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Do you ever recommend PEP for Giving Oral to a Man?
Nov 11, 2006

Hi Doctor Roberto!

I had aquestion, would you ever recommend PEP for giving oral sex to a man without ejaculation? Isn't HIV in precum? If a guy gave another guy oral sex and he was exposed to Precum (everyone precums) in his mouth, woundn't he then be exposed to the virus and should be advised to take PEP? And if the guy is positive isn't it an automatic recommendation for pep? Also, I notice you and other experts say there are no documented cases of getting from HIV from giving or receiving a rim job, but wouldn't a study on rimming be tough because no one just rims or receives a rim job they do other things. I am worried because I like to rim (I know other STDs can be passed this way)and am always concerned about microscopic blood that isn't visible in the anus or anal fluids passing the virus.

I love you tons, Doctor! You Rock!

LETS GO DEMOCRATS!!!!!!!

Response from Dr. Frascino

Hi,

Can pre-cum contain HIV in HIV-positive men? Yes, but in significantly lower levels than ejaculate or blood.

Is PEP recommended for receptive oral sex without ejaculation? No.

If the oral insertive partner is HIV positive, isn't it "an automatic recommendation for PEP? Nope.

PEP (post-exposure prophylaxis) or, more accurately in these situations, nPEP (non-occupational post-exposure prophylaxis) is "recommended" only for significant HIV exposures. The main reason for this is that nPEP involves taking multiple potent antiretroviral medications for 28 days. These medications can have significant side effects and toxicities. Consequently there is a need to balance potential benefit with potential risk. Most HIV experts and the published guidelines would not recommend nPEP for the situation you describe receptive oral sex without ejaculation even if the insertive partner was HIV positive. To read more about nPEP, check out the guidelines at www.cdc.gov/mmwr/PDF/rr/rr5402.pdf.

Regarding rimming, you are correct: we do not have ongoing double-blind clinical trials to evaluate HIV transmission risk, for obvious reasons. Consequently our statement, "no documented cases," relies on epidemiological studies and scientific data related to oral-anal-transmission risk factors. Please note we've been evaluating HIV-transmission risk for over 25 years now. Do you need to be concerned about "microscopic blood that isn't visible" as a potential HIV-transmission risk while rimming? No. The cumulative scientific data to date would indicate this is not a significant risk for HIV transmission.

Stay well. (Democrats are kickin' G.O.P. butt at the moment. Election results still coming in, but I feel it's now comfortable to say "hello, Speaker Pelosi!")

Dr. Bob



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