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One sexual partner - oral - should I have a test? The Body: Rick Sowadsky M.S.P.H., C.D.S, Answers to Safe Sex Questions

Jan 27, 1997

Dear Mr Sowadsky, I am an 18 year old male and last September, I had my first ever sexual experiences with a male (I was completely inexperienced until then). Basically, he performed oral sex on me to the point of ejaculation (on 3 separate occasions - each time, he swallowed my semen), while I performed oral sex on him once, for about 1 minute (during this time, I tasted a tiny amount of his precum - that's when I stopped sucking him). We also kissed deeply and he licked my anus for an extended period of time. He had tested negative for the HIV virus 7 months prior to our meeting, and since then, he had only participated in oral sex, during which he never used a condom (he had had many partners prior to me and after having had the test). While it is definite that my penis and anus came into contact with a lot of his saliva, I only actually came into contact with a tiny amount of his precum. At no stage during our sessions did either of us bleed. Since then, I have been worried that I may have put myself at risk of contracting HIV. What I would like to know is whether I should have an HIV test. How risky is what I did? My ex-partner has no intention of having a test in the near future, as he believes that fellatio and analingus are not high risk activities. If he had a test and it was negative, then I would know for sure that I could not have been infected, since he has been my ONLY partner. I would really appreciate your thoughts on this. Thank-you in anticipation.

Response from Mr. Sowadsky

Hi. Thank you for your question.

Based on what you told me, your risk of infection was relatively low. First of all, nobody has ever been infected by saliva, so when he kissed you, gave you oral sex, and oral-anal sex, your risk of infection was very low. The fact that you got some pre-cum in your mouth did put you at some risk, but not nearly the risk if he had cum in your mouth. Let me review with you in detail, about the risks of both giving and receiving oral sex. This way you'll be better able to understand the risks of infection during oral sex.

If you are RECEIVING oral sex from someone else, you are only being exposed to saliva. The concentrations of the virus in saliva are so low, that nobody has ever been infected from saliva. Keep in mind however that you can get other sexually transmitted diseases (like herpes) by receiving oral sex. However, as far as HIV is concerned, receiving oral sex is extremely low risk.

If you are GIVING a man oral sex, there is a risk of infection since pre-cum and semen can get into your mouth. The more of these body fluids you are exposed to, the greater the risk of infection there would be. If you have any open sores, cuts, abrasions, or gum disease in the mouth, the virus can get into your bloodstream. The risk is less than intercourse, but the risk is real, and transmission can occur. There have already been reported cases of HIV infection specifically through giving oral sex. In addition to HIV, while giving oral sex, you could also be at risk for other Sexually Transmitted Diseases (STD's) including herpes and gonorrhea.

Now, when we're talking about the levels of risk by giving oral sex, there is no one answer since several variables actually determine the true level of risk.

Both pre-cum and semen contain high concentrations of HIV. Semen is however a riskier body fluid because you are normally exposed to a greater quantity of semen as compared to pre-cum. Does that mean that pre-cum is totally safe? No! But we can say that the more infectious body fluid you are exposed to, the greater the liklihood of transmission. So, you can become infected by pre-cum alone, but you are much more likely to become infected if the guy cums in your mouth, since you're exposed to a much greater quantity of his body fluid.

Of course, the virus must also be able to get into the bloodstream through some type of open sore, abrasion, gum disease etc. The more openings that HIV has to get into your bloodstream, the greater your risk would be.

Without ejaculation, there still is some risk of getting infected through giving oral sex, but the risk would be much greater if the man ejaculated in the mouth. So rather than saying high risk vs. low risk, it's actually a spectrum of risk.

NO EXPOSURE TO PRE-CUM OR SEMEN: no risk as far as HIV is concerned.

EXPOSURE TO PRE-CUM ONLY: low risk (but still technically possible). The more pre-cum you get into your mouth, the greater the risk would be.

EXPOSURE TO BOTH PRE-CUM AND SEMEN: risky, especially if there are cuts/open sores in the mouth. The more semen you're exposed to, and the more cuts/abrasions/gum disease in the mouth, the greater the risk. But overall, although risky, it is still generally considered less of a risk than unprotected intercourse.

So again, we're talking about a spectrum of risk. This is why there will be no absolute answer of high vs. low risk of giving oral sex. But we can say that HIV has now been found to be transmitted by GIVING oral sex....especially if there is ejaculation.

And by the way.....A VERY IMPORTANT THING TO REMEMBER is that there doesn't necessarily have to be ejaculation to be infected with other Sexually Transmitted Diseases (STD's). For example, if you give a man oral sex, and that man has gonorrhea, you could get infected with gonorrhea in the throat, whether the man ejaculates or not. Gonorrhea can cause a discharge that can be very infectious if it gets into the throat (or penis/rectum/vagina) of another person. So things that may be lower risk for HIV (giving oral sex without ejaculation) may be high risk for other diseases, like gonorrhea.

Let me also add that if your partner had been infected for less than 6 months, his infection may not have shown up on his tests. Also, if he put himself at risk after being tested, his negative result becomes meaningless.

Giving oral-anal sex is generally low risk for HIV, since one is normally not exposed to blood. However while giving oral-anal sex, one can be exposed to various bacterial, parasitic, and viral infections, such as Hepatitis A. The only time giving oral-anal sex is risky for HIV, is when a person is actively fingering their partner before giving oral-anal sex, or if it's after intercourse. Under those two circumstances, it's possible to be exposed to blood while giving oral-anal sex. However, most of the time, the greater risk is for infections other than HIV.

In all reality, I am very concerned about the health of your partner. The fact that your partner has many other partners, and doesn't use condoms, puts him at high risk for HIV and other STD's. His risk becomes especially high if he allows his other partners to cum in his mouth. I have personally seen cases of men becoming infected by giving oral sex, especially when men ejaculated in their mouth. There are also cases reported in the medical literature of HIV transmission by giving oral sex. So although giving oral sex is lower risk than intercourse, it is still risky for HIV and other STD's. Your partner may have tested negative previously, but the more he continues to put himself at risk, the greater the chance he'll become infected with these diseases. So although your personal risk was low, I cannot say the same thing about your partner. However, even if your partner was infected, what you did with him was relatively low risk, and therefore your personal risk of infection was low.

If you have any further questions, please feel free to contact the Centers for Disease Control at 1.800.232.4636 (Nationwide).

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