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RE: I nned your advise may 5
May 10, 2003

Dr. Wohl

I wanted to know why you told this person to get tested when the only exposure was recieving oral sex? On the body site under transmission they say that hiv is not transmitted this way and that there is no real risk. Do you disagree with them? If so I would guess that you also think that kissing would be a risk since it is essentially the same thing albeit in different places. I also went onto the hopkins-aids site and Dr. Gallant also says that there is really no risk and he even tells patients on his site that are hiv+ that their hiv - partners are not at any risk when they perform oral on them. Am I missing something or do you believe this to be risky in the real world not the theoretical one. Thank you for your reply because I am getting confused.

Response from Dr. Wohl

Dear Confused,

The main reason I advised the writer to get tested is so that he would find out he was HIV- and get on with his life. Every provider he had seen followed the logical course, bolstered by the data you cite regarding oral sex and HIV transmission. This left him miserable and did not address his concerns.

Sometimes, you get an HIV test to find out you are negative rather than positive. This was so in this case.

Since we are on the topic of oral sex, let me add, I am certain Dr. Gallant and most other thinking people would agree that it is not impossible to contract HIV via oral sex - meaning there is some finite risk - albeit, I completely agree, a very very low risk.

Kissing and oral sex can hardly be compared. The amount of HIV in saliva is miniscule compared to that in genital secretions (remember, the vast majority of people on the planet with HIV received their virus in a package of genital secretions). Inoculum is one of the major factors which influence transmission of any infectious disease (along with the susceptibly of the host and the virulence of the germ).

I hope this helps clarify my advice. DW



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