[Question #9655] Oral Sex

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30 months ago
Dear Doctors:
I have read many of your responses to question's asked in regard to oral sex. I see where you say that there has never been a scientifically documented case of HIV transmitted by performing cunnilingus or recepetive oral, and a few cases where infection occured as the result of performing oral on an infected person. You indicate that it would be rare for this to occur. According to the CDC 1 in 20000 for receptive oral and 1 in 10000 for performing oral on a female or a male. The CDC also states on its fact sheet that there is little to no risk getting or transmitting HIV through oral sex. They go on to say its hard to estimate the risk because people who have oral also have anal and vaginal. 

Have there been studies of couples one negative and one positive that performed unproteced oral?
Also wouldn't it be more risky to perform unprotected oral on a male than a female? Due to semen and exposure to the virus from a female?
I also see where the risk of condom protected sex and performing cunnilingus - you say are about the same? Is that correct?

Thanks
Patrick



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Edward W. Hook M.D.
30 months ago
Welcome to the Forum. Thanks for your questions.  I'll be glad to comment.

For rare or virtually non-existent events such as acquisition of HIV through receipt of oral sex, risks are estimated based on a combination of data sources including studies of known exposure to infected partners, studies of high risk persons with numerous exposures, reports of individual cases based on isolated instances and discussion with other experts.  For the areas your ask of, receipt of oral sex from an infected partner and cunnilingus, we, like the CDC and other expert sources use all of these sources of information.  Thus:

Have there been studies of couples one negative and one positive that performed unproteced oral?
Yes, there have been numerous studies of HIV incidence in persons with known infection.

Also wouldn't it be more risky to perform unprotected oral on a male than a female? Due to semen and exposure to the virus from a female?
Yes, performing fellatio on an untreated, infected person is riskier than cunnilingus- there's not much doubt of that.  While there are no studies with enough newly acquired cases to define the incidence with precision, most experts are aware of and have seen the occasional case in which a person acquired HIV from performing fellatio on infected partners.  OTOH, there are virtually no such cases for cunnilingus.  

I also see where the risk of condom protected sex and performing cunnilingus - you say are about the same? Is that correct?
The risk of each when the condoms are used correctly and consistently are virtually zero.

Hope this helps.  EWH
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30 months ago
So what we the results of the studies? I am assuming that the reason the CDC says there is little to no risk of HIV with oral is because it would require quite a few acts of performing oral on an infected individual for it to occur - this the 1 in 10000
You will have to forgive me - I became sexually active in the late 70's early 80's. As such I have always been or had a hightened aniexty surrounding HIV 
I have had unprotected vaginal sex perhaps no more than twice in my life - and the fear of acquiring HIV was and continues to be overblown for me mentally. Both times that I did I tested negative. I have conversations with sexual partners before we have sex. But I still have that fear. The last time I had sex it was protected vaginal and unprotected oral both ways. My partner was age 42 I am 62 - we talked about testing and safe sex - she said she does not have any sti's. I have no reason not to believe her. Perhaps 10 days post the incident - I had symptoms that truly did not think much about at the time - started with chills - then I had a milld fever - a slight sore throat that lasted about a day - no true body aches - no lymp node swelling - no rash - I was able to drive a car catch a plane - did not feel really sick - and i developed a cough and had green mucus spit up for quite a while - unfortunately my fear took over - although logically I realize that - seeing some of you and Dr Hansfield remarks from others that more than likely it was a cold a flu - respitory or the covid virus and symptoms are unreliable indicators. Some times I get a tingling on left side of my neck. I think I know every indicator of HIV. But also realize that they are more common as well in people with out HIV.
I am choosing to look at this logically and I truly believe that both of you would tell me to manage my fear and there should be no worry about HIV - from this incident - would that be correct?

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Edward W. Hook M.D.
30 months ago
sigh- as both Dr. Handsfield and I have said, if the studies showed person acquiring HIV from receipt of oral sex or cunnilingus, don't you think we would have said so.  Yet what we say is WE HAVE NEVER SEEN OR HEARD (THIS INCLUDES IN THE SCIENTIFIC LITERATURE) OF A PERSON ACQUIRING HIV THROUGH RECEIPT OF FELLATIO.   The same is true for cunnilingus.

You are correct.  I urge you to put these concerns behind you.  Further, from what you say, it sounds as though your unwarranted fears are probably seriously hampering your mental health as it relates to healthy sexuality.  This is something you should address with confidential, professional counseling.  I am not suggesting you are "crazy" just that you need some help in putting these unwarranted fears into a healthy perspective.  I say this out of concern for you- nothing more.  EWH
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30 months ago
I appreciate your honesty and advice. I realize I have just one question left. I of course performed the cunnilingus 
So I have seen that you both say that there is no scientifically proven cases of a acquiring hiv through performance of cunnilingus on an infected person ? Is that correct - there are only claims that some have said that’s how they were infected. 
I appreciate your help 

Patrick

Thank you 
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Edward W. Hook M.D.
30 months ago
This is a repetitive question for which the answer is not going to change.  Reports of HIV acquisition due to cunnilingus are unproven.  All too often persons understate the nature of their activities making self-report sometimes suspect.

This completes this thread.  Please don't worry.  EWH
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