Another Nail in the 'Oral Sex is a HIV risk' Coffin

From Dr. Bob..........


'There was a recent study of 198 gay or bisexual men in San Francisco who said they only had oral sex for a year. Thirty-nine of those performed oral sex on HIV-positive partners. Thirty-five of those did not use a condom and 16 reported swallowing. No one became HIV positive during the study..

NO ONE! Not one! Over a year! Think of the buckets of sperm swallowed! Think of the mouth ulcers! Not one case of transmission. Not one.

Add that to the Spanish Study and I think it's safe to say that there ain't no HIV risk in oral sex.

While Dr. Bob says the study is too small to say that there is definitely no risk in oral sex, the Spanish study included nearly 200 serodiscordant couples and followed their unprotected oral exploits over a number of years - 19,000 exposures - so therefore we have a study that says oral sex is safe. Totally safe.

So please stop worrying about oral sex y'all!:)

[THING]

are you serious what about eating a girl out

[mike_no]

Should be yummy....lol
You need to have a worse oral condition
and every thing else remains the same as per what dobber has mentioned
practically, no risk

[bk4291]

Hi dobber!
just ot so sure that's fully convincing. You see, my situation, for example, is a cunnilingus based risk; everyone in online forums says no/miniscule risk.

But yesterday, i had my eight week test; spoke with a health advisor (who's been doing the job since before HIV was identified) who told me not to worry, low risk etc. She also told me that in my particular GUM clinic they HAD been able to prove ONE case of cunnilingus acquired HIV, but that that person had had a massive ulceration in his mouth at the time.

So this is why i have a real problem accepting the NO RISK thing; believe me i would love to! But the truth is that variables do affect HIV transmission. The health visitor said that four things would have to be true for there to be a chance of HIV positivity through oral; 1. partner has to have HIV 2. viral load high 3.quite a bit of infectious fluid involved 4. access to bloodstream through a sizeable open wound.

I have to say, having spoken to quite a few people about HIV lately, this person was the most honest and knowledgable of them all. I was more assured by her saying "slight risk, but just look at all those factors that would have to go against you" than i was by all the people that say no risk, because it just seems more realistic.

What i'm saying is, for the vast majority of people performing oral sex there would be no real worry. That i agree with. But there is risk, however slight; i read in one post by the doctor that if someone reported to him with cunnilingus on KNOWN HIV positive woman he would probably recommend a test. But the truth is, none of us would even be on this forum if we didn't think there was a good chance we'd had contact with HIV.

My line; oral not no risk, but very low risk. But for most, like the good doc says, "too low to worry about."

[dobber21]

'She also told me that in my particular GUM clinic they HAD been able to prove ONE case of cunnilingus acquired HIV, but that that person had had a massive ulceration in his mouth at the time'

The only way they would have been able to prove that is if they had been there while the guy was performing cunnilingus to CONFIRM that there was no other risk. Remember people lie. The guys at the GUM clinic are brilliant they really are, but all they can go on is what they are told. For all they know the guy could have had anal sex with the girl immediately after cunnilingus. Sex remains taboo (unfortunately) and this prevents people from telling the truth the whole truth and nothing but the truth in these instances.

So you have, on one side, one SUSPECTED - and that's all it is unless there is video evidence of the guy's ENTIRE sexual history, which is clearly impossible - case of cunnilingus transmission, and on the other you have a study of 190+ couples where one was negative and the other positive, 19,000 instances of unprotected oral sex, risk such as oral ulcers and swallowing, carried out over a three years.

And not one case of HIV transmission. Not one.

Who are you gonna believe?

I'm not saying the GUM nurse is lying. I'm just saying the guy most likely had other risks

[bk4291]

I agree with you insofar as even i winced when she said "we were able to prove." I thought "er, how exactly???!!" But she also said that this guy's risk was with a Thai sex worker. Why would he lie about cunnilingus; the bit considered "shameful" is already done. In fact, cunnilingus is arguably more intimate than anal/vaginal sex; looking back i can't believe i did that myself with someone i didn't know. And the clinic, despite the fact that it flew in the face of medical perception, obviously believed him over time. I just don't have reason to doubt the info and i think that's how the clinic felt.

Take me, for example. If (and i do realise it's an if) i were to test pos after my potential exposure and tried to say my only exposure was cunnilingus, i KNOW many would laugh me out of town. I've seen it happen on other forums. I just think there comes a point where you have to say "I've already admitted to sexual contact with a sex worker, why would i lie about what type it was?" I accept that some might; but many wouldn't.

All in all, you are right that it hasn't been PROVEN to happen. But the studies that we always talk about very rarely, if ever, take into account viral load, oral ulcers and other such variables. Presence of other STD's? This is a major factor in transmission risk, yet i haven't seen ANY oral sex studies that focus on people with genital herpes and HIV (and probably never will.)

It's an interesting topic though. I just don't think i could say to someone concerned about oral "no risk" because i think there's just enough evidence to say there is risk, however small.

All that said; you're a legend on here Dobb!

[dobber21]

Thanks for the thanks!

But the studies that we always talk about very rarely, if ever, take into account viral load, oral ulcers and other such variables.

The Spanish study did. Look, I know you're worried, and that you'll test. And yes, nothing is impossible. But I  know you'll test negative. I know it. I know you didn't have a risk.

And there are far, far more taboo things to do with a CSW than what the guy said.

For me it boils down to a study that delivered a 100% result. How often does that happen in Science? Against that you have a guy who SAYS his only risk was cunnilingus on a Thai CSW, which in comparison with other risks, eg participation in an orgy in a bath house, is both more forgiveable and less embarrassing.

You say you have no reason to doubt the guy's story. Yet you don't even know him.

And you doubt a 100% reliable scientific study that took years to complete....

You're worrying over nothing! I assure you!:)

[hellothere123]

hey guys,
I too am worried about an oral incident and would also love to believe that it can't happen.  However, I have to agree with bk.  Sure the risk is small, we all agree on that, but it is not non-existent.  The study that Dr. Bob cites is hardly evidence that there is no risk with oral.  The study only really includes 35 people who performed unprotected oral sex with HIV positive people, and that's an incredibly small sample size when the risk cited by the CDC is 1 in 10,000.  Assuming the 1 in 10,000 is correct, we wouldn't really expect to see seroconversion in our sample size of 35.  The Spanish study is the best piece of evidence I have see, but it is also not conclusive.  We are talking 19,000 acts of oral sex, but many of those include cunnilingus or oral sex without ejaculation, both of which carry negligible risks.  So we can assume that maybe we are talking about 10,000 episodes of unprotected oral sex with ejaculation.  How many seroconversions can we expect to see? About 1.  So we got 0 and that's not too far off.  See what I am saying?  So current thought remains that oral sex is very low risk, but that risk still exists.  Especially when so many people claim to have gotten it that way, it is hard to ignore as a risk.  Sure you can never PROVE anything, but you can't prove someone got it through vaginal either if you weren't there, right?  When enough people who have very little or no reason to lie are claiming something, you kind of have to take people's word for it at some point, no?  Anyway, I find this discussion interesting and thank you for posting it.  I'd be happy to hear any other response or comments you may have:-)

[bk4291]

I see where you're coming from dobber and i take your point about "far more taboo things", but i think the point that hellothere makes ("so many people claim to have gotten it that way") is valid; you see, it isn't just this one guy i'm talking about.

The impression i get from Doc H and certain other sources out there is that claims are made for oral sex transmission, but are rarely listened to. UNTIL (if) infection is PROVEN in a study such as those we have been talking about, such claims will most likely continue to be ignored. I dunno, suppose that just doesn't sit well with me; the idea that possibly crucial voices are being essentially ignored because the major factors (anal/vaginal sex, IV drug use) are the ones people believe everyone gets infected by.

Having said all that, yes people can and do lie. Just think that sometimes the science isn't as conclusive as it looks. As far as the studies go, hellothere has got a good point; they DO NOT PROVE that it can't happen, just that in these 19000 (yes, that is a lot!!!) assorted acts it did not.

I suppose what this whole thing comes down to is "no risk" versus "low risk." For me, i wouldn't want to tell someone they had no risk when in fact there is every possibility they did; we just don't have the evidence for it yet! I respect Doc H a lot, but thats something that makes me think; in some posts he says "zero risk" while in other similiar/identical cases he says "low," and if anyone questions this he says "splitting hairs!" :) Well i actually think the difference between low and zero is clear and makes a big difference to posters on this site. A low risk exists; a zero risk does not. And for me, the jury is still out on oral. But i hope my suspicions are wrong wrong wrong!!!

:)

[monkeyflower]

"cunnilingus is arguably more intimate than anal/vaginal sex"

Uh, what about all the "virgins" giving blowjobs? Almost everyone includes oral in their sexual repertoire, even those who don't have vaginal or anal sex.

Anyway, cunnilingus really is purely a theoretical risk. Yes, I recognize that for the folks here, that may still be just too much. Which is really too bad. You're missing out on everything that's worthwhile in life, worrying about and actually seriously debating whether there might be ONE documented case out of the billions of acts of oral sex.

You know, I've asked this before, and didn't get much of a response. Do any of you (aside from Teak and Sparkler, and probably some others) actually KNOW anyone with HIV? I think the majority of the underlying issues are guilt (whether for going out of a monogamous relationship, or partner choice, or sexual orientation), religion (the most hysterical posts always seem to end with some reference to god), childhood experiences, and overestimating the prevalence and seriousness of STDs, at least partially thanks to the **** that passes for sex education these days. But I also wonder if some of the anxiety might just be fear of the unknown.

Just curious.

[dobber21]

Thanks for your words on my situation.
You're right, if my immune system was incapable of producing antibodies, molluscum would be the least of my worries! Up till I was diagnosed, I put the lingering symptoms - mouth ulcers and numb feet - down to stress, then one comes along that isn't stress related! What a to do! But I acknowledge that I'm being irrational, and I thank you for pointing that out.

Yeah, the 'how will  my parents handle this' thing weighed heavily on my mind. The only way I got out of that trough was by turning it on it's head. How would I react if a family member related the same news? Of course I would be devastated, but I would embrace them and do everything I could to fight it.
I think sometimes we're too hard on those closest to us. There is NOTHING my partner could do to me to make me consider not supporting her. In difficult situations - a HIV or any life threatening diagnosis being but one of them - those who really care about you will put their concerns on hold and leap into the breach. At least that's what they should do, and certainly what I would do. And then, after a while you'd all start cracking jokes about it. Because that's how we humans cope.

Perhaps I've a bit of a cracked  worldview, but it works for me!

Regarding your own situation, you're in my thoughts and I'm sure this is a difficult time for you. But you'll be fine, and if you think about it, deep down you know this. If only we could switch beliefs; if you could believe my certainty regarding your risks and I could believe your certainty regarding test results, we'd be laughing:)

[bk4291]

If only we could switch beliefs; if you could believe my certainty regarding your risks and I could believe your certainty regarding test results, we'd be laughing:)

Funny; i was thinking the exact thing while writing out my last post to you!!!

And you're right about family; i've done the same as you and thought to myself "how would i cope if it was one of them." The answer is we'd be there for them.

Not to worry mate; between us, hopefully we will be laughing in the end!

[hellothere123]

hey dobber,
just read your post about being concerned your body doesn't produce antibodies.  I am sure that in your heart you know that that is nonsense - everybody produces antibodies eventually - including severely immuno-compromised people!  but more importantly, haven't you taken a duo test or any other test that will test for the virus/antigens - then you can expect your result to be accurate even if your body was weird enough to not produce antibodies at 7 months!:-)

[dobber21]

Nice one!
Your result next month will be the same. I wouldn't even bother if I were you, I really wouldn't!:)

[bk4291]

Cheers mate!

I will test; but i will fully expect a negative.

Cheers for your support on this, you've been a great help!

[dobber21]

Right back atcha:)

[dobber21]

Well, 19000 cases is pretty much all I need to know that if I ever have an anonymous sexual encounter again, I won't be worrying about getting or giving head. And I don't think you guys should either.

Let me ask you a question. In the Spanish Study, take the 19000 'risks' and make them unprotected vaginal and anal - remember insertive vaginal only carries a marginally higher risk than receptive oral - and do you really think that there would have been NO cases of transmission?

You guys are grasping at straws, believing you had risks because you were guilty. And BK, you're right about not wanting to tell someone they didn't have a risk when they in fact did. That's why I don't. That's also why I'm telling you guys that you didn't have risks. Because I'm certain you didn't.

[dobber21]

I didn't know anyone with HIV before all of this - it's not particularly prevalent in my country. But I got to know a guy who has it last December and we're still in contact.
I'm not afraid of HIV. Never have been. I'd hate to transmit it to someone else though. My problem stems from the continued symptoms, even after a 7 month negative; numbness in my feet, persistent mouth ulcers and molluscum contagiosum. ALL symptoms of late-stage HIV infection; essentially this leads my mind - which is, and always has been my biggest problem, one I'm seeking to solve in therapy - to think that I'm incapable of producing antibodies! So it's the lack of closure that's p.issing me off more than anything else.
But like I said, not afraid of HIV. Of course I'd rather not have it, and it looks  like I don't. But I know enough about it at the moment to know a positive diagnosis isn't the end of the world.

[bk4291]

It's always good to hear someone say you didn't have a risk, so thanks dobb :)

Monkeyflower, i do think that cunnilingus is a highly intimate act; for a start, it is often unprotected whereas in many cases of vaginal/anal, there is both the physical and psychological barrier of a condom. As regards virgins giving blowjobs, ironically i think this has something to do with misinformation itself; most young people believe oral carries no risk, of anything! Regardless of our HIV debate, we know that isn't true. One thing i will admit to though; if i was an MSM, i would not give oral without that person wearing a condom and if i could take back my cunnilingus incident, i would. Not because i think risk is high, just that it isn't worth the small one there is in my particular situation. I didn't love this person; to be fair, i didn't know them! Guess thats just something i need to review in terms of my life. Every situation is different though.

I don't know anybody who's positive personally, but i'm not so sure that means anything. 40 million people are.

You also make a good point about HIV fear; i don't speak for others, but for me my thoughts have often been along the lines of "if i'm positive, how do i ever tell my family?" It isn't about me, i don't worry for me; i worry for them. Because, short term at least, the news would shock and devastate them. Turn their world upside down. So it's no wonder we worry; once the idea gets in your head and those symptoms (i'm not talking the sniffles or rashes or feeling hot one night!) keep coming it's a hard fear to shake, whatever the exposure.

Dobber: I empathise with you mate; and since you've reassured me more than a few times, it's only right i return the favour. You see, i firmly believe in HIV testing accuracy. Once i get my result of three months, that is it. You place great store in the science of oral sex studies; have more faith in the tests. If you were HIV pos, you WOULD be producing antibodies. If you weren't, you'd have a bit more to worry about than mouth ulcers and mollusc.  Your HIV negative test at 7 months is everything. Your symptoms, in relation to HIV, mean nothing. Doubt it'll help, but hope it will! :)

Oh, and specifically mouth ulcers? They are just about my biggest problem right now; hardly ever had em before, now they're hammering me, all shapes and sizes! If you're so convinced i don't have HIV, then you too can scratch that symptom OFF the list!!!

So i guess doc H is right; it all comes down to the individuals perspective of risk. But i would stand by my statement; performing oral sex is low risk for HIV in general. Just my belief though, i concede that documented science hints otherwise. Cheers!

[bk4291]

Clinic just rang me! Test at 8 weeks 4 days negative. Thats relaxed me A LOT. Due back in a month to confirm!

[Never_Learn]

In one of your posting you said "So this is why i have a real problem accepting the NO RISK thing; believe me i would love to! But the truth is that variables do affect HIV transmission. The health visitor said that four things would have to be true for there to be a chance of HIV positivity through oral; 1. partner has to have HIV 2. viral load high 3.quite a bit of infectious fluid involved 4. access to bloodstream through a sizeable open wound."

In point 3 and 4 could you give an idea what quite of bit of infectious fluid is (for example is it like two table spoons etc) and what is considered a sizable wound?

[bk4291]

Hello!

In answer to your question, it's impossible to quantify specific measures. When someone says "quite a bit of fluid," i would take that essentially to mean a more than usual amount. And by sizeable wound, i mean definitely not bleeding gums/ the usual minor things people have in their mouths; i'm talking about something you would most likely already be aware of ie. it would cause you a lot of pain.

BUT...

and it's a big but! Oral exposure is generally considered low risk; i've heard Dr H say (though i wouldn't try the theory!) that you could swallow a few tablespoons of infected blood (more infectious than vaginal fluids by the way) and NOT expect to get infected. And aside from the four things my earlier post mentioned, there are plenty of other things that seem to make oral a highly unlikely mode of transmission.

All i'm saying is that there are far too many variables to consider when we talk about HIV transmission; certain things are proven, certain things are not, so who knows how much fluid is needed for any one transmission. I'm afraid it really is impossible to tell, but, IN GENERAL, most medical sources suggest A LOT of HIGHLY INFECTIOUS fluid would be needed for oral transmission, as well as other factors coming together at the same time. Unlikely then, but not impossible.

All the best!

[bk4291]

Your risk is EXTREMELY LOW, even in the context of an already incredibly low risk activity. Seriously, i don't think you're even close to this being an HIV situation.

I'd bet my last beer that you did not get HIV from the possible exposure as you describe it.

Cheers

[Never_Learn]

Thanks BK. I know to some people my questiopn might seem rediculous, but I have done so many HIV test already before my last exposure that I am now sick and tired of doing them. I have decided to wait untill my next physical check up which would be in January 2008 to find out if I am negative.

My exposure is this, I licked the vagina lip of a woman whose HIV status is unknown once (not inside) and in this one lick I may have lick the clit. And I am wondering how much fluid could have been taken up in one lick. I dont recall tasting any vagina fluid in this lick.

So I while I wait on my next physical to come around I am constantly assessing the risk of that exposure. What are your thoughts on my exposure?

Never_Learn

[Never_Learn]

Thankls BK, thanks for talking to me.