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extenuating circumstances? and, you are an "expert on medical sound risk assessment!"
May 2, 2007

Hi Doctor,

When you talk about giving oral sex to a man and extenuating circumstances what do you mean? I have given oral sex to a man who told me he was hiv positive, no ejaculation, some precum. And the doctor told me my risk was "minimal." Would extenuating circumstances mean performing oral on someone hiv positive with a high viral load or something else. And, how risky is precum?

By the way, do you know of the Fenway Community Health Center in Boston? They often refer people to thebody.com and Dr. Bob for "accurate, up to date and medically sound risk advice." How nice. So you are a real expert in every sense and meaning of the word!

Thank you! When are you coming to Boston again?

Trev

Response from Dr. Frascino

Hi Trev,

The extenuating circumstances I referred to would include such things as actively bleeding gums, gum disease and sores in the mouth. Regarding precum, HIV has indeed been identified in pre-ejaculate, but generally in much lower concentrations than what is found in semen.

I agree with your doctor: your HIV risk is very low. Oral sex, for instance, in general is much less risky than unprotected anal sex for multiple reasons, including:

1. Saliva contains substances that help inhibit/neutralize the virus.

2. The lining of the mouth is tougher and stronger than the lining of the rectum.

3. A penis is less likely to cause trauma to the mouth than to the rectum.

If you are worried and/or feel you've placed yourself at risk, you should get an HIV test at the three-month mark.

Please extend my warmest greetings and sincere appreciation to the fine team at Fenway Community Health Center in Boston! Regarding travel plans, Boston is not on my current itinerary, but I was in Beantown at least six times over the past year. So I'm sure I'll be back in the not too distant future. Order some clam chowder for me at Legal Sea Foods, OK?

Be well. Stay well.

Dr. Bob



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