Oral Sex & HIV Risk: Is Oral Sex Safe?

[pelastration]

May be this is a correct place to post this.
Some time ago I was discussing on a politics thread the issue of oral sex (in the Abu Ghraib prision, creating a risk to prisoners). Russ said I was misinformed.
What's your idea? It seems to a lot of people believe oral sex is safe.

https://www.physicsforums.com/showpost.php?p=207230&postcount=68
Pelastration: "And Russ, ever had the idea that AIDS is transferable by oral contact?"
Russ: "You are misinformed."

I gave you "the risk of transmission through oral sex was estimated to be approximately 0.04 per cent per contact." in https://www.physicsforums.com/showpost.php?p=207341&postcount=70. That study can be found here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10430236&dopt=Abstract

Pelastration: "As a PF mentor you should check before you post disinformation. Yes Russ, Yes ... you can get AIDS through oral sex."

Russ: "I'm standing by that one: the info you provided says that aids can be contracted by fluid transfer in open wounds - and that is unrelated to the sex act. You could similarly say it is possible to get AIDS by shaking hands with someone who has AIDS. You can call that factually accurate if you want, but its extremely misleading."

---
Now I go further here on PF/biology

Russ my point was that "that AIDS is transferable by oral contact" and you said "You are misinformed."
It seems to me that you want to apply a type of Heisenberg Uncertainty Principle reasoning on STD/HIV. Maybe a special super-position?

I have no problem if you used your ideas (that AIDS is NOT transferable by oral contact) in your personal behavior. It your business and that of your partner(s).

But I don't accept that you give the advise or give the impression to posters and visitors of Physics Forums that oral sex is a safe way to do sex. There is a risk. By the act of oral sex there is a related risk due a number of factors, and the most important is Blood. http://www.cdc.gov/ncidod/hip/BLOOD/UNIVERSA.HTM.

The risks have been explained by a number of people with "Authority" based on "facts". Do you have any medical authority?

Q&A on HIV Risk -- Kissing, Oral Sex, Symptoms: http://www.thebody.com/Forums/AIDS/Oral/Archive/Risk

http://www.thebody.com/cdc/mm4627.html

Q10. Will this change CDC's position regarding kissing and HIV transmission?
No. CDC maintains that casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the potential for contact with blood during "French" or open-mouth kissing, CDC still recommends against engaging in this activity with an infected person.

Q11. What is the risk of HIV infection from oral sex?
Getting semen, vaginal secretions, or blood from an infected person in your mouth puts you at risk of HIV infection. The risk of getting HIV from oral sex is not as high as from anal or vaginal sex, but there is a risk. Sores or cuts anywhere in your mouth or on a partner's genitals would make oral sex even more risky.

 

[Monique]

Published in AIDS

Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men.

Page-Shafer K, Shiboski CH, Osmond DH, Dilley J, McFarland W, Shiboski SC, Klausner JD, Balls J, Greenspan D, Greenspan JS.

Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.

We examined HIV infection and estimated the population-attributable risk percentage (PAR%) for HIV associated fellatio among men who have sex with other men (MSM). Among 239 MSM who practised exclusively fellatio in the past 6 months, 50% had three partners, 98% unprotected; and 28% had an HIV-positive partner; no HIV was detected. PAR%, based on the number of fellatio partners, ranges from 0.10% for one partner to 0.31% for three partners. The risk of HIV attributable to fellatio is extremely low.

From MedLine Plus:

The riskiest sexual behavior is unprotected receptive anal intercourse -- the least risky sexual behavior is receiving oral sex. Performing oral sex on a man is associated with some risk of HIV transmission, but this is less risky than unprotected vaginal intercourse.

HOWEVER: from the National Institute of Dental and Craniofacial Research (part of the NIH):

The lower transmission rates of HIV via the oral route are leading many individuals to the false conclusion that oral sex is safe from the risk of HIV infection. Epidemiological data support the premise that, whereas HIV transmission via saliva is low or non-existent, oral infection with HIV in semen appears to be possible. Animal studies confirm that HIV can be transmitted via the oral tissues. In addition, mucosal lymphoid cells in the oral epithelia and tonsils, as well as the salivary glands, appear to be a target of HIV infection and a possible reservoir of infectious HIV. In this regard, oral tissues can be infected in vivo and in vitro, and can support viral replication. Oral trauma, ulcers, drug use, smoking, co-infection with oral herpes, sexually transmitted bacterial diseases (e.g., oral gonorrhea) or periodontal disease might increase oral HIV transmission.

 

[Monique]

Ofcourse HIV would not be the only concern, but also other STDs with the implicated route of transmission: gonorrhoea, syphilis, Chlamydia trachomatis, chancroid, and Neisseria meningitidis. Other respiratory organisms such as streptococci, Haemophilus influenzae, and Mycoplasma pneumoniae could also be transmitted by that route. I don't know what the relative risks are for those though.

Moonbear might have more information on this subject.

 

[chroot]

HIV is really not at all an issue for oral sex. It just really isn't. No one's going to say it can't ever be transmitted orally, but it's just not worth worrying about. Worry about the other diseases Monique listed first.

- Warren

 

[Monique]

Well, it IS an issue, if the mucosal tissue in the mouth is damaged there will be direct blood contact and that is dangerous.

 

[chroot]

IIRC, Monique, there has never been a single documented case of oral transmission of HIV. Am I wrong?

- Warren

 

[Monique]

Published in http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6T1B-40W5V2N-6-1&_cdi=4886&_orig=search&_coverDate=07%2F22%2F2000&_qd=1&_sk=996430773&view=c&wchp=dGLbVtb-zSkWz&_acct=C000024218&_version=1&_userid=496085&md5=6e285739f6dc9752f1777396eb29f6af&ie=f.pdf" a commentary on the issue:

The risk of HIV-1 from oral exposure to semen has been controversial. In an exhaustive review, Rothenberg and coworkers summarised 21 case-reports in which receptive fellatio led to HIV infection.[2] However, oral exposure to HIV was identified as an independent risk factor for HIV acquisition in only three (12·5%) of 24 epidemiological studies designed to examine risk of HIV from different sexual behaviours. [2] The risk of oral transmission has also been assessed in investigations of primary HIV-1 infection. In a study of 46 men, Schacker and coworkers concluded that fellatio was responsible for transmission of HIV in four. [12] In a more recent study of 122 people with primary infection, Dillon and colleagues estimated that 6·6% of infections resulted from oral sex. [13]

 

[chroot]

Monique, thanks for the info.

- Warren

 

[iansmith]

Ofcourse HIV would not be the only concern, but also other STDs with the implicated route of transmission: gonorrhoea, syphilis, Chlamydia trachomatis, chancroid, and Neisseria meningitidis. Other respiratory organisms such as streptococci, Haemophilus influenzae, and Mycoplasma pneumoniae could also be transmitted by that route. I don't know what the relative risks are for those though.

I don't think you should worried about N. meningitidis, H. influenzae and M. pneumoniae to be transmitted from the oral-sexual organ route. they tend to be restricted to naso-pharynx mucosa. I would worried about herpes viruses or some other ST viruses rather than oral pathogens.

 

[Moonbear]

I agree with Iansmith regarding worrying more about sexually transmitted viruses than respiratory diseases. Transmission of the respiratory diseases is just as likely to happen from sharing a cup, kissing, or just breathing on each other (depending on the particular organism). Herpes can be and is transmitted via oral sex. The reason oral sex is less likely to result in transmission of HIV than anal or vaginal routes is that unless you have a pre-existing sore in your mouth, the act itself is not likely to cause tears or cuts in the mucosal lining of the mouth. In anal and vaginal sex, the act can cause very small tears in the mucosal membranes (not enough that you'd be likely to detect bleeding, though that can happen too, but enough for viruses to get past that protective epidermal barrier). This is more common with anal sex because of the increased friction due to less lubrication. So, bottom line, no form of sex is "safe" sex, all present at least some risk of HIV or other STD infection, though the likelihood of contracting HIV from oral sex is lower than for other forms of sex. Contracting other STDs is more of a risk than contracting HIV from oral sex. All of these risks can be reduced by the use of a condom or dental dam (thin sheet of latex that can be used as a barrier for performing oral sex on a woman), but even that is not completely safe as there is always the risk of a hole or break in the latex.

 

[russ_watters]

pelastration, maybe there was more to be said in that other thread - I haven't looked at it in a while, so sorry if I appeared to be ignoring you.

My point would be that the risk level here falls into the "anything is possible" category: if you want to say there is a risk of HIV infection with oral sex, fine, but that means there is a risk with virtually all human contact and the word "risk" starts to lose all meaning.

Given the much higher risk of other diseases, citing HIV just seems to me like picking the one with the most emotional content for the sake of arguement.

 

[Monique]

My point would be that the risk level here falls into the "anything is possible" category: if you want to say there is a risk of HIV infection with oral sex, fine, but that means there is a risk with virtually all human contact and the word "risk" starts to lose all meaning.

Not exactly actually, the amount of HIV virus present in semen is much higher than in saliva. That's why there's no risk of getting HIV by kissing.

 

[russ_watters]

Not exactly actually, the amount of HIV virus present in semen is much higher than in saliva. That's why there's no risk of getting HIV by kissing.

Well, it would be higher with oral sex than kissing (though still infinitessimally small), but the quotes you posted don't completely rule out oral-oral infection.

Epidemiological data support the premise that, whereas HIV transmission via saliva is low or non-existent...

It might sound like I'm nitpicking here, but "low" and "non-existent" are two different things. The point of my "anything is possible" thing was that scientists almost never say something is absolutely impossible or a risk is "non-existent." That's why its so important to quantify and correctly interpret risks. There is also a point at which certain risks become so low as to not even be worth considering on their own, much less when compared with other risks.

 

[Monique]

Well, it would be higher with oral sex than kissing (though still infinitessimally small), but the quotes you posted don't completely rule out oral-oral infection.

In the Lancet article it says that kissing can be regarded as safe, unless there are dental problems in both individuals (or the rare case wherein virus titers are high in saliva).

A 6.6% rate of transmission really is not infinitessimally small.. the issue is what the incidence of HIV is in a population, how likely it is to meet a HIV positive individual.

 

[killerinstinct]

Nothing is safe anymore. The only 100% prevention is abstinence.

 

[adrenaline]

Hey, once you see genital warts in the oropharynx (can't just freeze those off!), purulent gonnorhoea pharyngitis or herpes simplex ravaging the nasal and oral mucosa down into the esophagus... oral sex with a risky partner is distasteful enough without the HIV issue. :yuck:

By the way, this is a good link in Annals of Internal medicine in a study where there was a disconcerting amount of people acquiring HIV after only oral genital contact. Look under the heading oral genital contact as risk factor for HIV infection. The transmissin rate is still very low but higher than some of the other figures. In addition, they studied recent seroconverters and or HIV infection in the primary stages and that was exquisite. Small study, but still good. http://www.annals.org/cgi/content/full/125/4/257

 

[Kerrie]

it always amazes me how much hype there is over HIV transmission, but Hepatitis C (i think that is the letter??) is much more easy to transmit and people are at greater risk for that.

 

[pelastration]

He ...Thanks for all comments and links. I appreciate.

I needed to fresh up some biology, since 'semen' caused me some confusion about what it all contains. In Dutch we have of course other terms. So I googled a bit.

Semen is the thick, whitish secretions of the prostate, seminal vesicles and Cowper's glands mixed with sperm comprise semen. Semen may contain and transmit the HIV-I virus, the bacteria responsible for gonorrhea, the yeast responsible for Candida infections and the chlamydia bacteria.
http://en.mimi.hu/sexuality/semen.html

Now, I have another question for the biology experts.

Does the pre-ejaculatory fluid produced by the Bulbourethral Glands also contains in your opinion the same risk as semen in general?
I ask this because people might think that the risk is only when an ejaculation happens.
In case of oral sex (even) without ejaculation the Cowper's fluid will still be excreted.

Some more info:
"The bulbourethral glands or Cowper's glands, are two small glands located on the sides of the urethra just inferior to the prostate gland. These glands produce a clear slippery fluid that empties directly into the urethra. Small amounts of this fluid may appear on the tip of the penis prior to ejaculation. This pre-ejaculatory fluid serves to lubricate the urethra as well as to neutralize it from any acidic conditions that might be present due to residual drops of urine. This fluid may also contain small amounts of sperm." http://www.crankyeditor.com/Portfolio/Sex/Body%20Basics%20The%20Male%20Reproductive%20System.htm

Prostate Gland

The Prostate Gland is an essential part of the male reproductive system. The prostate gland, as it is commonly called, is not really a gland at all, but an organ that consists of about 70 percent glandular tissue and 30 percent fibromuscular tissue. In an adult male, it is about the size and shape of a walnut and weighs about 20 grams. It is located directly beneath the male bladder and in front of the rectum. A thick fibrous capsule surrounds the prostate.

In the adult male, the glandular tissue of the prostate secretes a fluid that contributes 20-30 percent of the total volume of the seminal fluid released when a man ejaculates. This prostate fluid is continuously generated by the prostate but increases during sexual excitement. The combination of spermatozoa, seminal vesicle fluid and prostatic fluid, in addition to a tiny amount of fluid from some minor glands, constitutes semen. The prostate gland fluid is a thin, milky substance that gives semen its characteristic color and odor. Contents of these secretions include calcium, zinc, citric acid, acid phosphatase, albumin, and prostatic specific antigen. These substances aid in the lubrication of the urethra, and protection, nourishment, and mobility of the sperm in the normally acid environment of the female vagina.

 

[Moonbear]

I'm not really sure with regard to HIV, but pre-ejaculatory fluid can even contain an occassional sperm (hence, the reason the withdrawal method of birth control has a pretty high failure rate). I would think the main difference in terms of risk of exposure would be the volume of pre-ejaculatory fluid is much smaller than of ejaculate, so lower numbers of virus present in total (though I don't know if the concentration would be any different).

Russ, I also wanted to respond to your comment about scientists never saying something is impossible. In the case of HIV infection, there are KNOWN cases of HIV infection transmitted through oral contact (Monique posted those). So, in the case of HIV, while the risk may be low, it is a definite risk. In the realm of "anything's possible," we use that term when we have not observed something to occur, ever, but certainly have not exhausted every possible sample or subject.

And Kerrie, yes, it is Hepatitis C that is being spread. As Adrenaline and Monique have both pointed out, there is far more to worry about with sexual contact than just HIV. In fact, I think that is what lulls teens into thinking oral sex is "safer" than other sex is that they don't consider themselves a high risk population for HIV, and beyond that are really only worrying about pregnancy, without being aware of how many other diseases they are putting themselves at risk for, some of which are not curable, and others that can cause a lot of permanent damage if treatment is delayed too long.

 

[pelastration]

I'm not really sure with regard to HIV, but pre-ejaculatory fluid can even contain an occassional sperm (hence, the reason the withdrawal method of birth control has a pretty high failure rate). I would think the main difference in terms of risk of exposure would be the volume of pre-ejaculatory fluid is much smaller than of ejaculate, so lower numbers of virus present in total (though I don't know if the concentration would be any different).

Russ, I also wanted to respond to your comment about scientists never saying something is impossible. In the case of HIV infection, there are KNOWN cases of HIV infection transmitted through oral contact (Monique posted those). So, in the case of HIV, while the risk may be low, it is a definite risk. In the realm of "anything's possible," we use that term when we have not observed something to occur, ever, but certainly have not exhausted every possible sample or subject.

And Kerrie, yes, it is Hepatitis C that is being spread. As Adrenaline and Monique have both pointed out, there is far more to worry about with sexual contact than just HIV. In fact, I think that is what lulls teens into thinking oral sex is "safer" than other sex is that they don't consider themselves a high risk population for HIV, and beyond that are really only worrying about pregnancy, without being aware of how many other diseases they are putting themselves at risk for, some of which are not curable, and others that can cause a lot of permanent damage if treatment is delayed too long.

Thanks Moonbear,

I conclude that oral sex - even without ejaculation - is risky, especially with many and/or unknown partners, since:
A) there are a disconcerting amount of people acquired HIV after (only) oral genital contact,
B) there are also STD risks and
C) risk to get Hepatitis C.

And, like you said,:"So, bottom line, no form of sex is "safe" sex, all present at least some risk of HIV or other STD infection, though the likelihood of contracting HIV from oral sex is lower than for other forms of sex.".