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oral sex transmission (DOCUMENTED ORAL SEX TRANSMISSION, 2010)
May 28, 2010

Amazing Doc, How many cases of HIV infection through oral sex did you face in your professional life? I've donated 200 usd for your most admirable foudation

Mike

Response from Dr. Frascino

Hi Mike,

It is very difficult for any of us to give an accurate count because we have no way of knowing if the HIVer in question really did have only oral sex as his or her only risk behavior. I certainly had a number of patients who claimed to have contracted the virus orally. Without employing the sex police in everyone's bedroom to document everything that happens between the sheets, the best we can do is take their word for it. Some folks may claim they were infected orally because they thought that was safe. They may choose to conveniently "forget" episodes of unprotected anal or vaginal sex because they don't want to admit their lapse in judgement to their doctor or even to themselves.

We have better evidence for the contrary: HIV is difficult to transmit orally. This comes from longitudinal studies of magnetic couples who report lots of unprotected oral sex and yet the negative member of the couple almost (a very important "almost") always remains HIV negative. Certainly in magnetic couples if the poz partner is on effective combination antiretroviral therapy, which drives the plasma viral load down to undetectable levels, this would have a significant effect on decreasing the risk of HIV transmission, and this may be playing a role in the epidemiology as well.

Mike, I do remember a few very specific cases where I'm convinced HIV was transmitted orally; however, these were early in the epidemic prior to the widespread availability or use of potent antiretrovirals. As you probably know from reading this forum, I consistently advise readers that oral sex without extenuating circumstances carries a low HIV-transmission/acquisition risk. However, it's also worth noting that approximately one in five HIV-positive Americans has absolutely no idea they are infected. These individuals could be similar to the cases I saw early in the epidemic, because they would have high viral loads and therefore be highly infectious. I hope that addresses your question, Mike.

Thank you for your very generous gift to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). I can assure you that your one gift touched many lives in a very meaningful way. We are currently partnering with other organizations to provide crucial HIV prevention, testing and treatment in the Republic of Congo and in Liberia where dollars and HIV services are extremely scarce.

Be well Mike.

Dr. Bob



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