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Oral sex study confusing and vague. Opinion on pre-cum?
Feb 16, 2001

Hey, Doc. I'm an HIV negative gay man who takes great care in HIV prevention. One of the most frustrating things for me in staying safe has been the uncertainty or "maybe" position the experts have taken about oral sex and HIV transmission thoughout the years. We have always been told that the overwhelming majority of HIV cases comes from unprotected anal sex & there seems to still be a very permissive attitude about oral sex in the gay community. I'm aware the goal of the Options Project study was to ascertain the extent of HIV transmitted by oral sex as well as the finding that 7.8 (8 of 102) were probably infected through oral sex. I have a degree in psychology and whenever I read about the study, the wording is very vague about the sample population. For example, "Nearly half (3 of 8) of these cases reported oral problems, including occasional bleeding gums. Almost all (7 of 8) of these men reported to have had oral contact with pre-semen or semen." Well, there is a huge difference between swallowing semen and having bleeding gums in contrast to basic pre cum which issomething that seems to be a reality in unprotected oral sex. This vague wording is frustating and consecending to us. It seems like scare tactics. My question is...is there anyone in this sample population of 8 who claims to have received it just from pre-cum. If that is true, why isn't this guy on Oprah...screaming his lungs out and warning the rest of us? Sometimes, these studies anger and frustrate those of us who are trying to take care of ourselves. Did any of these 8 get it from pre-cum alone without swallowing semen or having a bleeding gum situation? If someone would answer this, it would serve to help us protect ourselves as opposed to freaking us out!

Response from Mr. Kull

You are not alone in your frustration with the issue of HIV transmission and oral sex. The study to which you refer (see the CDC's summary Primary HIV Infection Associated with Oral Transmission) will not provide you with answers to all of your questions. Future studies hopefully will.

The Options Project study demonstrates that HIV could very well be (and most likely was) transmitted through performing oral sex on a man, but it does not venture to examine the exact mechanism for transmission. The study confirms something that many already knew: oral sex is low-risk when compared to unprotected anal or vaginal sex, but transmission can happen. Infected fluids coming into contact with mucous membranes is understood to be a means for transmission and infection. The numbers in the study are not all that surprising, and there has been a great deal of hype in the press (see Don't Swallow: A Look at the Risks of Oral Sex).

The exact factors that contribute to or prevent HIV being transmitted orally are still unclear and are difficult to determine. The amount of virus that gets in a person's mouth probably plays a big role in determining the risk for transmission. That's why it is advisable to get as little semen in your mouth as possible. Cuts, sores, and irritation are all suspected as factors that increase the risk of transmission. The fact that researchers can't actually observe infection happening in the moment and must rely on animal and laboratory studies and clients' self-reporting complicates matters.

The wording in the study may seem vague in some areas because it does not, nor should it, have all of the answers. There are some promising studies on the horizon that will hopefully provide more clarity. Until we know more, you can only do your best to protect yourself from infection and find ways to deal with the anxiety and confusion that HIV causes you in your life.

RMK



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