Hi Dr. Pavia:

I would like to share this information found today on my email and what you think about that??

ATLANTA (Reuters Health) - Unprotected oral sex is highly unlikely to transmit HIV (news - web sites) infection, according to findings from a small study released Tuesday.

In a study of mainly male participants who had performed oral sex on a male partner, researchers found that the risk of HIV transmission through this sex act was virtually nil. Dr. Kimberly Page-Shafer, of the University of California, San Francisco, presented the findings at the National HIV Prevention Conference here.

``We found that the probability of acquiring HIV through that specific sexual activity is very, very low,'' Page-Shafer said in a statement. However, she added, given the small study sample of 198 people, ``we cannot rule out the possibility that the probability of infection is indeed greater than zero.''

In fact, although oral sex poses a much lower HIV risk than unprotected anal or vaginal sex does, experts have stressed that oral sex does not equal safe sex. Recent studies in other populations have indicated that 6 to 8 of HIV cases may be attributed to oral sex.

The 198 participants in this study, nearly all male, were recruited from anonymous testing and counseling sites in San Francisco. All identified themselves as gay or bisexual and reported no anal sex, vaginal sex or injection drug use during the 6 months before the study.

Participants were screened for HIV infection with a test that can detect an infection contracted within the past 6 months, as well as one that detects the longer-term presence of HIV infection.

Nearly all reported having had unprotected oral sex with a male partner, and 20 said they had performed oral sex on an HIV-positive partner. Of those, 89 did not use a condom and 40 swallowed ejaculate.

Yet only one HIV infection was found among all participants, suggesting that the risk of transmission through oral sex was close to zero. According to the researchers, that one infection had not been acquired within the last 6 months and so may not have been attributable to oral sex.

Although the rate of HIV transmission in this study was near zero, Page-Shafer cautioned that the findings do not mean oral sex poses no HIV risk.

She also stressed that other sexually transmitted diseases, such as gonorrhea, syphilis, and chlamydia, can be transmitted orally.

I find the article troubling, probably because it is only summarized in a newspaper and perhaps inaccurate. According to the summary, the followup was 6 months on 198 men, and only 40 acknowledged having oral sex with an infected partner. One new infection was found. Yet, the article concludes that the rate is low "almost zero" but that does not seem to be a reasonable conclusion. Even high risk sex only transmits at rates between one in 10 and one in a few hundred.

We have said for some time that oral sex is lower risk than receptive vaginal or anal intercourse, but transmission can definitely occur. There are other studies which clearly show this, and we have several patients in our clinic who are convinced that it is the route they were infected by. This article does not change my opinion that the risk is low but very clearly NOT zero nor extremely close to zero.

ATP