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Insertive Oral Clarification
Apr 22, 2011

Hi Dr. Bob,

I would like to know why there is a risk assigned to insertive oral sex. In Canada, the risk counselling guide assigns insertive oral a neglible risk based on this criteria..

"Negligible Risk: This means that this activity presents a potential for HIV transmission because there is an exchange of bodily fluids (meaning seman, rectal secretions, pre-cum, blood, vaginal fluids, and breast milk) BUT there has never been a confirmed case of transmission this way."

Now, in a normal situation one's penis is only coming in to contact with saliva. There is an exchange of fluids if precum/semen is present but that fluid would be the fluid of the receiver. If saliva does not pose a transmission threat, contains an enyzme that inhibits transmission and is not infectious why is there any risk associated with the act of receiving oral assuming NO BLOOD?

You state saliva alone does not pose a risk so if that is all one is coming in to contact with, how is there a risk? Wouldn't that in turn implicate kissing as a risk or any sort of behaviours where saliva is introduced to mucous membranes?

Thank you for your continuing help for the concerned community.

I've read the chapter on oral sex and couldn't find an answer that I was comfortable with.

My individual risk was a male partner licking my penis for like 10 seconds.

God bless you.

Response from Dr. Frascino

Hello,

It's always difficult to give a black and white answer when the true color is a shade of gray. I agree with the statement you quote from Canada's counseling center. However, there are a few caveats:

1. ". . . There has never been a confirmed case of transmission this way." The critical word here is "confirmed." We certainly have a number of anecdotal reports of HIV transmission via oral sex, even insertive oral sex. (You'll find some of these testimonials in the archives of this forum. Have a look!) These cases are not "confirmed," because we really have no way to confirm them! We can't automatically assume that a person who claims only to have had insertive oral sex didn't accidentally (or conveniently) "forget" a brief unprotected vaginal or anal episode. We also don't know if there were other extenuating circumstances, such as oral trauma or concurrent STDs that could increase the likelihood of HIV transmission via oral sex.

2. You mention the risk of a "normal situation," but many blow jobs may not qualify as "normal". Trauma from teeth or braces or forceful deep throating could increase the risk. A receptive partner might have herpes, gonorrhea or a host of other STDs that could increase the risk. HIV transmission also depends on viral strain, viral load and the host's immune integrity.

Consequently, although I firmly believe and very frequently state that oral sex carries a very low risk for HIV transmission/acquisition, I think it would be misleading to categorically state oral sex carries absolutely no risk.

Kissing could also be considered a gray area, but I feel there are significant differences when compared to oral sex. There is much less risk for trauma during kissing and there is no surging load of potentially highly infectious baby-batter brimming with HIV involved with smooching. Consequently the gray color here is so faint that I'm willing to state there is essentially no risk. Hopefully this helps clarify the theoretical risks involved in these low-risk activities.

Dr. Bob



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