conflicting evidence? - and my risk

[jfunky1]

Dear Dr,

I've read what's been written on this site about the risks of deep kissing. According to your collective view (as I understand it), there is no risk from deep kissing & a person who french kisses an hiv + person does not need to be tested for HIV.

I've been reading on the CDC website, and other expert forums. I've found some academic articles which dispute what is said on your site about deep kissing. According to other experts, there IS a low risk from deep kissing, a the risk is higher if one or both parties have gum disease or cuts/sores in the mouth. Moreover, one case of transmission is documented and doctors now advise against deep kissing a person who is known to be HIV +.

The reason I am asking about this is because I am confused reading these discrepancies, and also because I am very worried over personal encounters I had. About four months ago, I deep kissed two sex workers. I have gum disease and my gums bleed. I was not bleeding when I kissed them, but my gums were sensitive. I did not see cuts in their mouths. I am very worried (and feeling very guilty) because I have a wife and baby, and the baby is being breastfed. I cannot have an HIV test for another ten weeks (because I am in a country that does not keep those tests confidential). I do not know if I can have sex with my wife or not, and I've been avoiding her for a couple weeks. Moreover, adding to my worry is that I have had a mild flu -- with really constant wet cough, stuffy nose, mild nausea, off-and-on low fever, fatigue and weakness -- for three weeks!

So, I guess I am asking two questions here, if that's okay: first, what is the deal with all the differences of opinion on deep kissing; and second, how at risk am I given the behavior I engaged in, my gum disease, and the fact that I've been feeling crummy for three weeks? (I mean, assuming they had gum disease and our kissing was deep and prolonged (a few minutes each time), what is my risk?)

Thank you

[Dr Sean Cummings]

Thanks for the comment and thanks to BeSafe2010.

It is difficult when collecting data to know exactly what people have done and even when they are asked and given lots of opportunity to answer many people forget/prefer not reveal etc and this will confuse the issue.

Best wishes to both of you, Sean

[BeSafe2010]

I doubt the doctors will answer your comment.  Quite frankly, they'll probably view it as too low a priority relative to other posters' questions.  But before others read your comments and freak out here's some commentary of my own.

1.  The American doctors on this forum have frequently commented on how the CDC is an extremely conservative organization that "can't afford to be wrong" no matter how theoretical a "risk" is.  I too have read posts about one case of kissing but it involved participants with terrible bleeding mouth ulcers or something; others comment on how the anecdote might not have even been confirmed.

2. Saliva simply does not transmit the virus, so for kissing to transmit, a whole lot of blood would have to be present (and who kisses with bleeding mouths, anyway?) and even then it's probably super unlikely.

3. If kissing transmitted the virus--and given how common it is--then after close to 30 years of the epidemic, specialist doctors like the ones on this forum would know by now.  Negative partners of positive individuals that are tracked in long-term studies stay negative when they always use condoms correctly for penetrative sex.  Do you think they never kissed?

BOTTOM LINE:
(1) the more you think about this stuff, the more paranoid you will get, so let it go;

(2) the doctors have seen everything and as experts and medical professionals they probably review the latest research on transmission and on the virus itself regularly, so when they say 'no risk' they mean it; and

(3) kissing is no risk, mate.  

[jfunky1]

Thanks, Doc, for answering my question. I have to say, though, the response still doesn't address why other experts -- with all due respect for your expertise and experience (and I do respect it a great deal!) -- have different conclusions.

The point is not whether I am a medical scholar and understand academic literature. The point is that other SCHOLARS and experts HAVE drawn these conclusions based on evidence they've deemed valid. Why is the CDC officially recommending that no one open-mouth kiss an HIV-infected person, claiming not a theoretical risk but a real risk based on at least one known case? I referenced at least one published journal article, and one actual case (which I am surprised you haven't learned about in all your years of studying) of hiv transmission through kissing. Moreover, if there is only one case, that doesn't mean the odds are 1 in 85 million, as you said. That simply means only that 1 of the 85 million cases found are due to kissing. It doesn't mean that a person who kisses an HIV positive person has a 1 in 85 million chance of being infected. The reality happens to be that most people don't deep kiss while doing nothing else. And, moreover, people who deep kiss anonymous people probably have other more risky sexual relations, and it would be difficult to pinpoint the precise cause of infection. So, there are lots of reasons why --- when hiv positive people are evaluated --- we only find an extremely rare case of hiv transmission through kissing. In reality, though, it could be higher. Unless someone sets up an experiment whereby a thousand randomly selected HIV negative people are caused to kiss HIV positive people in different experimental conditions (with and without gum disease, etc), the evidence will not be conclusive.

No disrespect. I really do respect your expertise, which is why I paid money to ask a question on this site. I'm just not totally convinced of the evidence against hiv transmission through kissing and am wondering if experts on this site and others need to temper their advice to people a bit.
thanks again,
questioner

[Dr Sean Cummings]

Good Morning,

You are not at risk of acquiring HIV through deep kissing - you will not acquire HIV this way.

Without wishing to demean you I would suggest that a few hours reading on (good) websites such as the CDC is not a substitute for 9 years of rigorous academic training and a total of perhpas 25 years clinical practice per person together with an automatic ability to porcess complex data and also to correctly apportion that data in terms of medical /scientific importance.

I would ne keen to see the reference to the academic articles - I'm not interested in general unreferenced statements that things are "theoretical possibilities etc" - I'd like to see the hard data, how it was collected, what the sample size was, what technique was used, who the researchers were, where the data was published etc etc etc so on the basis of what you have said so far, I am not convinced that the collective view expressed here on Medhelp is wrong.

To date there have been in excess of £85 million documented cases of HV through the world. Many of these have died and I think most of us writing on the Forum have vivid recollections of the early days when people were dying in huge numbers and very swiftly. That landscape has been entirely transformed due to 1) highly active medications and 2) better education.

Deep kissing with or without gum disease is simply not a route to transfer HIV. If you truly have found one case then the risk is 1 in 85 million onthe basis of what I have said above.

best wishes, Sean