Negligible risks & extenuating circumstances for oral


Thanks for the tremendous comfort you bring to so many of us. This "frequent" question is more then worth my commitment to making a $100 donation. After performing oral on a woman sex worker of unknown HIV status within the past month, I'm assured by the many posts in different boards that either say no risk, low risk, or negligible risk. However, the doubt inevitably creeps in when I think about gums that may not be bleeding, but may be inflamed perhaps with underlying root infections or bacterial infections, or other issues in the mouth such as a sore throat. Seems like the category of extenuating circumstances could include so many things, such as a high viral load of an untreated and recently infected woman who has oral performed on her. With strangers, we could never be sure what the partner's viral load really is. Most often, it is also very hard to tell from just looking, whether or not the woman has another STD (co-infection), or any other type of vaginal infection or bacteria that she could pass on. At the same time, just about all men/women have issues with bleeding gums, inflamed gums, and other dental problems; to include just chewing nervously on your cheek. Given all these potential contributing factors, it truly does seem very very remarkable that HIV transmission via oral on an infected woman apparently is still a rare event, and is still categorized as negligible risk (and even no risk), for HIV infection by many experts in the field of HIV and STDs. It seems the list of extenuating circumstances could include so many common things, it's hard to figure out what really is "extenuating". I know saliva plays a role, and perhaps other factors as discussed in several past responses posted on this board. My question is whether in the risk decision we all make, whether the key factor for the individual performing the oral is whether that individual has open/bleeding cuts in the mouth; also I'm not clear if inflammation alone is enough to provide a pathway for HIV in the mouth, or is it more the "open" sore that is specifically the cause of a higher risk? Many people have inflamed gums, but not sure how many actually have "open" sores in the mouth. So is inflammation of one of the gum area near a tooth a problem, or is it primarily actual open (as opposed to closed) sores we are worried about? Also, if the woman has any infections at all or bacteria in the vagina, does that also raise the risks to the person performing oral? Since 2006, have you still yet to treat or meet someone that you felt reasonably certain, the person may well have been infected via oral (cunnilingus) on an infected woman? Or is this still so rare, despite all the potential and common everyday risk factors, that most medical personnel are still reasonably confident that this remains negligible risk, (and even possibly no risk for just about all reasonable extenuating circumstances)? Do you know of other HIV/STD specialists who may have met or treated someone who acquired HIV via oral sex with an infected woman? Thank you so much for your humor and kindness. (Sorry for asking so many questions).



You pose a great many hypothetical questions. I will try to respond to the most pertinent issues and then give you a final piece of advice for the way forward, OK?

You write: "Or is this still so rare, despite all the potential and common everyday risk factors that most medical personnel are still reasonably confident that this remains negligible risk." That is indeed the case. Cunnilingus remains a very low risk for HIV acquisition/transmission. You are also correct that within that very low risk there are a number of difficult to quantify potential extenuating circumstances, including gum disease, oral lesions, concurrent infections, local trauma, presence of menstrual bleeding, etc. Despite all this, the overall risk remains very low. Open oral cuts, sores and lesions would be somewhat more risky than mere "inflammation;" however, inflammation in and of itself recruits white blood cells to the inflamed area, which may increase HIV-transmission risk somewhat.

As for documented cases of HIV transmission resulting from cunnilingus, these would be very difficult to definitively document without having the sex police involved monitoring the encounter to make sure there were no other activities that might have resulted in transmission. Our consensus that transmission resulting from cunnilingus remains a very low risk results primarily from epidemiological information from magnetic couples who choose to practice unprotected cunnilingus. HIV transmission rates remain extremely low in this group. We also have well over a quarter of a century of large epidemiological studies of HIV transmission (self-reported questionnaires), which corroborate the very low transmission risk.

Despite the above information, it's important to point out that low risk is not absolutely no risk. As with any sexual encounter, if you feel you've placed yourself at risk for HIV, you should get a single HIV-antibody test at the three-month mark. That is the only certain way to evaluate "extenuating circumstances" and to be assured of your HIV status.

Thank you for your donation to The Robert James Frascino AIDS Foundation ( It's warmly appreciated. In return I'm sending you my good-luck/good-health karma that you are now and will always be HIV free.

Dr. Bob

Eager for Beaver!!! (I love u Dr.Bob for real.) Sep 5, 2009

I'm seperated and getting a divorce. After 8 months I'm horny and ready for safe sex with condoms. I love to please a woman by giving oral.I want to see multiple women as I'm not interested in a relationship right now. I would always use a condom for penetration but no dental dams for me.My oral health is good and I don't have any bleeding gums or mouth problems that I'm aware of. Am I putting myself at a risk for HIV by performing cunnilingus on women? I have posted questions before. I want to say I think you're a great man and doing a valuable service. Your blend of wit,humor,intellect and compassion are a rare find indeed. By the way...are you available next Saturday night for dinner and drinks?

Response from Dr. Frascino

Hello Eager for Beaver,

First off, 10 points for best title of the day!

Next, the HIV-acquisition risk associated with canyon yodeling is extremely small, barring any extenuating circumstances (see below). As you can probably imagine, you're not the first horned-up dude to post this question!

Finally, as for dinner and drinks next Saturday night, well, I thought you were on the warpath for the Bermuda Triangle of Love, right? Since I possess a tallywhacker and not a Va-Jay-Jay, you might find yourself barking up the wrong tree!

Stay safe. Stay well.

Dr. Bob

Worried again (CUNNILINGUS, 2009) May 16, 2009

Dear Dr. Bob:

Thank you for all that you do here. It is a fact that knowledge is the best tool we have in order to fight this desease. Nevertheless, sometines emotions and libid interfere with good thinking and knowledge, and so does alcohol!!!

Im a 33 year old guy, normally intelligente but this time I was drunk, had sex with a female prostitute, I wore a condom when she gave me a bj and then during penetration I wore a condom properly all the time. But, unfortunately I gave her oral sex too, very superficial though, just the the surface of it, not for long also. My oral healt is very goood also.

What are my odds of being infected?

By the way, this site came to my mind even when I was very drunk and that made be careful at leat at two of three scenarios.

Thank you very much.

Is testing (ELISA) needed?

Response from Dr. Frascino

Hi Worried Again,

I'm pleased that what you have learned on this site came to mind, even when very intoxicated, and enabled you to protect yourself from STDs, including HIV, during your boozy session with the naughty lady from Shady Lane. Assuming the latex (or polyurethane) condom was used properly and did not break, your chances of contracting HIV from the protected blowjob and "penetration" are essentially nonexistent. Regarding the risk from unprotected cunnilingus, that information is also readily available on this site, in the archives (see below). The HIV-acquisition risk is negligible, barring extenuating circumstances.

By the way, as a normally "intelligente" guy with "goood" oral "healt," you might want to cut back on the Jack Daniels and bone up on your spelling.

Regarding HIV testing, your HIV risk is extremely low; however, since you are obviously worried, an HIV test at the three-month mark should help psychologically to put these concerns permanently to rest.

Good luck.

Dr. Bob

magnetic couple: + male and receptive cunnilingus Jan 29, 2009

I apologize if I'm asking a question that has already been answered here, but I can't seem to find an answer that fits my situation specifically.

I recently began dating a very good friend of mine who is HIV+. His viral load is currently undetectable, and neither of us have any other STDs.

If he performs cunnilingus on me without a dental dam, what are my chances of contracting HIV? I really hate the idea of a dental dam. Condoms are great, but dental dams really just turn both of us off....

Thank you, and I will be donating like many others. This site is a Godsend.

Response from Dr. Frascino


The risk of HIV-acquisition/transmission from cunnilingus is exceedingly low, barring extenuating circumstances. See below. Thanks for your donation to the Robert James Frascino AIDS Foundation (

Dr. Bob

cunnilingus Sep 18, 2008

Hello Dr. Bob

I went down on a female in Hong Kong six weeks ago. I had a canker sore in my mouth that popped a day or so before the episode. I also vomitted a couple of hours before from eating some horrible food. As you can tell this was a great night for me. Does any of this constitute having abrasions or cuts in my mouth. I have read that there are no cases from cunnilingus and then I read there are a few cases reported. Which ine is it. How many case are there? I can't sleep and I lay in a pool of sweat every night. I have gotten tested. There was no blood visible form her. I did lick her clit pretty vigorously and wonder if that makes the odds even more? I plan on making a donation and thank you for your time.

Response from Dr. Frascino


The risk of HIV transmission/acquisition from cunnilingus is extremely remote, baring extenuating circumstances (see below). Vomiting would not constitute an extenuating circumstance. Canker sores in the mouth are generally fairly superficial and heal quickly. Without examining your specific canker sore, I cannot advise you if it was significant enough to constitute a risk. However, since it "popped a day or so before the episode," I would assume it was well along in its healing process, thereby decreasing any HIV risk. As always, if you're concerned that you placed yourself at risk for HIV, get an HIV-antibody test at the three-month mark.

As for cases of cunnilingus, the discrepancy has to do with "documented cases" versus "case reports." Case reports are merely anecdotal reports in which the patient claims that was their only HIV risk behavior. A "documented report" has more stringent requirements, such as would be the case in a clinical trial. No matter which definition you use, the HIV risk related to cunnilingus remains exceedingly low, baring extenuating circumstances, OK?

Thanks for your tax-deductible donation to the Robert James Frascino AIDS Foundation ( It's warmly appreciated. In return, I'm sending you my good-luck karma that your definitive HIV test is negative.

Be well. Good luck.

Dr. Bob

cunnilingus (CUNNILINGUS 2008) Sep 6, 2008

I know that lots of guys probably asked u this, but I was interesting in your opinion on the next matter: I started doing the foreplay thing with one girl that I met, she had a quick change of mind during the cunnilingus and decided to stop the whole thing..yea very humiliating by the way. I was a bit drunk at the time so I forgot the she had, while not a addict herself,a boyfriend whos a reall junky (needles and stuff), so finaly my question whould be: should i get tested? Iam not asking that just for a peace of mind, but i want to a doctors point of it posible that I got infected from that contact?

Response from Dr. Frascino


Yep, lots of dudes (and a few dudettes too!) ask about canyon yodeling (cunnilingus). (See below.) Your HIV risk would be negligible, barring extenuating circumstances, such as the presence of menstrual blood, oral mucous membrane lesions, concurrent STDs, etc.

Second, yep! very humiliating indeed! Maybe you should check your technique (or wait until you have your braces removed)???

Dr. Bob

Each night I wait up till you make your posts. (CUNNILINGUS) Aug 14, 2008

First of all let me say this is the only place I would trust the information that is given and I think that is why so many come here for answers to their worries. I have written to your forum a couple of times and was not able to get an answer to any of my questions. Perhaps my problem is trivial to the questions asked by others, but none the less still troublesome for me. I am almost 60 years old. I have Sjogren's Syndrome and test postive for both the SSA and SSB antibodies. I also have had surgery to my prostate and am pretty much impotent. Recently, after a couple of years of no sex, met a lady and performed oral sex on her. I got little from this other then making someone else feel good. Before this I was HIV negative and hope I still am. This is the only exposure I have had in at least two years. A couple of days after this exposure, i expereinced terrible stomach problems and persistent headaches. I went to a clinic and they did a CBC and found my WBC to be slightly elevated, and prescribed me Two antibodics (Cipro and Flagll) with a diagnosis of diviticulits. I often have bouts of slight pain in the area of my parotid gland even before this exposure. I went to my Rhuematolgist and was tested for CBC with differential and other tests specific to other autoimune problems such as Lupuse, etc. The only thing that came of that was Vitamin D deficiency and positive for SS. I am however feeling uncomfortable in the left side of my neck, left arm pit and left groin area. Laying down and getting rest, or after a nights sleep, relieves these symptoms and everything starts out fine but as the day progresses my left parotid gland area, feels puffy, and tender, then later in the day the groin will really start to hurt. My head itches a a lot at night, and I am using a medicated shampoo to relieve this but still iches. I have had no fever, night sweats, or other problem and it has been two months since my exposure. Here are my questions: 1. Does someone with SS have a greater chance of becoming infected from a low risk exposure such as mine. 2. Can the nodes come and go each day or would they be swollen constantly ( I have never ever felt a node but they do hurt in the area they would be found). 3. If one has such symptoms and is indeed infected would he test postive at that time. 4. Would someone who takes plaquenil for SS experience less symtoms then someone who does not take any medicaations.

Response from Dr. Frascino


Before addressing your specific questions, I'll point out a few facts. First of all, the symptoms you experienced "a couple of days" after your "lunch at the Y" (cunnilingus) would not be HIV related. Acute retroviral syndrome (ARS) symptoms take weeks, not hours or days, to appear. Second, cunnilingus carries an extremely minimal risk for HIV transmission. (See below.) Third, swollen lymph glands related to HIV disease would not be limited only to one side of the body. The virus quickly spreads throughout the body and therefore the symptoms would be generalized, not unilateral.

Turning to your specific questions:

  1. No.

  2. Lymphadenopathy associated with HIV is a more constant phenomenon. I do not believe your symptoms are HIV related.

  3. HIV-antibody tests taken prior to three months are not considered to be definitive, symptoms or no symptoms.

  4. No.

Dr. Bob

The Perfect Symptoms - beat this (CUNNILINGUS) Feb 24, 2008

Male, aged 25 Exposure: Unprotected cunnilingus


One week - three months after exposure: diarrhoea, fatigue, mild fever, white coated tongue, sore throat, cough, red rashes on chest and thighs, swollen lymph nodes (4) on thigh

Three months - ten months after exposure: swollen nodes remain, red itchy rashes on and off, muscles start paining with limited activity (very quick lactic acid formation)

Guess you could probably use my symptoms as a textbook example of the symptoms can't you doctor?

Do I even need to get tested or is it a surety that I am HIV positive?

Response from Dr. Frascino


Actually I could probably use you as a "textbook example" of someone convinced he is HIV positive when in reality he is not. Dude, I've said it before and now I'll say it again: Symptoms, no matter what they are, are notoriously unreliable in predicting who is and is not HIV infected. The only way to determine HIV status is to get an HIV test. Period.

Your risk cunnilingus carries only a negligible risk for HIV transmission. (See below.)

My advice is to get a rapid HIV test. You'll have a definitive answer in as few as 20 minutes. Statistically the odds are astronomically in your favor that you did not contract HIV from your "lunch at the Y."

My bet is that the next time you write in the title of your post, rather than "The Perfect Symptoms," will be "The Perfect WOO-HOO!" And then I could use you for that "textbook example" I mentioned. But if you peruse the archives you'll find I've already got gazillions of other "textbook examples" identical to you! So join the crowd of ex-worried wells, OK? So what are you waiting for dude? Get moving! Get tested!

Dr. Bob

scared and confused in uk! (CUNNILINGUS) Jan 31, 2008

super bob!! all was well until a few days ago, could you help me out with this one,? i performed a sesion of clit licking on a lady of unkown status, my tongue never penatrated her just liked her clitoris, i had no cuts or nicks in my mouth that i could see, do i need a test for hiv, i know your the guru on this my freind, ill send a donation anyway as your cause touched the lives of so many people thanks dr your the man misguided in limey land!

Response from Dr. Frascino

Hello Misguided in Limey Land,

Cunnilingus carries a negligible risk for HIV transmission. The main reason for you to consider HIV testing would be to put any residual fears you might be harboring permanently to rest. The HIV test results will undoubtedly be negative. I'll print some information below from the archives that addresses the issue of HIV risk associated with cunnilingus.

Thanks for your donation mate! Cheers!

Dr. Bob

unprotected cunnilingus Jun 28, 2007

Yo Bobby!!!

Let me begin by saying how much I love this site. I'm currently working abroad and unfortunately have no peeps I would feel comfortable disclosing my HIV concerns. I plan on making a donation upon my arrival back to home. Ok... on to the good stuff. I'm a 26 year-old heterosexual male living in Japan. I've been tested twice over here for a multiple STI's including HIV and have thankfully tested negative each time. My concern is that recently I had an encounter with a Japanese women. I asked if she had ever been tested and she responded no. A bit worriesome but unfornately not uncommon in Japan. We had sex with limited penetration (Unfortunately she could only stand the the girth of my manhood for a few moments :(). I used multiple condoms provided in the love hotel (for multiple attempts, lol). However, I did perform unprotected cunnilingus on her at least twice and for an extended period of time (1-5) minutues. I didn't notice any sores, there was no blood, my good oral health on my part, and she showered and cleaned her vagina beforehand. It's been 2 weeks since this encounter and I have developed a white tongue with painless white rings and I am freaking out!!!! As a result, I am losing sleep and appetite and I am terrified everytime I get a headache or feel discomfort. Here are my questions - (1) What are the current risks of contracting HIV from a heterosexual women in Japan who is not a sex-worker? (2) Should I be concerned and hence get retested for HIV keeping in mind that I recieved a negative test result 1 month ago and 7 months ago? (3) I'm aware that oral thrush is common in HIV patients but is it a symptom that will show 2-3 weeks after exposure? (4) What is the rate of cunnilingus transmission? (5) What is the rate of unprotected fellatio transmission (for the receiver)? (5) Although I am unaware of the quality of the condoms at the love hotel (there were colored and thin) - they looked like flavoured condoms. The condom did not break or slip off - what are the chances of transmission via flavoured condoms? I have read some horror stories on the internet concerning HIV transmission over here even though from all the statistics the rate is extremely low here (at least reported rate). I've been tested 2 times this year and I am worried if I show up a third time they'll offer me a straight jacket with the free condoms!

Ease my pain!

Big Boy

Response from Dr. Frascino

Hi Big Boy,

Let me guess. You're nickname in college was "beer can," right???

OK, on to your questions:

  1. Sorry, a specific HIV-transmission risk statistic for "heterosexual women in Japan who are not sex-workers" doesn't exist any more than a specific statistic for "bisexual cross-dressing Mormon midgets with webbed toes in Salt Lake City".

  2. Assuming the latex condoms stayed on the "beer can" and did not break, your HIV risk would be limited to cunnilingus on a partner of unknown serostatus. This carries a negligible risk for HIV transmission. (See below.) HIV testing would be primarily for peace of mind.

  3. I doubt you have thrush. It is not common two-three weeks post-exposure.

  4. See below.

  5. The estimated per-act risk for acquiring HIV from unprotected insertive oral sex with a partner confirmed to be HIV positive is 0.5 per 10,000 exposures.

  6. Depends on the flavor! Why not bring your own condoms (the extra girth variety) next time you visit the love shack?

Dude, relax! Your level of worry is way out of proportion to any real risk!

Dr. Bob

Oral Sex question...Pls Pls answer!! (CUNNILINGUS) Apr 24, 2007

Hello Dr. Bob,

About 3 months ago I asked you a question and you responded, which was awesome! I feel like I am talking to a celebrity. I really admire you and all that you do. I know I said I was going to send a donation and I will I promise as soon as I get back to the states next month.

Anyways, my question is regarding HIV and oral sex. I know by reading in the archives that it is a low risk but for some reason I keep on worrying.

Here is what happened. I was with a Romanian sex worker. We had protected intercourse and at the end I performed unprotected oral on her. I didnt notice any open sores or anything unsual down there. After the act I checked my mouth for any open sores and I dont recall seeing any. I also washed my mouth out and when I got back I brushed my teeth. However, I did notice two small canker sores, one on the side of my tongue and the other at the bottom of the inside of my lip. Could any HIV-infected fluids gotten in there?

I assume she was HIV negative. Before and after the act she washed both hers and mine genitals and seemed to be really cautious. As for transmission, is the risk of getting HIV from vaginal fluids lower than from Semen? Does it have to be an open sore in the mouth to get infected? I know blood is the riskiest way as is unprotected anal and vaginal intercourse. Also, does saliva contain agents that help kill the virus?

I would really appreciate it if you could answer this one question for me, I promise this is the last time you will get a question from this worried well. Take care and god bless!

Mikey the Sailor

Response from Dr. Frascino

Hey Sailor-Boy Mikey,

The risk of HIV transmission from cunnilingus is extremely low. (See below.) Even with your two small canker sores, I would put your HIV risk in the remote-to-nonexistent category. Certainly if you're worried, get a rapid HIV test at the three-month mark to put your residual fears permanently to rest. Undoubtedly the result will be negative, but just to be extra sure, I'm sending you my best good-luck karma, OK?

Regarding saliva, yes, there are substances in salivary secretions that inhibit HIV. As for the infectivity of vaginal fluids versus semen, that depends on viral load, viral strain and many other factors.

Be well, Mikey.

Dr. Bob

Tested today. Alone and need some one to talk too. (CUNNILINGUS) Mar 5, 2007

Hey bob, your the best! Well i finally did it, went today and was tested for all sti's including HIV. Im studying in another country and have no one to share the stress of this with. Heres my story...... A few of months ago i performed unprotected cunnilingus. Stupid now i know but i thought this was a safe practice at the time. It lasted for a mere 45 seconds at most. A couple of days later, i came down with chills,which subsided within a day or so. I also had a chesty cough and swollen glands under my chin, which lasted for a week at most. I thought nothing of it at the time as i had just started college and everyone i knew was down with the flu. Then 2 weeks ago (a few months after my exposure) i had some unusual white discharge after urination. This got me worried about gonorrhea and chlamydia, ive been to the toilet several times since and nothing! Anyways today i went to my local clinic in order to put my fears at rest. I honestly didnt think they would test for HIV, but they said i should, so i went along with it. This has got me rather spooked to say the least. My questions are- 1-What do you think my chances of catching HIV from this one off brief exposure? What are my chances of dodging the HIV bullet Dr Bob? Secondly do you think the one episode of discharge indicates gonorrhea or chlamydia? Can symptoms appear month later and only occur the once? Im making a donation to your wonderful cause, will you please send me your goodluck karma in return! Thank you, stay well, Ewan

Response from Dr. Frascino

Hello Ewan,

I'll proceed directly to your specific questions:

  1. Negligible (see below).

  2. Excellent.

  3. Probably not, but you're getting tested anyway, so you'll have a definitive answer very soon.

  4. Extremely unlikely.

  5. Good luck karma signed, sealed and sent.

Be well. Stay well!

Dr. Bob

Tonsils and Oral Sex (CUNNILINGUS) Sep 30, 2006

Dr. Frascino,

You are definitely a person admirable character. I have just donated $50 to your wonderful foundation. I wish I could afford more at this time, but money is very tight on my end with my graduate school studies. Like everyone else, I have a question for you.

I performed unprotected oral sex on a woman of unknown status about 2 weeks ago. I purposely avoided unprotected intercourse because of its risk. However, I am know concerned about this oral sex episode. I have recently developed enlarged tonsils and my tests for sterp have been negative. I have a sore throat which is understandable, but no other symptoms. I have tried to use your past answers of similar exposures to help ease my anxiety. But there is just something about hearing it directly from you.

Have you ever seen a person with whose only exposure was unprotected oral sex on a woman test positive for HIV?

I hope that your good health will continue to remain. I promise I shall make another donation later on this year.

Thank you,


Response from Dr. Frascino

Hello Kenny,

Unprotected cunnilingus on a woman of unknown HIV serostatus carries only a negligible risk for HIV transmission. (See below.)

To answer your specific question, nope!

Thanks for your kind comments and donation.

Stop worrying! If you can't stop worrying, get tested at the three-month mark, but do realize the primary reason to do so would be to put your unwarranted fears permanently to rest, OK?

Good luck. Stay well.

Dr. Bob

Oral Sex and HIV

Feb 18, 2006

i have just stumbled on this site, and would like your opinion, on jan 1st 2006 i had protected vaginal sex with a prostitute, but i performed unprotected oral sex on her, before i performed she whiped her virgina and when performing oral sex i could taste no secretion or menstural blood, immediately afterwards i realised what a rediculous thing i had done and became increasingly paranoid about the possibility of HIV infection, on the 3rd of Jan i started on 28 PEP course, what do you think my chances of having HIV are, alot of other sites i have been on say Cunnilingus is Low risk, some say no risk, quantatively what is this risk? i am due to go for an HIV test at the end of march and am petrified of the result, many thanks

Ben C

Response from Dr. Frascino

Hello Ben,

She "whiped her virgina?" Would that be "whiped" as in whipped or "whiped" as in wiped? And would that be "virgina" as in Virginia or "virgina" as in vagina? I would assume "whipped" and "Virginia" are out, because nothing kinky ever happens in that state. The risk of HIV transmission from cunnilingus is extremely low. I'll post a question from the recent archives that addresses this problem. (See below.)

I do not believe PEP was warranted for your potential exposure. There is no reason to be "petrified" of your HIV test results. I see nothing but good news heading in your direction. I suggest you begin practicing your WOO-HOOs!

Good luck.

Dr. Bob

Cunnilingus - no blood, good oral healt Jan 12, 2006

Dear Dr. Bob,

Just sent a donation of 200 dollares - thanks fo you help - people need it and now i feel i need too

You had answered a number of questions related to the risk of cunnilingus. I was engaged in one 2 months ago but no blood was involved and my oral helth is ok. The experience was with the mistress and when i asked her afterwards she told me she is DD free .What concerns me that you mentioned once that the probability of getting HIV in this case 0.5 per 10000 cases. doest it mean that there is 1 possible transmission in 20000 cases. a number of cunnilinguses given is much more then that and there are no documented cases so far. How do these 2 things reconcile?

I am still concerned although i understand i should not know...

How is it possible generally to get HIV via giving cunnilingus in case when there is no blood and my oral health seems to be in order. Appreciate your reply.

I have another general question re the symptoms...

It seems that in case there are symptoms there are ususally more then one should be present based on the statistics you posted earlier.

Appreciate your reply

Thanks for the help

Response from Dr. Frascino


The estimated statistical per-episode risk of 0.5 per 10,000 exposures for unprotected oral intercourse refers to fellatio (oral sex performed on a man), not cunnilingus. The cunnilingus figure would be much less. In fact, it's so small it's difficult to quantitate. There are only very few cases of HIV transmission resulting from performing oral sex on a woman that have been reported to the CDC. Considering we've been monitoring this epidemic for over two decades, that alone is excellent evidence that the HIV-transmission risk through cunnilingus is extremely low. There are a number of scientific hypotheses as to why this is true, but the bottom line remains the same: it's an extremely low-risk activity. (Note: the risk increases if the woman is menstruating and/or the person performing cunnilingus has oral mucous membrane sores, abrasions or inflammation.)

Regarding your second question, ARS can be quite variable in scope, number and severity of symptoms. However, yes, generally more than a single symptom is present.

Thanks for your generous donation!

Stay well.

Dr. Bob

Update from Tonsils and Oral Sex (Cunnilingus) Dec 14, 2006

Dr. Bob,

Thanks for responding to my previous question entitled Tonsils and Oral Sex (CUNNILINGUS). May I woohoo based on the following tests and events:

Week 2: Oraquick Negative Week 7: Oraquick Negative Week 9: Oraquick Negative Night after test, fever of 101.3 and horrible earache Week 12 (86 days): Oraquick Negative

I have not had any other exposures since my unprotected cunnilingus episode. So I will ask again. Do I have your blessing on woohooing?

Happy Holidays!!!


P.S. I plan on sending a donation to your organization once I get paid at the end of this week.

Response from Dr. Frascino

Hey Kenny,

Your week 2, 7 and 9 tests were encouraging, but not WOO-HOOable. However, your negative week-12 OraQuick allows you a full-throated, ferociously committed, screaming-banshee-type WOOOOO-HOOOOO!

Thanks for your donation (

Happy WOO-HOOing Holidays to you, too!

Dr. Bob

performing cunnilingus then brushing my teeth? Mar 29, 2008

Hi Dr.,

I performed oral sex on a woman of unknown status; (she was really hot by the way) After I got home from the encounter I brushed my teeth. Would I be at increased risk for brushing my teeth after I performed oral sex? Could some of her vaginal fluid be still in my mouth then get into my bleeding gums when I brushed my teeth? I have a feeling this is a stupid question.

Thanks Doc.

Response from Dr. Frascino


Actually you've got things a bit turned around. The potential increased HIV-transmission risk would involve brushing your teeth before, not after, oral sex. Stupid question? Nah. Dubya has set the bar for stupid so very, very low hardly anything qualifies these days.

Dr. Bob

Straight Question (TRANSMISSION VIA ORAL SEX 2010) Jan 3, 2010

Hi Doctor Bob,

Is it in your view permissible to let a negative partner give you oral sex (without ejaculation) where precum is produced but where the recipient is on HAART and undetectable. If there are no recorded cases of transmission in this way and the risk is only theoretical and miniscule with it, then should anyone really be worried about a condom in this situation. Where is the line. Sometimes I wish there were a universal factsheet provided unanimously by healthworkers saying when and in what situation a condom should be used. Complicated medical articles, conflicting opinions and non-committal responses by professionals just add to the confusion & I think may put people in danger. What are your thoughts.

Thank you

A confused London Boy


Response from Dr. Frascino

Hello Confused London Boy,

Another "straight question" for the gay cyber-sexpert. Unfortunately, there is no straightforward answer! You're looking for a "line" when in reality what exists is more of a "zone." All reasonable HIV experts will agree the risk of oral sex is very low, but not completely nonexistent. There can also be a number of confounding variables, including: (1) concurrent STDs; (2) oral membrane trauma, bleeding gums, gingivitis; (3) differences in HIV plasma viral load and viral strains; etc., etc., etc. London Boy, read through the chapter on oral sex in the archives of this forum. Yes, the whole chapter! It'll give you a better understanding of the risks associated with oral sex. I'll also post below some recent information from the archives.

Happy New Year.

Dr. Bob

Positive through oral sex (TRANSMISSION VIA ORAL SEX 2009) Dec 29, 2009


You strongly say that HIV is not transmitted through oral sex on your other posts. Then y did you not raise any concerns on the below post where the person claims of having caught HIV through oral sex.

Response from Dr. Frascino


OK, let's set the record straight once again! I have never said, let alone "strongly said," that HIV is not transmitted through oral sex! If you read my comments carefully, you will quickly see that I consistently say that the HIV acquisition/transmission risk from oral sex is very low.

Please see below for a more detailed discussion and review of my very consistent comments on this topic. You should also review the chapter on oral sex in the archives of this forum.

Dr. Bob

HIV from Oral Sex Confirmed!!!!! Dec 25, 2009

Dr. Bob.

I read the post from earlier today from the man that wrote he got HIV from Oral Sex. Will you and the "experts" now retract your assurances that Oral Sex is a low to no risk exposure and take a more strident stance that Oral Sex is a significant risk. I am another example. I believe that I as a man was exposed as a result of receiving oral sex from a man. I haven't been tested yet but the symptoms I have are very indicative of HIV. I wish you would take a sterner stance and warm people of the great dangers of Oral Sex. There are probably hundreds if not thousands of us out here that have contracted HIV from Oral Sex. Your thoughts please.

Response from Dr. Frascino


You want me to "warm" people??? How should I do that? Pop them in the microwave?

I'd be delighted to give my thoughts as you request, but I'll warn you in advance you won't like what I have to say.

You ask: "Will you and the 'experts' now retract your assurances that oral sex is a low-risk exposure and take a more strident stance that oral sex is a significant risk?" No, of course not, silly boy! Why would we do that if it is not supported by sound scientific facts? The scientific epidemiological evidence collected over the past quarter century is very consistent. Oral sex carries only a very small risk for HIV transmissions/acquisition. Please note, I never claimed oral sex is a "no risk" activity! That one person wrote in to the forum claiming to have contracted the virus via oral sex does not change the overall HIV risk! Please note the gazillions of others who have written in over the years who had oral sex with HIV-positive partners, but did not contract the virus! Science is science; fact is fact; no matter how freaked out you are about your blowjob incident. I'll reprint below some recent information from the archives.

Next, I must point out you also state: "I am another example. I believe that I as a man was exposed as a result of receiving oral sex from a man. I haven't been tested yet but the symptoms I have are very indicative of HIV." Hmm. That statement speaks volumes! I agree you are indeed "another example." However, not an example of oral sex HIV transmission, but rather another example of someone convinced he is HIV infected based on "symptoms," but who has never been tested. (Others have tested negative multiple times, but still remain convinced they are HIV infected, because of "symptoms." In reality, they are not!)

Your claim that there are "probably hundreds if not thousands of us out here that have contracted HIV from oral sex" is pure lunacy.

Dude, get tested. Then write back. I can just about guarantee your opening line will be: "Dr. Bob, I tested negative!"

Our assessment of the risk of HIV transmission/acquisition via oral sex remains unchanged.

Dr. Bob

HIV Risk From Oral Sex and Can RX's Increase Risk? (TRANSMISSION VIA ORAL SEX 2009) Dec 16, 2009

What is the true risk from oral sex? After looking at many other forums....some sources say there is low risk, some say no risk, some say that while HIV could transmit in theory, there has never been a recorded case of infection from only receiving oral sex - no other activity involved. Also, can being on RX's increase exposure risk - specifically sertraline, atorvastatin, valsartan hydrochlorothiazide or good old aspirin? 6 days ago a stripper went down on me, unprotected, and I ejaculated in her mouth. Is there a transmission chance of virus entering the penis through the tip (no sores here) and can the meds mentioned here make one more susceptible? No excuse as protection should have been used though alcohol was a definite factor here....and six days without a beverage is feeling pretty good right now. This was the first (and last) time this happened. Immediately I was filled with regret and outright fear. Thinking about the stupid thing has consumed me and I really can;t talk about it with anyone. Did a mail in anti-body test (neg) which I now know was a waste - too early. The first few days after this incident I was a basket case, hard to function, extremely down, convinced I'd ruined the future. Constantly checking for symptoms and only have a slightly stuffy nose, little tweak in the ears. I'm worried that the stuffiness is about to turn to a sore throat as some forums say sore throat can happen right after infection and is a symptom (in days???) other don't. So should I be obsessed with worry here, by the sertraline it's easy to tell I go anxiety ridden pretty easily and can be a hypochondriac or am I overreacting? what is the real risk? Thanks in advance.

Response from Dr. Frascino


What is the true risk from oral sex? This is a somewhat difficult question to respond to, as there can be confounding variables. See below for some recent information from the archives. (By the way, we have an entire chapter in the archives devoted to oral sex. Check it out! My opinion that oral sex carries only a low risk for HIV transmission/acquisition hasn't changed.)

The medications you listed do not increase the HIV risk associated with oral sex.

Should you be obsessed with worry? No.

Dr. Bob

Oral sex/Magnetic Couple (TRANSMISSION VIA ORAL SEX) Jun 15, 2009

Dear Robert,

First of all, thank you very much for providing such great advice and information on this site. I am HIV-negative and have just recently started to date a guy who is HIV-positive. I am 29 years old and have only ever slept with one person, who was also negative. So as you can imagine, this has been a really emotional journey for me. I have not had sex with my current HIV positive boyfriend yet. I am waiting till I am informed on all of the risks involved, before preceding. I have been doing a ton of research online, and keep getting conflicting results. I really love him, and want to try to make this work. I also want to feel comfortable having sex with him. My question I had was regarding oral sex. How safe is oral sex without a condom and without the guy ejaculating in your mouth? I am trying to keep an open mind, but I cannot imagine not being able to have unprotected oral sex with my boyfriend. Using a condom for everything else is fine by me. Please shed some light on this situation for me. I am just trying to make good choices and have the knowledge before we start having sex. Thank you so much for your time.

Response from Dr. Frascino


The HIV risk associated with oral sex is definitely a QTND (question that never dies). What we can say is that overall risk of HIV acquisition/transmission via oral sex is very low. An insertive partner has less risk than a receptive partner. Review the information in the archives. We have entire chapters devoted to oral sex, magnetic couples, HIV-sexual transmission, etc. Also, I'll post below a summary of recent information presented at medical conferences discussing the latest information on the HIV transmission risk related to oral sex. Many magnetic couples have decided the risks associated with oral sex are acceptably low and forego using condoms. Others try to adhere to an absolutely no-avoidable-risk policy and hence cover their penis popsicles before all oral action. Ultimately only you and your partner can decide how much risk is acceptable. Some risk-adverse folks never drive above the posted speed limit even if there isn't another car in sight for miles and miles. Others never wear their seatbelt and text while speeding on the freeway during rush hour. We all make calculated decisions about acceptable risk everyday. You need to do the same thing with HIV and oral sex.

Dr. Bob


The risk of HIV transmission through oral sex has been a subject of debate since the early years of the epidemic. But the issue is difficult to resolve based on epidemiological studies, since most people do not limit themselves to a single sexual practice. As described in the December 2008 issue of the International Journal of Epidemiology, researchers from Imperial College in London undertook a systematic review to assess the risk of HIV transmission via "orogenital intercourse," both fellatio (on a man) and cunnilingus (on a woman).

The authors searched the PubMed database and bibliographies of relevant articles through July 2007. Out of the 56,214 titles searched, they identified ten potentially appropriate studies. Two additional studies were identified through bibliographies, and one was found through discussions with experts. Ten studies, all from North America or Europe, provided estimates of HIV transmission probabilities per partner, incidence per partner, incidence per study participant, and incidence per sex act. Only three were conducted after the advent of HAART, which suppresses viral load and therefore reduces transmission risk. Given the small number of studies, they did not consider a meta-analysis (in which data from all studies are pooled) appropriate.

Six studies reported no instances of transmission via oral sex. The four studies that reported non-zero estimates included per-partner estimates of 20% (in a small study with only ten participants) and 1%, one per-study-participant estimate of 0.37%, and one per-act estimate of 0.04%. "There are currently insufficient data to estimate precisely the risk from orogenital intercourse exposure," the investigators concluded. "The low risk of transmission evident from identified studies means that more and larger studies would be required to provide sufficient evidence to derive more precise estimates."

In a related study reported in the January 28, 2009, issue of AIDS, Swedish researchers sought to determine whether exposure to HIV via oral sex results in HIV-neutralizing antibody activity in the saliva. Saliva samples were collected from 25 HIV negative gay/bisexual men with positive male partners and from 22 low-risk HIV negative healthy male control subjects; 21 of the 25 HIV-exposed but uninfected individuals reported unprotected receptive oral sex and three reported unprotected receptive anal intercourse.

Saliva from both exposed uninfected individuals and low-risk control subjects exhibited HIV-neutralizing activity. However, a significant difference was seen for immunoglobulin A1 (IgA1), with 13 of 25 exposed uninfected individualsbut none of the 22 presumably unexposed control subjectsexhibiting HIV neutralization. Based on these findings, the researchers concluded, "Unprotected oral sex evokes a salivary IgA1-mediated HIV-neutralizing response that persists over time during continuous exposure in uninfected male partners of infected men."