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Oct 10, 2002

good day dr. wohl, i was wondering your opinion on a matter of risk factors. i realize this is not your particular area of expertise, but surely you know more than most people on the matter and have an opinion. which would you say is logically a higher risk: insertive vaginal sex, or receptive oral sex (on a man)? what do the numbers show? last i heard, something like 13 of newly infected gay men were probably infected orally, whereas i still haven't heard of someone actually being infected via vaginal secretions unless the man was not circumcized or had penile ulcers present during sex. the reason i ask for your opinion is that i think with all the political correctness involved, some things aren't said because they seem to echo conservative religious anti-gay rhetoric. but people do need to hear certain things even if they "sound" like they point the finger all at one group. the truth should come before political correctness and even before what is frequently percieved as protecting a group's rights. i beg any and all id specialists to respond to this question. the reason im writing to you is i think you might be the only one with enough cahones to actually respond.

Response from Dr. Wohl

Trying to figure out which sex act carries the greatest risk of transmitting HIV sort of reminds me of when I was a kid and tried to imagine who would win if Superman and Mighty Mouse were to fight. Exposure to any bodily fluid that has HIV in it is bad for your health. Certainly, there are relative risks and having an infected man place his penis in your rectum and ejaculate carries the highest risk for transmission. Of course, HIV infected semen deposited in the vagina also is very risky.

Oral sex has been associated with transmission particularly, again, when semen that is infected finds its way into someone's mouth. I am convinced that this type of oral sex transmits HIV.

Vaginal secretions definitely transmit the virus, make no mistake about it. In most parts of the world men infect women and women infect men. One recent study in Uganda of couples in which one partner was HIV+ and the other HIV- found similar rates of transmission of HIV by women and men. Female to male transmission does not require an uncircumcised penis or an STD. Our little urethras are all that is needed.

The infectiousness of vaginal secretions that come into contact with only the mouth is not as well understood. Theoretically there would seem to be a risk but much has to do with the inoculum of the virus in the fluid received. The jury is still out on this one, sorry to say.

The difficult truth is that safe sex requires avoidance of body fluid containing virus. Anything less is less safe. Thanks for the question. DW


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