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What do you think?
Oct 12, 2002

First let me congratulate you caring and compasionate manner in which you address the questions on this fourm! I was reading your response to the person who wrote about risk of transimission risk. While the honest truth is if one is infected with HIV it really does not matter how they aquired the virus its still not a good thing. Having said this I have a question or two and would like to hear your opinion: 1.) Re: oral sex there was recently a study done by the University of San Francisco by Dr Kimberly Paige-Shaffer(I apologize if I mispelled the name) in her study of 198 there were no infections over the 12mo. study period. Inspite of the fact that more than 40 admitted swallowing ejaculant and that more than 20 said that they had performed oral sex on a person "they knew to be HIV+) In a second study carried out in Spain over a 10 year period involving about 19,000 episodes of unprotected oral sex with serodiscordent couples(one infected the other not infected). They couples used condoms for intercourse but not for oral sex. There were no reports of infection. In light of all of this is it safe to say that oral sex is a very very rare route of infection? I mean would we honestly be able to say that it is more likely to be struck by lightning? Although I dont support plaing outside in a lighting storm it appears that the risk is possible but negligable? Would you agree? 2.) You recently had a person write about the use of lemons as a possible "cure" for HIV/AIDS. While I think we both can agree 100 that it will take more than Lemons to "cure" HIV/AIDS I came across an artical about resercher in Australia using lemons as a means of preventing infection. He suggest that it maybe possible use it the vagina or on the penis to protect aganinst possible infection. Do you think this could have merit? I would love to think that we could help millions around the world and the lemon farmers as well! I would appreciate hearing your opinons if you would.

Response from Dr. Wohl

You are absolutely correct when you point out that the data suggest receptive oral sex is less risky than many other acts of sex in the transmission of HIV.

In both the studies you mention, however, the total number of subjects was rather small (under 200), albeit in the Spanish study there were many exposures. Also, there have been case reports of HIV transmission via oral sex. In my own practice I have men who seem not to be the bashful type who swear they have only performed oral and not anal sex yet are HIV+.

Dr. Paige-Shafer herself says, "While our study is the first to attempt to systematically define the risk, case reports exist of infections acquired through oral contact. I want to emphasize that, while rare, acquiring HIV infection orally is possible and that many other sexually transmitted diseases (STDs) such as gonorrhea, chlamydia, and syphilis are transmitted orally."

Her last point is an excellent one. Although the risk of acquiring HIV via oral sex is relatively lower than other insertional sex, there is more than HIV to worry about and many of other sexually transmitted diseases are well known to be efficiently transmitted through oral sex.

I understand the need to define the risk of sexual behaviors that people enjoy and that help us to express affection. At the same time I can not help but be concerned about the sharing of a bodily fluid (semen) that is the vehicle by which most infections of HIV are transmitted - even if mostly through other types of sexual intercourse.

As far as the lemons, the use of fruit in this particular way is news to me. Lets hope the same applies to chocolate! DW

Doc recommends starting treatment, but afraid of meds
starting treatment

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