by lightning' but scientifically they might all kind of mean the same thing in terms of determining risk.  Any further thoughts?

Also, please advise me if this new question warrants an addition purchase. It is in no way my intention to take advantage of this site. 

Thanks again!




Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

I believe that I provided you with numbers and an explanation to your question above.  FYI, your risk lifetime risk of being struck by lightening is about 1 in 10,000, the same as the CDC's prior estimate of getting HIV from performing oral sex on a person with untreated HIV.

As I said above, there is no doubt that persons have acquired HIV from performing oral sex on persons with HIV but it is rare, particularly when compared to participating in rectal intercourse.

Finally, I would encourage you to talk to prospective partners about their HIV status and when they were last tested for HIV.  You are correct that some persons might not tell the truth but my bias is that most people are honest when asked the question.

This is my 3rd response to your questions.  As per Forum guidelines, the thread will be closed in a few hours and there will be no further replies.  I hope the information I have provided is helpful.  EWH

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13 months ago
Dr Hook,

Thanks for clearing that up! Apologies for basically asking the same question twice. I got little confused because I wasn't sure what the implications were (if any) that the CDC used to list the 1 in 10,000 figure and then changed it to the more vague 'low.'

 I appreciate your  time and expertise!