[Question #7428] Clarification on HIV risk for insertive oral and cunnilingus menstrual blood

4 months ago
Hello Doctors,

Until 2015 or so on MedHelp, inquiries about all events of oral sex, regardless of menstrual blood,  were given a point blank “no HIV risk” declaration.  (Setting aside other STD’s here for now. ).  I recall HHH’s comment that “if you stick with oral sex and condom protected vaginal or anal sex you have no HIV worries and very little (though not zero) other STD risks”.  Couldn’t be more clear.  Now, I recently see some qualifications to these answers.  I am feeling nervous about some incidents and would appreciate your response.  

My facts:  during a month separated from my wife, I received oral sex from two woman, and gave them both cunnilingus. Total events  3-4 times.  One woman was unknown status, the other is a Bangkok bar girl who claims she is tested negative regularly. Probably but uncertain. Once, the second woman’s period began during cunnilingus (which I immediately researched on this site and others,  told “no-risk / no worry”  (per Garcia, Handsfield, others).  There was one condom protected vaginal insertion, with no unusual events.

 Can I  walk about from this without concerns for need to test HIV nor fear of transferring HIV back to my wife (who I am now reunited with)?  

Noting:   from 2019 HHH, a different remark from pre-2014 responses:  “... A few cases of penile to oral transmission clearly have occurred. [what?!]  If your only exposure are receiving oral sex (i.e. you are the insertive partner in fellatio) or performing oral sex on women), you can consider yourself risk free in regard to HIV [good!].  

Could you reassure me please, given my specific events: insertive oral and cunnilingus with a small menstrual leak,  condom protected vaginal, am I free to proceed without HIV  testing or restricted sex with my wife? 
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Welcome to our forum and thanks for your question. Medical knowledge and, specifically knowledge about risks for transmission and acquisition of HIV continue to evolve. You are correct that in the past we both indicated that there were no data to suggest that oral sex in anyway lead to risk for acquisition of HIV.  Evolving medical knowledge has changed that slightly. 

Oral sex remains the safest of all potential varieties of non-condom protected penetrative sexual activity. There are still no proven cases in which HIV has been acquired through receipt of oral sex or cunnilingus. In contrast, there are a small number of cases of HIV which have been acquired through performance of oral sex (fellatio) on an untreated HIV-infected partner.  The CDC currently estimates a risk for acquisition of HIV from performance of fellatio on an untreated, infected partner as being less than one infection per 10,000 (in other words, 99.99% of such sex with infected partners will not lead to infection).  Further, it is reasonable to think that since even extraordinarily rare events do occasionally occur, someday, somewhere someone will require HIV through receipt of oral sex or cunnilingus.  That does not change the fact that the risk of infection is extraordinarily low. 

I would not be concerned about the sexual encounters that you describe.  You do not know that your partners had HIV and statistically it is unlikely that they did. Even if they did, as described above, the risk of infection is very very low. If that information is insufficient to address your concerns, an HIV test at this time would be entirely conclusive.

I hope this information is helpful to you. EWH