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Your advice appreciated - is my doctor wrong? and the Dems win!
Nov 13, 2006

Hi Doctor Bob,

First, you must be excited as much as we are here in NYC about the recent election results! Do you believe it? Maybe things will change for the better!

My question. My doctor who works for a leading gay/lesbian/TG clinic recently told me something that surprised me. When talking about my risks - protected anal always, oral unprotected, rimming - he told me giving oral was more risky than unprotected insertive anal sex. Huh? I thought oral was pretty minimal risk for hiv? especially, since I don't allow anyone to ejaculate in my mouth. Is he off his rocker? I asked him twice - just to be sure I heard him correctly and he said the same thing. He said I have patients, more so than I would believe that have gotten hiv from giving oral.

Can you clarify? There is so much conflicting info out there on oral sex that I don't know what to believe.

Thank you - and Good bye George Allen, Rummy, et al! It's been real.

Response from Dr. Frascino

Hi,

I do not agree with your doctor. Nor does the vast amount of epidemiological scientific evidence that has been generated over the past quarter century. Here are the estimated per-act risks, according to the CDC (Centers for Disease Control), for acquiring HIV from a partner confirmed to be HIV positive:

Unprotected receptive oral sex 1 per 10,000 exposures.

Unprotected insertive anal sex 6.5 per 10,000 exposures.

I can't really tell if your doctor is "off his rocker" or just misinformed, but if he's basing his opinion solely on his personal anecdotal experience, he should know better!

Patient self-reports can be unreliable, particularly in situations like this. Most sexually active folks know that oral sex is indeed low risk for acquiring HIV and many folks are willing to accept this level of potential risk. Likewise most sexually active folks realize that unprotected vaginal or anal sex carries a much higher risk and consequently protection should be used. When questioned by their doctors about risk factors, recent seroconverters, understandably, would be reluctant to admit they were irresponsible enough to be having unprotected anal or vaginal sex. Admitting they had unprotected oral sex is somehow more acceptable. This phenomenon may explain why your doctor appears to have so many of his patients infected via oral sex.

Off his rocker? No, but I, too, doubt his claims.

Be well.

Dr. Bob



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