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HIV and ORAL SEX: The Facts

Aug 30, 2012 - 69 comments

I want to  discuss the great oral sex debate.  This is probably THE most common topic we see on the HIV forum.  We get criticized a lot for stating that oral sex is "no risk".  What people fail to understand is HOW we came to that conclusion.  You have to look at the SCIENTIFIC facts, along with the statistics.  I'm going to try to explain them to you...


**Before I even go into the reasons why oral sex is not a risk (and to appease the people who will argue that other experts say it's a theoretical or negligible risk)...consider for a moment the other FACTS that would further decrease the chances of infection:  

ONE..most people don't even HAVE HIV.  The % of the population who are infected is actually a lot lower than most people assume.  In the U.S. for example, 1.2 million people, out of a TOTAL population (in 2011) of 311,591,917 people.  I hope that puts things into a better perspective.  

TWO...if you managed to FIND an infected person, there would have to be exposure to a substantial amount of infectious fluids, not just a drop or two.  Further, the infectiousness of certain bodily fluids varies in it's viral content, with semen being the highest among genital fluids, then vaginal fluids, then pre-seminal fluid.

Now...down to the nitty gritty....



FIRST: THE STATISTICS:

Look at it from a common sense standpoint.  ALL of the expert docs on MedHelp alone, have said time and time again that none of them have seen a convincing case of HIV being caused by oral sex.  They also have said that none of their COLLEAGUES specializing in the field of HIV have either.  Further, they have never heard about or read a convincing case of HIV caused by oral sex in the combined DECADES they have been working in this field.  

Too add to that, in 18 years of being a nurse, I've worked closely with several wonderful ID docs, also specializing in HIV/AIDS, most for quite some time...some with 30+ years in the medical field, specializing in infectious diseases.  Their comments were the same.  While they often said they wouldn't be comfortable saying something was impossible (that's a doctor thing), they all said that oral sex carried no risk.  Also, a doctor isn't going to NOT recommend testing for a situation where they feel someone is at risk.  It speaks volumes that both the docs I've worked with, and the docs here never recommend HIV testing for an oral exposure.

Additionally...let's say oral sex is a risk.  Where are the reported cases?  Even if something is a LOW risk, we would certainly see some kind of consistent statistics indicating where, when, how often these cases were being reported.  The CDC collects very detailed HIV related data all the time, as HIV is a mandatory reportable disease in the U.S. The info about oral is just NOT available, which would kind of lead one to believe that's because cases aren't being reported.  For example. occupational exposures overall are considered low risk, and account for a small number of reported cases, but there is data out there about who got infected, where, when and how.  

That data leads to statistics being born. It's nearly impossible to find a SOLID number-based statistic about oral sex infections.  Other transmission routes, because they are constantly being reported, generate % figures.  All the CDC can say about oral is there have been a "few cases".  A few cases?  A "few" generally is assumed to mean THREE.  So, THREE cases in over 25 years?  NOT very convincing.

If there were new infections being reported with oral sex listed as the cause, you better bet your bottom dollar the CDC would be more passionate in warning the public about the risks.  Presently, the CDC has a very wishy-washy statement about oral sex on its site.  They are a conservaticve agency, and they are NOT going to tell people it is not a risk, God forbid someone finds a way to get infected that way tomorrow, or much MORE likely, someone CLAIMS they were infected that way.  They could make some serious ruckus for the CDC in that situation.  It's a liability.  You'll never see them commit to a "no risk" stance, but you have to think of the info that ISN'T there.

Where are all the people who have been infected by oral sex?  Surely there should be more than a handful of questionable cases in 25 years if it is a risk, right?  If oral sex was a risk, overall infection rates would be MUCH MUCH higher than they are.  Try to imagine how many people have unprotected oral sex out there.  It's impossible to imagine how many, how often. Probably, at any given moment accross the globe, there are tens of thousands of people doing the oral deed.  If HIV was resulting...even SOME of the time,  there would at LEAST be a few cases a month, if not more...being reported.

A few fun factoids about oral sex:

~•Half or more of women ages 18 to 39 reported giving or receiving oral sex in the past 90 days. NSSHB, 2010
•Receptive oral sex is reported by more than half of women who are in a co-habitating relationship between the ages of 18 and 69. It was also reported by more than half of women cohabitation between ages 18 and 49, and more than half of married women ages 30-39.NSSHB, 2010
•A similar pattern was found for women performing oral sex. NSSHB, 2010

~(Info courtesy of The Kinsey Institute)
http://www.kinseyinstitute.org/resources/FAQ.html

(Check out the above link, there is a table that indicates the % of people engaging in oral sex in a year...LOTS of oral sex going on!)



NEXT: THE SCIENCE

There are SCIENTIFIC reasons to explain how oral sex wouldn't be a risk for HIV.  I'm going to try to explain all of the reasons, in detail.  There are several factors that in an oral sex situation, would not allow for transmission.

1.)  Tissue/Mucous Membrane Structure:  First, there are only a few "points of entry" that contain the vulnerable tissue that allows for HIV transmission.  Generally speaking, that would be mucous membranes, and the actual bloodstream itself (for example, injecting the contents of a syringe with HIV+ blood into a vein could easily lead to infection, as a person is introducing the virus DIRECTLY into the bloodstream.)  HIV cannot get through intact skin, or even superficial cuts.  WHY?  Because it doesn't allow for access to the bloodstream, which HAS to happen for infection to occur.  

Anyway, back to the mucous membranes.  There are alot of locations where you would find a mucous membrane.  HOWEVER, not all mucous membranes are created equally.  As an example, there are mucous membranes in the lining of the nose, the eyes, the oral cavity, rectum, lining of the male uterus, vaginal wall.  

Without getting too technical, there are target receptor cells in the mucous membranes that are the ones responsible for "latching on" to the virus from the partner...allowing it access to the bloodstream.  The oral mucosa of the mouth is not comprised of the same celluar makeup and structure as the mucous membranes in areas that commonly allow for transmission (rectum, vagina, male urethral lining).    In the oral cavity, the receptor cells are far reduced in number than those of the rectum, vagina, etc...and are located much "deeper" in the tissue.  In the susceptible tissues of the rectum and vagina, those target receptors are very superficial, and found in MUCH higher numbers.  There alone, you can see how the virus would have a MUCH harder time finding a receptor cell, then getting to it.  

2.)  Vulnerability of Virus:  It's a well known SCIENTIFICALLY STUDIED fact that HIV is a very weak virus that cannot maintain it's virulence and infectiousness OUTSIDE of the body.  During unprotected anal sex, for example, any infectious fluid is INSIDE the anus, not exposed to the elements.  

When HIV is exposed to the elements (temperature, pH, acidity, moisture, oxygen), it begins to basically "break down" and become inactive (or, as some people say, "die").  The outer shell of the virus immediately becomes damaged.  Referring back to the mucous membrane topic...remember I mentioned those target receptor cells?  Well, on the virus, it's the outer shell that contains the part of the virus that "latches on" to that receptor cell.  Even with a slightly damaged outer shell, the virus loses its ability to do that.

HOW LONG?  HOW LONG?  We get questions ALL the time from people wanting to know the EXACT amount of time it takes (down to the millisecond) for the virus to "die".  There is no one, uniform answer.  There are a lot of factors that go into the inactivation of the virus (agaion, environmental factors, temperature, pH, etc).  The important thing to remember is, that as soon as that outer shell becomes damaged, all bets are off, game over.  So, to answer that common question...it doesn't matter "how long".  The virus doesn't have to be completely inactive to lose its infectiousness.

Therefore, in conclusion, obviously, oral sex doesn't involve the virus remaining INSIDE the body, which leads to the virus becoming inactive.  

SO, if you've been paying attention thus far, you would know that, in oral sex...in order for it to cause infection it has to stay active...and attach to receptor cells to get it to the bloodstream.  So far, I've showed you the challenges that poor little virus is up against.  So...for fun, we'll assume that we're talking about one HECK of a tough virus.  This guy is the "Superman" of all HIV viruses...and he's managed NOT be become damaged with exposure to the elements...AND, his lucky butt found a receptor cell to latch on to.  Now what?  Here's what...yet another factor that would interrupt the HIV transmission process....

3.)  Proteins/Enzymes as HIV Inhibitor:  There have been NUMEROUS studies researching how the proteins and enzymes in the saliva affect the HIV virus.  Guess what?  Bad news for the virus.  The results of the studies show that just about every protein and enzyme in the saliva...from enzymes produced by the parotid glands, to the salivary glands...to others...significantly inhibit the HIV virus.  A few of the studies deduced that the virus was inhibited by more than 50%!  That's pretty incredible!  So, when we say that saliva inhibits HIV, we're not just blowing smoke up your hind end...it's a FACT.  Here are just a few studies I've cited where real SCIENTISTS found this to be fact (yep, guys in white lab coats with vats full of spit, cool job, eh?).:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2199189/

http://www.ncbi.nlm.nih.gov/pubmed/11355444

http://online.liebertpub.com/doi/abs/10.1089/aid.1990.6.1425

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC185219/pdf/jcinvest00013-0472.pdf

IN SUMMARY, hopefully the above information, ALL put together in terms you can understand...taking into consideration HOW transmission happens, will ease some of your minds about oral sex, as obviously, to put it lightly, the mouth is a horribly hostile place for HIV.

Now, there will always be the naysayers and people challenging this.  That's FINE.  The bottom line when it comes to anything relating to HIV is that people's comfort levels vary.  Some people, no matter how much "proof" we present, will still not buy it, that's fine!  Then, for those people, I say...use condoms for oral sex, or simply abstain from it all together.  If you've already had oral sex and fear infection, then get tested if you just can't get past it.  We would never recommend testing for an oral sex exposure, but we also understand that anxiety can be a rough thing.  Thing is...if you DO decide to test to put your mind at ease, BELIEVE your results and move on.  Don't let your mind dream up ways that the test results could be wrong.  

If you get to THAT point, then the anxiety may need addressed with a professional.  I've lived with anxiety all my life, so I can say with conviction that severe or chronic anxiety won't typically just "go away" on its own..it's going to require professional intervention.  We don't recommend that to be mean, but rather because we see people with out of control anxiety every day on the HIV forum, and we also watch that anxiety get worse and worse as people keep posting and ignoring the suggestions to seek help.  Before long, those people are dreaming up all kinds of crazy scenarios where they could be at risk for HIV.  It's actually very sad.

Lastly, for those of you who are going to say, "but, but...the DOCTORS say *low risk*!!"..I say to you...look at EVERYTHING they are saying to you, don't cherry pick one or two words from a 5 paragraph response.  Don't read with tunnel vision.  If they're telling you you have as good a chance of getting hit by a meteorite as you do from getting infected from oral sex...you can take that as a "no risk".  If they are not advising you to test, then even if they say "low risk", it's obviously not sufficient enough to worry about.  MOST docs, due to the fact that science is ever changing, will seldom use words like, "never, impossible, always, zero", they just won't.  We have quoted our Dr. HHH plainly saying that, for all intents and purposes, there is NO difference between THEIR use of "low risk" and our use of "no risk".  I think you can pretty much take THAT to the bank.  Teak has comprised a LONG list of quotes from our MedHelp docs talking about oral sex not being a risk.  You'll see us post that a lot.  It's a nice reflection of different oral sex scenarios.

The fact of the matter is...HIV is actually a very difficult virus to transmit.  VERY.  Because of people's overinflated views of HIV, they just can't wrap their heads around that.  It only makes sense that if a virus is that hard to transmit, and you then add in all the factors it would have to overcome (in relation to oral sex) to allow for transmission, you can then see how we get our assessment of "no risk".  It comes from FACTUAL information and the simple fact that there are just NOT cases of HIV from oral sex being reported with any regularity.  I've now shared that information with all of you, as best I can.  I hope it helps at least some of you understand why we give the advice we do.

As always, you're free to believe whatever information you wish, and take whatever advice makes you comfortable.  It also needs to be said that ANY health concern should be addressed with your own personal physician.  An online forum should NEVER be substituted for real, in-person medical care.  


COMMENTS ARE FINE...BUT KEEP THEM RESPECTFUL PLEASE, AND NO RISK ASSESSMENTS HERE.  PLEASE DON'T COME HERE AND ASK ABOUT YOUR EXPOSURE, THAT IS A QUESTION FOR THE HIV PREVENTION COMMUNITY, NOT HERE.  I WILL REMOVE ANY COMMENTS THAT ARE RUDE, ARGUMENTATIVE, IRRATIONAL...AND, WELL...IF I DON'T LIKE YOUR SPELLING OR GRAMMAR....

(kidding about that last part).    ;0)


Thanks for reading!


Wishing you all Peace,
Nursegirl6572


P.S.  I will accept tokens of appreciation for this info in the form of brownies or chocolate chip cookies.  Now, I'm headed to the carpal tunnel community, as I've been typing for two hours now.


P.P.S  I will leave you with the wise words of Lizzie Lou.  I use this saying all the time now, because it is SO appropriate.  ~FEAR is not FACT!~  Thanks, LL!  





Comments
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Avatar universal
by jjpatrick135, Aug 30, 2012
Really good job nursegirl!  Love this article even more than the one you did 3 years ago.  This has def helped me.

Avatar universal
by tad780, Aug 30, 2012
I needed to read this ... I appreciate all the time you took to provide such a detailed explanation. After a somewhat high anxiety day your words really hit home.  Funny thing, I already knew the majority of this information but the added explanations really really helped .... thanks again!!!!!

480448 tn?1426952138
by nursegirl6572, Aug 30, 2012
Thanks for the thanks.  I've been wanting to write this for a while...finally just sat down and did it today.  

Avatar universal
by jjpatrick135, Aug 30, 2012
Very cool I'll make the chocolate chip cookies. Lol

Avatar universal
by tad780, Aug 30, 2012
And I will make the brownies....ha ha!

480448 tn?1426952138
by nursegirl6572, Aug 30, 2012
Well, alrighty then!  (Crap, I should have asked for cash!  lol)

Avatar universal
by tad780, Aug 30, 2012
Ha ha, well I will send some cash as well as the brownies will not be that fresh when they arrive to you as they will be sent from Canada.....

Avatar universal
by Apollo1971, Aug 31, 2012
Excellent Post NG,

Avatar universal
by gumm_BIH, Aug 31, 2012
This is really excellent.
Good job!

495284 tn?1333897642
by dominosarah, Aug 31, 2012
Since you requested to keep this clean i will just say hi!!  lol



Avatar universal
by Teak, Aug 31, 2012
Bump

480448 tn?1426952138
by nursegirl6572, Aug 31, 2012
Thanks all!  Sarah, I know how hard that is for youm, so thanks!!    LOL

1699033 tn?1514116733
by JGF25, Aug 31, 2012
Great job as always NG...let's just hope the people that need to read it actually do.  I know I will be sending some people to this journel entry.  

480448 tn?1426952138
by nursegirl6572, Aug 31, 2012
Thanks JG!  I know I'll be referring to it as well.  That's what's nice about having info in a journal (I also made it a health page, so people searching the health pages can find it)..it's always there to link to, etc.  It will save me some typing too, when responding on the HIV forum.

Avatar universal
by tevezbest, Sep 11, 2012
Great article. Explaining simply everything. I got answers what I looked for. Great and thanks again.

Avatar universal
by bicky5757, Sep 11, 2012
Great article and explaination ng....m much relieved of stress after reading ur article..blessed to have true helpers and advisers like u ng,teak,grace ,lillie etc :)

Avatar universal
by Night292Rec , Sep 11, 2012
I was just lying in bed trying to muster the hope to get into work. This posting really helped me out. Thanks.

Avatar universal
by MadWithWorry, Sep 11, 2012
Re the common meteorite analogy; only one person has every been killed from a falling meteorite in all of recorded history, a Nigerian man in the 1970s.

480448 tn?1426952138
by nursegirl6572, Sep 11, 2012
Madwithworry...then it's even more suitable as an example for this!

Avatar universal
by lee7lee, Sep 27, 2012
I actually can't stop readin this stopped me worryin a lot thanks

Avatar universal
by manish107, Sep 27, 2012
Really useful information...everyone must read this

4202320 tn?1366275800
by tensed19, Nov 07, 2012
:) really helpful , big thanks

766573 tn?1365170066
by Idyllic, Nov 07, 2012
Wow this is very informative. I am ashamed to say I was unaware of many of the points you illustrate.

Avatar universal
by wishtomoveon, Dec 08, 2012
Nursegirl this was honestly my saving grace..I've posted on the forum a lot over the last three years...my cod took control..it started to get better but with every time I would engage in oral the fear came back...and its not funny..I'm serious nursegirl u seriously saved my life!!!! Believe it or not today was the day I was going to end it all!!! U spoke to me a few times..but reading Ur post I realized you all knew what you were talking bout my professionals tried to help with no luck... :-( nursegirl thank you because of Ur post I'm still here ready to breath another day..it might not of been in the ER but u brought me back to life...smileur my hero... :-)

480448 tn?1426952138
by nursegirl6572, Dec 08, 2012
wishtomoveon...

I'm glad this helped you.  Listen, if you were that close to harming yourself, you need to seek professional help.  OCD can be very manageable, but when you let it go, or continue to feed it by searching the internet, convincing yourself of some irrational truth, you aren't doing yourself any favors.

You may feel better now,....and you may have decided against taking your life, but with OCD, there will always be another irrational worry to take the place of the last one.  NOTHING is worth taking your life, certainly not something that wasn't a legitimate concern from the beginning.

PLEASE, get yourself some help!

Good luck!

370181 tn?1428180348
by RubyWitch, Dec 08, 2012
You need to write a book, Pam.  "HIV FOR DUMMIES."
Excellent work.
Thank you

973741 tn?1342346373
by specialmom, Dec 08, 2012
Pam,  If i haven't told you---  which I know I have---  you ar such a valuabe asset to med help.  I am among the masses that appreciate the quality information that you bring to the site.  Honored to call you my friend!

163305 tn?1333672171
by orphanedhawk, Dec 08, 2012
After reading this I wish you could help us on the hep C forum educated this anxiety/OCD types who pop up there with far fetched fears of contracting the hep C virus as well as HIV.

480448 tn?1426952138
by nursegirl6572, Dec 08, 2012
Wow, guys, I'm blushing!  Thank you ALL for your very kind words!  I really appreciate it.  OH..I know you guys get a lot of them too.  It's so hard to convince people their problem is fear based, not realistic!!

Thanks again...it was so nice to read your comments! XOXO

Avatar universal
by Rosso330, Dec 09, 2012
Hi, NG, thanks for your helpful and informative Journal, really helped a lot on my axiety about HIV risk through oral sex, but back in China, a lot people feel terrified on oral sex may bring HIV to them, so do you mind if i translate part of your artical into Chinese and post it in local forum?I promise I will let them know your ID and it will not be used for commercial purpose! waiting for your permission...

480448 tn?1426952138
by nursegirl6572, Dec 09, 2012
Rosso,

Thanks for the kind words.  I don't mind you copying the journal, just provide a link to it, and explain where it originated from...as both myself and MedHelp deserve the credit for it.  Thanks for asking, hope it helps someone!

Avatar universal
by abtul, Dec 14, 2012
it has really enlightened the masses:...apologies for spelling errors:)


Avatar universal
by WorriedNate242, Dec 14, 2012
What an awesome post. You helped me tremendously recently NG and I thank you for your keen insight and knowledge. Thank you for sharing. You are definitely a blessing to everyone on these forums who need help.

Avatar universal
by limuhan, Dec 19, 2012
thank you nursegirl~~~~for giving us the info
there r alot of docs in china says the opposite...... even some docs says that get someone's semen on genital is a huge risk.........makes a lot of people going crazy...

Avatar universal
by wishtomoveon, Dec 19, 2012
Ng you were right..rereading Ur entry does help me everytime I go into am irrational thought.. I believe you all I do...my mind tries to take these symptoms I feel I'm having..I.e consistent headaches..body aches ( in my right hip..feels like nerve pain) dull pain in my right testicle..very tender..it's always the what ifs? It's been over two weeks since my last oral where I gave oral..and these headaches r driving me crazy..don't worry I'm fighting every day...not to give into any negative thoughts..ya ending it at times might seem easier..but I think of my family now..how would they deal if I ended it..it wouldn't be fair to them..but I'd be lying if I said the thought isn't there...sometimes I need constant reassurance that I'm ok that I have nothing to worry bout..I understand u all here at medhelp get bombarded with these questions..but you guys are
All I've got..I've laid to much on my family I can't put them thru anymore..so that's why I come to you..I don't want to live in fear every single day..every morning is the same I wake with that fear every morning n I fight all day to function while fighting off that fear...befriend me nursegirl I can use the understanding!!!

Avatar universal
by Stephyc41, Dec 19, 2012
Wow! This really help me thank u ;)

Avatar universal
by mentalprisoner, Dec 30, 2012
Nursegirl,

Thank you so much for this amazing article! I've been dealing with intense fear of exposure for a few months now, but your article has definitely helped allay some fears.

Thanks so much for all you are doing to educate everyone. You are inspiring all of us to do the same!

-mentalprisoner

Avatar universal
by soashamed123, Mar 19, 2013
great post nursegirl

Avatar universal
by Bluearrow, Jun 03, 2013
I hope this get's published everywhere online, a lot of people are really concerned about getting HIV from oral sex. Thanks for this nursegirl.

4113881 tn?1415853876
by ActingBrandNew, Jul 05, 2013
NG,

Your article was very thorough and compelling to say the least. I found the information to be fascinating and learned a great deal. Being as you obviously have many years of medical experience and that you have been around ID docs, Id be interested to hear your take on the risk of HCV in the context of sexual behavior in general since the clinical data seems to be quite limited (At least to those of us who are laymen)

Enjoyed your article immensely...Thanks!

ABN

4810126 tn?1503946335
by EvolverU, Jul 05, 2013


NG, this is an Amazing piece of work! Well done & thank you.

ABN, I followed you in here & it's really weird because I have the exact same questions re: HCV, lately. In fact, I was thinking of PM'ing you & NG.on this very subject. (Just a little shy about asking you.)

Again, NG, Excellent Job!

Annie

480448 tn?1426952138
by nursegirl6572, Jul 05, 2013
Thanks ABN!

I'm not nearly as knowledgeable about HCV, but I DO believe that sexually speaking, there isn't a lot of risk, even with more risky behaviors, for transmission of HCV.  I wouldn't think oral would carry any risk at all, but again, I can't say that with conviction.

I worked in the employee health dept of a hospital years ago, and MOST of the education out there revolved around HBV and HIV.  HCV seems to get left out quite a bit.  That's curious to me, just thinking about it.

Thanks again for the kind words.  I just reread it and found some typos I need to fix...lol.  

480448 tn?1426952138
by nursegirl6572, Jul 05, 2013
So, you two crazies are following me, eh?  LMAO!!!  (Just kidding of course!)

I would be happy to answer any questions you guys have (to the best of my knowledge).  If there is something I'm not sure of, I have a few ID docs I am friendly with, they would not mind the questions at all.

PM me anytime!  :0)

4705307 tn?1447973922
by timothy141, Jul 05, 2013
NG
Thank you for the info, I too followed ABN here. Seems he goes to all the good spots. I too have the cursed HCV. I have heard over and over, Don't get pregnant...okay that's easy. But my concern is transmission of the virus. I heard although it is extremely unlikely,less likely if a person is monogamous...and yet possible. This whole idea of causing some to be ill has really effected me, and caused me to be more than reluctant to engage at any level. Partially tx related to be sure, my issues, I am sure.
Again great stuff. Thank you.
Tim
        

480448 tn?1426952138
by nursegirl6572, Jul 05, 2013
Thanks so much timothy!  I'm sure having a chronic illness like that causes so much stress to begin with, and it doesn't help when there doesn't seem to be a lot of clear cut answers as to the risks.  Best to you!

Avatar universal
by bradmars2013, Jul 06, 2013
Pick up the good work! Thanks for always answering PM!! Ill keep in touch for my test results, Be safe

Avatar universal
by Teak, Jul 06, 2013
No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS: Volume 16(17) 22 November 2002 pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan
Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117
Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

There is no debate (among experts) about the HIV risks associated with oral sex. The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way. Among experts, it's a semantic issue about using terms like "no risk" and "very low risk". There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
DR. HANSFIELD

"And oral sex is basically safe sex -- completely safe with respect to HIV and although not zero risk for other STDs, the chance of infection is far lower than for unprotected vaginal or anal sex. Please educate yourself about the real risks. If you stick with oral sex and condom-protected vaginal or anal sex, you have no HIV worries and very little worry about other STDs. " DR HANSFIELD

"I am sure you can find lots of people who believe that HIV is transmitted by oral sex, but you will not find scientific data to support this unrealistic concern..." DR HOOK

"HIV is not spread by touching, masturbation, oral sex or condom protected sex."- DR. HOOK

in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?
I TOTALLY AGREE / DR GARCIA
"HIV is not spread by masturbation, through oral sex, through kissing or other casual contact." Dr. Hook
"The observation on thousands and thousands of observations is that HIV is not spread by oral sex (of any sort)." DR HOOK
"I would not say your risk ,if he had HIV is "slim to none"- that's too high.  I would say they are effectively zero.  How much of his ejaculate or other genital  secretions you may have swallowed makes no difference.  EWH "
"As far as HIV is concerned, there is no known risk of getting HIV from performing oral sex on an infected partner, even if that person's genital secretions get into your eyes or if you swallow." Dr.Hook
HIV is not spread by oral sex, giving or receiving, even if sores, gum disease or blood is present
DR HOOK
The fact is that there are no cases in which HIV has been proven to be transmitted by oral sex, including fellatio..  EWH


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by chinaguy29, Nov 05, 2013
This really is a fantastic article (and I say that as a person going through my own anxiety about an oral "risk"). I just had one question for you, namely pertaining to the science section. You mentioned that saliva has enzymes that inhibit the HIV by up to 50%. Does that mean that saliva still poses a risk for HIV? I've read in numerous places that it has zero risk from saliva, so hearing your comments, in my head, made me think maybe saliva is a risk, but 50% less of a risk?

Thanks for any clarifications, and thank you again for this article. It blows my mind how generous the contributors are with their time and assurances, and it goes a long way towards easing the anxiety!!!!

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by Teak, Nov 05, 2013
The section is not for asking questions.

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by chinaguy29, Nov 05, 2013
I apologize. I had only meant to ask for a clarification of something within the blog, but recognize it might not be the right forum (might there be a better place?). Feel free to delete my post.

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by Teak, Nov 05, 2013
HIV Prevention Forum.

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by hlmale, Jan 18, 2014
Great Job was worried as I preformed oral and have been worried reading this article helps with my fear factor , I wish doctors would take a more of the stand like the doctors on med help do , if more spoke up it would be really great I just don't know how we can get them to do that! when ever my panic takes over i will seek this article out for reassurance thanks Nursegirl ! Thanks very much to all who help and give us hope..

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by b3b3kterbang, Apr 23, 2014
Just sharing, fyi right now I am waiting for my test result (vidas ultra duo and pcr rna test), I always use condom when I am doing vaginal sex (I am a male heterosexual), earlay march 2014 I had an interaction with a csw (we both done insertive and receptive oral sex without condom) and I use condom when we had vaginal sex, afterward she told me that she have mouth ulcer. Last saturday (29 days after the intercourse) I had a realy high fever and chills, the next day I feel week but the fever is gone, that sunday night I starting to have rash in my body (keep on spreading and cover almost my whole body), and I got sore throart (there is an ulcer in my amandel), couple days latter I feel pain in my finger (left arm). I am a little bit of paranoid so I take an hiv test (still waiting for the result), if I am tested positive (which I fell I will considering the symptomps I had) I think its will shown that hiv can be transmitted trough oral sex. I am crossing finger and hope that its true that oral sex hiv transmission is only a theoritical risk (in hope that I dont catch the virus), but I am already resigned for the worst possible outcome and already thinking where can I got proper hiv therapy in indonesia. I'll update you guys in a couple of days after I receive my test result.

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by carlover21, May 08, 2014
thank you nurse-girl

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by carlover21, May 08, 2014
I notice this is from 2 years ago, have things changed since then?
thank you

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by stu36, Oct 21, 2014
This is just what I needed!

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by Brad275, Apr 20, 2015
This research is my hope and light for tomorrow. wishing myself good luck for my HIV test.
#FEARisnotFACT

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by Wazmeister, Jun 03, 2015
Fantastic piece Nursey, thank you

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by ScorpionKing8, Jul 02, 2015
WHAT A NICE ARTICLE. You relieved my anxiety somehow. Keep it up. Thank You Very much

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by malbat, Aug 05, 2015
Is this applicable today?.....are there any changes in regards to transmission? Is this applicable  across the globe or confined to the US only? I'm from Asia....

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by Vance2335, Aug 05, 2015
Why would transmission matter where you are from?

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by malbat, Aug 13, 2015
Because she was giving statistics based on the US?

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by malbat, Aug 13, 2015
Sorry I'd posted ignorantly...

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by fearedornot, Dec 03, 2015
Thanks Nursegirl..Nice article with huge info and steady logic included..Really...
It's more than a year now I am on the side of this way of thinking.But sometimes I'm wondering :
Does it may also has to do with sexual tactics related to oral sex?

Scenario : Firmly closed mouth with a bit gingivitis, high viral load, for respectful amount of time?

E.g If someone's  on  the INSERTIVE partner side -  over an oral sex scenario-  maybe a long lasting b*job having the receptive partners' mouth firmly closed for a respective amount of time maybe you are in some danger?
Virus contained in blood won't have the time to get damaged, so it can find a route through the urethra lining?

But that tactic would also make it not "oral sex" the way it is "meant to be"  :-|


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by fearedornot, Dec 03, 2015
I mean maybe I should avoid this tactic if I want to be on the no risk , not test side?

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by fearedornot, Dec 03, 2015
@ ActingBrandNew,

If you are still interested about HCV : I had a relationship for 2 years with a young woman HCV infected. We didn't know for one year though she has been infeced . We were not using condom for vaginal and oral. Only for anal whenever it was the case. I was not  infected though, even if I remember me a few times  seeing small quantities of blood. And doctors used to tell me that is very risky with HCV. Since we knew about we kept on without condom for oral and condom protected until her medication made her viral load almost not existent. Maybe it was luck.
Additionally I know that she is not using condom with her next guy. But again, he viral load is almost not existent since medication...That's all I have.

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by PeterVN, Mar 19, 2017
How about if people have herpes virus ? Will it increase the risk of getting HIV via oral sex ? i've recently read some articles saying that once people had herpes , their body will produce White Blood Cell ( CD4 ) that make people get HIV easier . I'm looking forward to receiving your reply . Thank you very much Nursegirl .

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by MalaysianMelaka, Mar 11, 2018
I have done more than 100 times (oral sex). There is a possibility?

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by xoneill, Sep 01, 2018
Does the ~311 million include babies, toddlers, preteens, elderly and the countless other groups I would not be interested in having sex with?  Account for these groups and calculate that statistic.

"ONE..most people don't even HAVE HIV.  The % of the population who are infected is actually a lot lower than most people assume.  In the U.S. for example, 1.2 million people, out of a TOTAL population (in 2011) of 311,591,917 people.  I hope that puts things into a better perspective"

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