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the great fellatio debate
Feb 15, 2003

dr bob

what do you think about the risks of performing oral sex on a man with respect to hiv infection? i personally feel its higher risk than is being made out to be. i also think its got nothing to do with cuts in the mouth, but rather seminal exposure to the back of the throat and tonsils. what do you think?

Response from Dr. Frascino

Hi,

Well actually the final verdict is still out, but my personal opinion is the direct opposite of yours. The risk of HIV infection associated with receptive oral sex (fellatio) has always been a hot topic.

Early studies found no independent risk for giving or getting blow jobs; however, the high correlation of risk with multiple sex partners raised the possibility that a risk existed, but could not be detected. Subsequently, there were anecdotal reports of possible HIV infections from men who deny other risk behaviors. Consequently, the prevailing wisdom was fellatio appeared to carry a very small, but not non-existent risk. Most safe sex guidelines list unprotected oral sex as "low risk." A study last year (AIDS 2002; 16:2350-2352) reported that 8% of HIV-positive participants acquired HIV from fellatio. All hell broke loose following that report, because it was interpreted (or should I say, "misinterpreted?") to mean that 8% of HIV infections among men having sex with men are attributable to receptive oral sex. That's not the case. I can't go into great detail about statistical analysis, but to understand this study, one needs to understand the PAR (population-attributable risk percentage). The PAR percent can explain how a very low-risk exposure could result in a substantial proportion of infections in this type of study.

More recent data confirm that oral sex carries a very low risk of contracting HIV. In San Francisco, for instance, 10,283 clients were evaluated, of which 413 (4 percent) were eligible, and 243 (2.3 percent) agreed to participate in a study to evaluate the HIV risk from fellatio. The estimated probability of orally acquired HIV was found to be zero, because no recently acquired HIV infections were detected. These folks were all men having oral sex with men. The median number of oral sex partners within the previous 6 months was 3 and 28 percent of the oral sex episodes were "unprotected." One third reported getting cum in their mouths and of those, 70 percent swallowed it. Oral sex on a known HIV-positive partner was reported by 28 percent, and 39 percent of these guys swallowed the ejaculate. Again, no cases of HIV infection were found. OK, back to statistics. This is a small study and certainly does not completely rule out the possibility that HIV can be transmitted by receptive unprotected oral sex. It does, however, give considerable weight to the argument that the risk of acquiring HIV from oral sex is extremely low. The take-home message here is really that one's choice of sexual practices does matter when it comes to HIV risk.

Stay tuned to The Body. We'll report more information on this topic as it becomes available.

Dr. Bob


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