Tips for oral sex without condoms

Question

I am positive and my partner is negative. We would like to have oral sex without the use of condoms. I read that this can be done and greatly reduce the risk of oral transmission through certain tips such as: 1. making sure there are no open cuts or sores in the mouth, 2. not swallowing ejaculatory semen due to sensitivity of the trakea, 3. waiting at least two hours after brushing teeth to perform oral sex and one hour afterwards, and 4. rinsing with mouthwash such as Listerine both before and after oral sex. It said that taking tips like these can reduce risk of transmission through oral sex to 1 in 1,000. Do tips like these really work? Are there other oral sex tips that can be done in order to reduce risk of transmission without condoms? I am currently not on medications as my doctor says it is not necessary yet. My doctor also said I have an infectious level the same of someone who has been diagnosed for several years (meaning my body is out of the newly diagnosed realm). I do however tend to have a decent (but not a ton) amount of pre-ejaculatory semen when engaging in sexual activity.

Any help would be amazing. Thank you.

Scott

Answer

Hello Scott,

Oral sex, in general, carries a very low HIV-transmission risk. Certainly the measures you mention are common-sense tactics to potentially further decrease the already very low risk. Also it should be noted we really can't conduct clinical trials to prove these measures are effective, as those types of studies would be unethical. I should also mention there really isn't any indication that the trachea is more susceptible or "sensitive" to HIV. (Perhaps you meant tonsils?) One measure that we know decreases HIV-transmission risk is driving the HIV plasma viral load to undetectable levels. Some magnetic couples opt for this approach, i.e. starting antiretrovirals before the CD4 count drops into the 250-350 range, which is the range in which the current guidelines recommend beginning treatment. Another possibility would to be to enroll in a magnetic couples PrEP study. In these studies the HIV-negative partner takes anti-HIV meds (pre-exposure prophylaxis). Scott, I suggest you talk to your HIV/AIDS specialist and come up with a plan that you, your partner and your HIV doc agree would offer the best protection. At the Frascino Medical Group different magnetic couples opt for different options for a whole variety of different reasons. The best solution often turns out to be a "one size fits one" type of situation! Each couple's situation is in many ways unique.

Good luck.

Dr. Bob