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in regards to your answer
Apr 17, 2001

Dr. Little

In regards to your answer about recieving oral sex you say that the risk is not zero is that because that ther might be blood in a persons mouth or because you believe that saliva is an infectious body fluid. I know that nobody can say that anything is no risk but after 20 years and no documented cases of anyone becoming infected through recieving oral sex dont you think that if this was a route there would at least be a handful of cases by now? I would also guess that if somone had blood in their mouth or if saliva was an infectious fluid that french kissing would also be a risk. I asked the CDC about both issues and they say that if this was a persons only risk that testing is not nesesary but they to will not say zero risk is this because this is "theoretically" possible?

Response from Dr. Little

Saliva can be an infectious fluid if it contains inflammatory cells (not necessarily blood) as a result typically of an ongoing mouth ulcer, bad gums, etc. I am personally convinced that the literature supports the fact that transmission HAS occurred as a result of oral sex. I have seen at least a dozen cases myself as well. I believe that the reason french kissing is less of a risk is because most people do not have many inflammatory cells in their mouths. Oral-genital contact (ie. oral sex) involves genital secretions which are much more likely to contain inflammatory cells which can be carried into close contact with an uninfected persons mucous membranes (oral or genital) and cause infection. HIV testing is not generally recommended after limited oral-oral contact, because the risk is thought to be quite low (not zero). I for one, do advise HIV testing after unprotected oral sex simply because I do believe that transmission does occur in this manner.


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