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Unprotected Cunnilingus
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Unprotected Cunnilingus

Doc,

There are many threads about this already, but I wanted you to clarify a couple of things please. When it comes to a male performing unprotected cunnilingus on a female, you say the odds are too low to really concern yourself about acquiring HIV. Something on the order of winning a lottery or getting struck by lightning. Is it safe to assume that would remain true in whatever country you did this in? i.e. Central America where there is perhaps a higher percentage of CSW's with it. Do you say that even if the woman was HIV positive that the chances from one encounter are still that low? Assuming this was the ONLY at-risk activity one ever had and it was ONLY one-time, is testing truly only necessary if that gives one peace of mind?

Thanks.
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239123_tn?1267651214
There are no data to answer your question with the precision you seek.  To my knowledge, there has never been a reported case of HIV in which the only exposure that the infected person reported was performance of cunnilingus on a woman known or suspected to have HIV.  That's fairly reassuring in itself.  We also have firm data on the rarity of other STDs transmitted by that route.  For example, in heterosexual men with gonorrhea who perform oral sex on their partners, we almost never see a postive gonorrhea throat culture.  In other words, they acquire urethral (penile) gonorrhea but virtually never get oral gonorrhea despite cunnilingus on a known-infected partner.  Since gonorrhea is many times more easily to transmit than HIV, these data are pretty strong evidence against HIV transmission.  (By contrast, when a person has performed fellatio on a man with gonorrhea, throat infection is quite common.  So it isn't oral sex in general that is low risk, but cunnilingus in particular.)

So, yes, I mean exactly what you say:  If a woman has HIV, a man performing cunnilingus on her has an extremely low risk--if any risk at all--of catching HIV.  Most likely there is no difference based on geography--Central America, Asia, Africa, Europe, North America.  But again, no definitive data are available.

If a person came to my clinic reporting cunnilingus as his/her only exposure to a woman known for certainty to have HIV, I probably would recommend testing despite the low risk.  But if it was with a partner not known to have HIV, I would normally recommend against testing.  But in the real world, all those persons get tested anyway:  anyone nervous enough about the possibility of HIV to go out of his/her way to come to an STD clinic (or to post a question on this forum) almost by definition will need testing for peace of mind.
8 Comments
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Avatar_n_tn
Hi, Doctor:

I think this thread poses an interesting question.

When you conduct rough risk assessments (e.g., protected sex ), are you making the assumption that the other person is HIV-positive.

After all, shouldn
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79258_tn?1190634010
I was under the impression that cunnilingus is the safest activity there is, and HIV is just a theoretical possibility. In fact, there's virtually no risk of contracting *any* STDs from performing oral on a woman. So I wouldn't think it'd be a high risk activity at all, regardless of your location and her HIV status :-)
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239123_tn?1267651214
If you carefully read my responses to questions about HIV risk after a particular kind of exposure, I always say the risk is low "even if your partner had HIV"--and often add "which s/he probably doesn't".  I may forget to say that sometimes, but not often.  Of course the risk is zero if the partner doesn't have HIV.

There are "so many threads about protected sex" because individuals who post questions on websites like this are not representative of sexually active people in general.  Most people having protected sex don't worry much about it and don't visit (or post questions about the risk) on the forum.

As always, Monkeyflower is right once again.

HHH, MD
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Avatar_n_tn
Doc,
Thanks very much. If I understand your points here, you are saying that if I performed unprotected cunnilingus on a CSW in El Salvador and have no clue as to her HIV status then you would not recommend testing, but assume that a person asking this will do it for peace of mind anyway? Thanks again.
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Avatar_n_tn
Doc,

I forgot to mark the question above to you and wanted to make sure you saw it. Thanks.
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239123_tn?1267651214
The country you're in doesn't change the basic fact that cunnilingus is a low risk exposure.  If you performed cunnilingus on an HIV infected woman once a day for 10 years, you probably wouldn't catch HIV.

HHH, MD
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Avatar_n_tn
I ve been thru the similar thing... 10mins of unprotected cunnilingus with the hotel prostitute. After 8 weeks I actually came back to confront her, she told me she didn't think she had it. Apparently it never even crossed her mind. She always uses condoms for vaginal sex (also because she is not on the pill) and rarely practices unprotected oral sex. Most of her customers are middle aged businessmen from industrial countries in Western Europe. Myself I had few symptoms (one night sweat at day 21, "dead arm" when waking up in the morning, i am peeing more often then before, currently Im having a cold with no high temp and my lymph nodes might be little swollen). I have consulted few telephone lines and doctors dealing with the issue, and everybody says the risk is too little to worry about it, here Dr.H is on the top of the things and I actually come back to the forum for yet more reassurance. In any case I plan to get tested at 12 weeks mark, maybe little earlier if I reach the end of my reasoning. What I just want to say is that if you have any symptoms it is probably anxiety as in my case. There is lot of guys outhere practissing unprotected cunnilingus and they probably don't even thing about any risk involved.
I don't know about you but in my case it is also a lot about the guilt i feel, sometimes it drives me absolutely up the wall. But i firmly believe that all of us posting on this forum will be OK.
And I would like to thank to Dr. H again for his terrific help.
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A related discussion, HI was started.
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A related discussion, hiv transmission was started.
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