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Comparing Risk of Anal and Oral Sex in Magnetic Couples
Mar 22, 2010

I am pos and my partner is neg. We follow the "usual" safe sex guidelines, so we use condoms for anal sex, but don't use them for oral sex, and I do not ejaculate in my partner's mouth. My question is this: is there any EVIDENCE concerning the relative risk of a negative man fucking a positive man without a condom, versus a negative man fellating a positive man without a condom and without ejaculating? Intuition suggests that anal sex without a condom with the negative partner on top would be the lower risk, as the urethra is so small and there is not much bodily fluid involvement, while the mucous membrane in the mouth is much bigger, there can be sores in the cheeks and gums, and there can be pre-cum involved. Are my partner and I forgoing a less risky act (anal sex without condom with neg man on top) for a more risky act (oral sex without condom with poz man on top)? Thank you.

Response from Dr. Frascino

Hello,

There are many factors involved in HIV-transmission risk aside from the surface area of the mucous membrane involved. You can read about this in detail in the archives. Regarding "relative risk," the best I can offer is the CDC statistics of estimated relative risk. The estimated statistical risk of acquiring HIV from unprotected insertive anal sex (negative top, positive bottom) with a partner confirmed to be HIV infected is 6.5 per 10,000 exposures. The estimated statistical risk of acquiring HIV from unprotected receptive oral sex (positive suckee, negative sucker) with a partner confirmed to be HIV infected is 1 per 10,000 exposures.

I would strongly urge you and your partner to continue to adhere to the safer sex guidelines.

Good luck. Be well. Be safe. Stay well.

Dr. Bob



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