Aug 30, 2012
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)
(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?).:
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,
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!