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HIV and AIDS

ORAL SEX RISK

02/14/2005

Question:

Hello. I Am a 20 year old teenager boy wanting to know more about HIV/AIDS. I have browsed quite a lot of sites and have a fair amount of knowledge about the subject. My questions are related to risks involved in oral sex transmission. When the person person performing oral sex has NO open,cuts/sores in the mouth. Now I know oral sex is less risky as compared to vaginal or anal sex. I also know there are a few documented cases of oral sex transmission found, but I've heard that in almost all such cases, the person performing oral sex had some kind of dental problem or dental disease in the mouth.

I haven't come across any case of oral sex transmission in which it is proved that the person performing oral sex had a healthy unbroken mouth, and yet he got infected through "Absorbtion" of the virus through Micro cuts in the mouth. On this most experts answer that maybe because most people don't just perform oral sex and other types of higher risky activities like vaginal/anal sex is performed so it's difficult to figure out from which route the infection took place.

My argument on this would be: Let's leave aside all such cases in which other activities apart from oral sex is performed. Let's just consider ONLY those cases in which ONLY oral sex is performed.

Now my main question is: 1) Amongst MILLIONS of people and amongst so much Research, cases, studies performed by scientists and doctors all around the world, haven't we been able to find ONE SINGLE case? In which it is being PRACTICALLY PROVEN, that inspite of having a healthy mouth, someone has been infected through "MICROCUT" Absorption via oral sex? Do we have any kind of practical evidence, that in REAL life, someone is infected in PRACTICAL life inspite of having a HEALTHY mouth to prove the "Theorotical" possibility of transmission through Micro cuts ?

2> If the Answer is "NO",then Dont you think that Unless there is an OPEN Wound/Cut in the mouth,.....Oral sex can be said more or less Safe....If not 100 % Safe ? Sir,I understand my questions are long and may need research.Hence its my humble request to you to please take all YOUR TIME but please reply back to my email id given below. Also its my request that please answer me pointwise,eg: Ans1> Ans2> etc...the way I have asked you for my better understanding. Thanking you and anxiously Awaiting ur reply,

Answer:

 I am going to insert my comments in UPPERCASE to expedite my answer Hello....! Am a 20 yr old teenager boy wanting to know more about HIV/AIDS.I have browsed quite a lot of sites and have a fair amount of knowledge about the subject. My questions are related to risks involved in Oral sex transmission, When the person performing oral sex has "NO" open, cuts/sores in the mouth. IT IS QUITE DIFFICULT TO SAY THAT A GIVEN INDIVIDUAL HAS "NO" OPEN CUTS, SORES IN THE MOUTH. INNOCUOUS ACTIVITIES OF DAILY LIFE, LIKE TEETHBRUSHING, FLOSSING, CHEWING CAN AND DO PRODUCE LESIONS IN THE ORAL MUCOSA, AND EVEN EPISODES OF BACTEREMIA. MOREOVER, THE ACT OF ORAL SEX ITSELF, LIKE ALL SEXUAL ACTIVITIES, CAN PRODUCE LESIONS IN THE ORAL MUCOSA WHICH ARE THE ENTRY POINT OF ALL SEXUALLY TRANSMITTED DISEASES, INCLUDING HIV. Now I know oral sex is less risky as compared to vaginal or anal sex. I also know there are a few documented cases of oral sex transmission found. But I heard that in almost all such cases, the person performing oral sex had some kind of dental problem.....or dental disease in the mouth. WE ARE TALKING ABOUT DEGREE LEVELS HERE. CERTAIN SEXUAL CONTACTS HAVE A HIGHER RELATIVE RISK THAN OTHERS, FOR EXAMPLE: MALES ARE MORE EFFECTIVE TRANSMITTERS THAN FEMALES, DUE TO THE HIGH VIRAL TITER PRESENT IN THE SEMINAL FLUID. THE PRESENCE OF ANOTHER SEXUALLY TRANSMITTED DISEASE INCREASES THE LEVEL OF INFLAMMATION AND CONSEQUENTLY THE INFECTIVITY OF THE GENITAL OR ORAL SECRETIONS. RECEPTIVE ANAL INTERCOURSE HAS HIGHER RISK THAN RECEPTIVE VAGINAL INTERCOURSE. BUT NO CONTACT WITH mucosae CAN BE DEEMED COMPLETELY SAFE. I haven't come across any case, of oral sex transmission in which it is proved that the person performing oral sex had a healthy unbroken mouth, and yet he got infected through "Absorption" of the virus through Micro cuts in the mouth. IT IS VERY DIFFICULT TO "PROVE" ANYTHING IN MEDICAL AND BIOLOGICAL SCIENCES. THE CASES REPORTED IN THE LITERATURE ARE A BIASED SAMPLE OF WHAT IS GOING ON IN THE POPULATION. HOWEVER, THERE ARE A FEW REPORTS OF HOMOSEXUAL MALES WHO BECAME HIV INFECTED, WHO CLAIM THAT THEIR ONLY SEXUAL ACTIVITY WAS RECEPTIVE ORAL SEX. On this most experts answer that, maybe because most people don't just perform oral sex and other types of higher risky activities like vaginal/anal sex is performed, and so its difficult to figure out from which route did the infection took place. My argument on this would be: Lets leave aside all such cases in which other activities apart from oral sex is performed. Lets just consider ONLY those cases in which ONLY oral sex is performed. Now my main question is:- Q1> Amongst MILLIONS of people, and amongst so much Research/Cases/Studies performed by scientists and doctors all around the world, Haven't we been able to find ONE SINGLE case ? YOU ARE ASKING FOR AN UNUSUAL EVENT: HIV TRANSMISSION THROUGH ORAL SEX, IN AN UNUSUAL POPULATION: SEXUALLY ACTIVE INDIVIDUALS THAT LIMIT THEMSELVES TO ORAL SEX, AND THOSE INDIVIDUALS COMING FORWARD WITH THE INFORMATION. SUCH A SURVEY HAS NOT BEEN PERFORMED, AND WOULD PROVIDE RATHER MARGINAL INFORMATION. MOST PERSONS CANNOT REMEMBER HOW OR WHEN THEY ACQUIRED HIV, BECAUSE THE DIAGNOSIS USUALLY HAPPENS MONTHS OR YEARS AFTER THE PRIMARY INFECTION. ...In which it is being PRACTICALLY PROVEN, that in spite of having a healthy mouth, Some one has been infected through "MICRO CUT" Absorption via oral sex ? Do we have any kind of practical evidence, that in REAL life, some one is infected in PRACTICAL life....In spite of having a HEALTHY mouth.....to prove the "Theoretical" possibility of transmission through Micro cuts? THE EVIDENCE AVAILABLE SUGGESTS THAT THE RISK OF HIV TRANSMISSION THROUGH ORAL SEX IS NOT ZERO. MIGHT BE LOWER THAN OTHER MODES OF TRANSMISSION, BUT IT IS DEFINITELY NOT ZERO. 2> If the Answer is "NO", then Don't you think that Unless there is an OPEN Wound/Cut in the mouth,.....Oral sex can be said more or less Safe....If not 100 % Safe ? SEE ABOVE

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Response by:

Francisco   Gomez, MD Francisco Gomez, MD
Assistant Professor
College of Medicine
University of Cincinnati