1) Cunnilingus, previously said consistently for years there are no known cases, so previously considered little to no risk. Recently, I noticed Dr. Hook mentioned in a couple posts within the last few months there are a few cases of HIV transmission with cunnilingus. Are these new discoveries and does this mean there is a meaningful change to risk assessment with cunnilingus?

2) Condom protected vaginal sex - condoms are highly effective, but not zero risk because there is a 1% of rupture and over time with more partners and more acts, risk of human error also increases. Hence there is a need for periodic testing. However, on a per act basis with proper use and no failure, transmission is reduced by more than 99 percent or perhaps more than 99.9 percent? 

3) Insertive fellatio - no known cases to date, little to no risk. If a condom is used, there is no risk.

Thank you.

1) Correct, cunnilingus is considered to carry little or no risk for HIV. I wonder if you misunderstood something from Dr. Hook; I am unaware of any documented cases of HIV transmission by oral-vaginal contact. In general, oral exposures are low risk. In any case, even if there have been a few such transmissions, it is so rare that I would continue to consider it zero risk for all practical purpose. To my knowledge, there has been no knew knowledge or generally accepted information this in the last couple of decades.

2) These figures are about right. The key, of course, is consistent and proper condom use. But be aware that on average, consistent condom users probably have around 90% reduction in HIV risk, not 99%; because in the real world, condom use often is not consistent and correct. Obviously, each individual has a lot of control over the error rate.

3) This statement also is correct according clinical experience. There have been no new published estimates in recent years.

Another factor to keep in mind is the low rate of HIV in sexually active women in the US and most industrialized countries, especially in women who are not sex workers or injection drug users.

Thanks again. Let me know if anything isn't clear.sf

HHH, MD

To clarify regarding condom use - It sounds like the figures I mentioned are about right with respect to biological effectiveness, correct? However, in reality effectiveness with people who claim to be consistent users in these large studies is lower because these people may not actually be that consistent in their use or human error is there. In summary, the user effectiveness is about 90% in the broad population but the biological effectiveness of condoms is >99%. Is that fair to say?

Regarding HIV rates in sexually active women in the US, the chance one has untreated HIV is less 1/1000, correct?