Slightly worried about UK data

Dear Dr H,

I have gone through a lot of threads in this forum and find the information very reassuring. Please allow me to ask a question which shares some features with some earlier questions, but has something new.

I am a 32 year old heterosexual. This may sound strange, but I have had actual vaginal sex only 3 times, 3 years back , with my girl friend and that was protected and I have no concerns about that.

Due to geographical reasons,I am now seperated from my gf by thosands of miles. I live in UK now.I work in a hospital and am aware of HIV etc.

During the past 3 years , I have visited several massage parlours, probably once every 2-3 months. I have always had protected oral sex( receiving bj) and a few "handjobs" and nothing else.

During the last 4 months, I think I got slightly more adventurous and had the following incidents.

1. I received an unprotected  blow job from a Afro-carribean escort, lasted for about 1 minute.No cuts/sores visible on me . Her status unknown.

2. About 2 weeks back, I met another lady escort, white caucasian , looked healthy, received unprotected blow job for around 2 minutes.I fingered her vagina for a few minutes. There was a small cut, around 1 day old on my finger as I had pulled out a corner of my nail. No blood visible anywhere .

I have never had any other sex, anal or vaginal.

Based on this,

a. What is the risk for HIV?
b. Should I get tested?
c. I saw an article in BMJ which suggested that risk of HIV following oral sex is much higher than what US researchers think.The leading UK hiv charity also thinks so.What do you think about that?

d. A 1998 review in a leading uk medical journal gives 4 references for confirmed cases of HIV following insertive fellatio. Please see  http://sti.bmj.com/cgi/reprint/74/1/6.pdf

The references they give are :
Rozenbaum W, Gharakhanian S, Cardon B, Duval E, Coulaud
JP. HIV transmission by oral sex. Lancet 1988;i:1395.

Bratt GA, Berglund T, Glantzberg BL, Albert J, Sandstrom
E. Two cases of oral-to-genital HIV-1 transmission. Int J
STD AIDS 1997;8:522

[H. Hunter Handsfield, M.D.]

I have long been aware of such literature reports, but I haven't gone back to re-read the references you cite.  The issue revolves around the terms "documeted" and "proof".  I'll just make two points:  1) All or most are based on reports by infected people who might have had plenty of reason to deny other risks, or might have had other risks they didn't even know about.  Most people at risk have multiple potential exposures and their judgment about which one was actually the source of infection often is flawed.  Few if any of the report you cite meet standards that most experts would consitute "proof" of transmission.

2) Even if the reports are true, the fact that they were reported in the medical literature underscores the rarity of such transmission.  That is, those cases were reported precisely because transmission by oral sex is controversial and undoubtedly very rare.  (Nobody reports cases of HIV transmission through anal sex, for example.)

I stand by the many statements I have made in this forum about the lack of clear proof that HIV is transitted to the insertive partner in fellatio or by cunnilingus; and, if such transmissions occur, that they are very rare.  I also reiterate that I generally recommend against HIV testing after single exposures of such low risk, except to the extent that testing will help frightented people in dealing with their anxieties.  If that applies to you, get tested.  Four weeks (28 days) is fine.

HHH, MD

[monkeyflower]

I don't know, but I think I'd be wary of HIV related data from the 80s. But even if there really were four documented cases of HIV from receiving a blowjob, well, that's four out of how many hundreds of thousands of blowjobs over the last 20-some years... At that rate, you must be worrying like crazy about getting hit by a meteor. :-)

Seriously, oral is really very safe, and sex in general is a normal, healthy, integral part of being human. I think therapy could help if you can't get past this, or if your fear of HIV and other STDs is having this significant impact on your life.

[skerdstraght68]

Americans (99.9%) of them consider unprotected oral with protected sex "Safe Sex"  It happens by the millions daily.  If there were cases where this was an issue it would be noted.  Also there are many many +/- couples in the world that practice unprotected oral sex.  If it was an issue it would surface.  Bottom line.. Dont worry about it.

[laker]

I do know what you are going through and I have read many conflicting info on this matter and alot of people say differant things. I also have posted my question of unprotectred oral sex on this site. Im a male and the doctor did inform me that I was safe but the human mind reallt plays tricks on you and it can be scary. after searching the net I came across an interesting site with a few highly respected doctors and they were talking about oral sex transmission among the receptive partner and by my understanding the receptiv means the one being sucked. They have all done plenty of research and are very knowledgable in this matter they dont however talk about the risk from the person being sucked. correct me if im wrong doc but I do know that the one sucking would be at more risk if any than the one being sucked. having said that please read this and let me know what you think on this matter. Im sure the doc has read many articles and written many articles about this but if you do get a chance to read this Dr. H please let me know what you think. It is a little lenghty but I do recommend reading it. I hope this will help you.

http://hivinsite.ucsf.edu/InSite?page=pr-rr-05

[bemyown234]

I am pretty sure "receptive" fellatio refers to the person who is sucking (giving the bj) . My query was about the risk to insertive partner( getting bj)

[nonegiven]

That article is definitely discussing how at risk the person actually performing the blow job would be.  This is not trying to suggest the person actually receiving a blow job is at any risk.  You really have nothing to worry about, unfortunately I on the other hand, performed a blow job and two weeks later had a viral illness so I am much worried, even though statistically odds are very much in my favor.

[monkeyflower]

The risks from oral are very, very small. For giving a blowjob, the risk is around 1 in 10,000, which translates to something like 1 in 27 years of daily oral. The statistics are more hypothetical for receiving a blowjob, but it's thought to be around .5 in 10,000, or one in 52 years of daily oral.

Most people don't use any sort of protection for oral, and this is no doubt why. It's pretty safe, or at least safe enough for most people to feel comfortable enjoying it without condoms or dental dams :-)

As I said before, it sounds like this is having a pretty significant impact on your life. If so, you might consider talking with a therapist.

[laker]

Yes but this is very useful information to us all worried wells out there who are concerned with oral sex as the receptive partner. My understanding is that the insertive partner has a much less chance of contracting the virus rather than the receptive althogh I've heard that either way it is bery low risk to begin with.I know that this is a very frightnening thing for most people including myself but we need to understand the facts and try not to worry so much. I'm one of those worried wells as well and I'm working on dealing with my fears and think rational even though at times it is hard.

[nonegiven]

Yes, I agree, the continuous focus and worry on the very miniscule possibility of oral transmission is unhealthy!  I know I have driven myself crazy over the fact and I can't stop focusing on the "flu" I had, but that means nothing as I am sure many worried wells also experience many symptoms within a couple of weeks post exposure.

[bemyown234]

Thanks for the answers.

Yes, I understand all the explanations and its good to have reassurance.

But I am a bit confused by statistics. If you say that the risk from insertive fellatio is 1 in 20,000, does it mean that:

a) if one person has insertive fellatio with a Hiv +ve female 20,000 times, you have a chance of getting  it once?

OR

b)If 20,000 people  have fellatio with an HIV +ve partner once, one of them might get it?

If its b,  isnt that a bit scary, as there is defenitely millions of people who have fellatio, and if you say 1 in 20, 000 of them will be infected, should  be a big number?

Could Dr H please clarify the meaning of this? Many Thanks.

[gunilla]

oh well i gave oral sex as well and i'm pretty much frightened, i have had yeast infection 2 weeks afte my exposure, diarreha, and mouth thrush. does anyone know how relible the test is after 6 weeks of exposure?

[splashsplash]

The doctor has said that one can, if a very low risk situation, trust a 6 week result.  I imagine that is what he would say in gunilla's situation.  That is interesting that you had thrush, I have some suspicion of throat thrush following receiving oral.  Have you received your test already?
I doubt the number is that high, regarding insertive fellatio, or it is quite likely that they would have well several documented cases of transmission, which they currently do not.  I say that of course but I am freaking out as well, having had only a 24 day negative test myself.

[bemyown234]

Thanks for the answer. Could you explain the statistics a bit more as I have queried in the previous comment. Many Thanks for taking your time to answer all of us.

[H. Hunter Handsfield, M.D.]

The available data are not sufficient precise to answer your question.  Either interpretation is valid.  If 1 in 20,000 is correct, a person could receive oral sex from an HIV positive person once a day for 54 years before there was a substantial risk of transmission.

ie, forget it.

HHH, MD

[gunilla]

no i didn't receive the test result yet will get them on saturday

[splashsplash]

gunila- Please let us know your results, which will surely be negative, but just so that we know you are feeling better, and to help others in your situation feel better about their risks.

[bemyown234]

I found this comment about the CDC risk of 1 in 20, 000 for insertive felltio, by Dr Joel Gallant from Johns Hopkins very useful:

http://qa.hopkins-aids.org/forum/view_question.html?section_id=61&category_id=90&id=105753

[gunilla]

splashsplash, i got the reults tested negtive yooowwoooo

[marg_]

A related discussion, receiving a blow job was started.