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second time
Apr 17, 2001

Dr. Litttle

I have read two of your answers about your opinion on recieving oral sex and it seems that you believe this is risky. I have asked the CDC and other doctors on this site and they say that testing is not nessesary as long as this is your only risk factor. I am assuming that if you believe that recieving oral sex is a risk that you also believe that french kissing is risky. why is this is it because there is always a chance of blood in the persons mouth or do you believe that saliva is an infectious fluid. Either way if either of these activities were a risk dont you think 20 years later that there would at least be a handful of documented cases by now? Are you just being cautious in saying the risk is not zero?

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, particularly if associated with ejaculation, simply because I do believe that transmission does occur in this manner. There is not a great deal of data on this question, so what you are left with is my opinion and the CDC opinion. I do not recommend testing of ALL individuals who engage in unprotected oral sex, only those that I believe are of higher risk (known HIV positive partner, esp with high viral load, oral sex with ejaculation, oral sex in a pair where a genital ulcer or other sexually transmitted disease is present). It is not unfortunately a black a white topic, but one that I believe has a significant amount of grey associated with the type of risk and perception of relative risk factors.


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