risk of transmission during oral sex

[medhelp112233]

Dr. EWH,

How high is the risk of transmission from an infected woman to a man during oral sex if a man is a receiver of oral sex? What if a woman is a receiver?

Also, do people normally discuss sexual past with a new partner before they get intimate? How would you start a conversation and ensure that a partner doesn't react irrationally and does not misinform?

Thank you very much.

[medhelp112233]

Thank you Dr. EWH

[Edward W Hook, MD]

Good questions.  While in theory, the anatomy of an infected person inserting a penis into a partner's mouth should result in higher transmission rates than with cunnilingus on an infected sex partner, the truth of the matter is that the risk of HIV transmission through oral sex is so low that there is no measureable difference.  Official sources estimate that the risk of HIV transmission through oral sex is less than 1 transmission per 10,000 exposures to an infected partner but the truth of the matter is that these estimates are proably too high.  Neither of us on this site, nor anyone we have spoken to, nor any convincing report in the medical literature have described anyone who got HIV only through oral sex.  

Regarding the discussion with partners, I would suggest that you enter into the discussion from the perspective of mutual respect.  Such a conversation might say, "I respect you and want you to know that I have been checked for STDs and HIV and am not infected.  Have you been checked?"  From there the conversation might cover when each person was checked.  In some instances, the couple might agree to go and get checked together.  None of this assures that someone might not take the statement in the right way but nonetheless, that is what I would suggest doing.

Hope this helps.  EWH